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Current Drug Safety, 2020, 15, 000-000 1

REVIEW ARTICLE

Poor and Unsatisfactory Disposal of Expired and Unused Pharmaceuticals:

A Global Issue

Sunil Nepala, Anil Girib, Ramesh Bhandaric, Sharad Chandd, Sudip Nepale, Santosh Aryalf, Pukar
Khanalg, Jeet Bahadur Moktanh and C. S. Shastryi,*

a
Department of Clinical Pharmacy, School of Health and Allied Sciences, Pokhara University, Nepal, bAssistant
Professor, Department of Clinical Pharmacy, School of Health and Allied Sciences, Pokhara University, Nepal;
c
Assistant Professor, Department of Pharmacy Practice, KLE College of Pharmacy, Belagavi, KLE Academy of Higher
Education and Research (KAHER), Belagavi, India; dResearch Scholar, Department of Pharmacy Practice, NGSM In-
stitute of Pharmaceutical Sciences, NITTE (Deemed to be University), Paneer, Deralakatte, Mangaluru, Karnataka,
India- 575018; eDistrict Coordinator-The Leprosy Mission Nepal, Rupandehi, Butwal, Nepal; fDistrict Coordinator-The
Leprosy Mission Nepal, Morang, Biratnagar, Nepal; gDepartment of Pharmacology and Toxicology, KLE College of
Pharmacy, Belagavi, KLE Academy of Higher Education and Research (KAHER), Belagavi, India; hDepartment of
Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, B.G. Nagara-571448;
i
Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, NITTE (Deemed to be University),
Paneer, Deralakatte, Mangaluru, Karnataka, India

  Abstract: Pharmaceuticals are beneficial to humankind and emerged as crucial arms to

treat/manage multiple disease pathogenesis in the present era. In analogous, these medicines/ medi-
cal devices should be used cautiously as they possess a potential threat to induce multiple undesired
effects that may be related to human health or the environment. Daunting effects may arise due to
the improper disposal of unused/expired medicines. Hence, to minimize such harm, there should be
A R T I C L E H I S T O R Y   adequate knowledge and practice among the population regarding the safe disposal of un-
used/expired medicines or related pharmaceutical devices. The lack of approved information re-
Received: January 29, 2020 garding safe disposal of such substances may invite serious concerns like environmental pollution,
Revised: April 27, 2020 which may induce immediate health hazards to the present population and upcoming future genera-
Accepted: May 29, 2020
tions. There are numerous ways to dispose of, or manage the unused and expired pharmaceutical
DOI:
substances. Sharing the medicines among siblings, friends, and family members are never free from
10.2174/1574886315666200626164001 serious health risks. Storing the unused and expired medicines in the home increases the risk of in-
tentional or accidental ingestion of such substances and may create a health emergency. Disposing
  medicines like household and municipal waste may lead to environmental pollution and harm to
humans and animals. The present review finds the multiple unsafe ways of disposal of unutilized
medications/tools. Furthermore, it also summarizes the disposal pattern of unutilized medications
among the few developed and undeveloped nations.

Keywords: Expired pharmaceuticals, health hazards, leftover medicines, outdated medicines, pharmaceutical pollution, unused
medicines.

1. INTRODUCTION and integral part of health as they help in restoring health

The pharmaceutical drug disposal practice of unused and
expired medicines is a global problem and a neglected issue
that is growing day by day and needs attention [1]. Quality
use of medicine means selecting medicines appropriately,
using them safely and effectively, and disposing of them as
per standards [2]. Pharmaceutical products are an inevitable
*Address correspondence to this author at the Department of Pharmacy
Practice, NGSM Institute of Pharmaceutical Sciences, NITTE (Deemed to
be University), Paneer, Deralakatte, Mangaluru, Karnataka, India;
E-mail: drcshastry@gmail.com
from various ailments and illnesses. Health is a dynamic
state and may deter at any point in time; hence the pharma-
ceuticals are always a wiser and effective tool to regain
health. However, the complex nature of pharmaceuticals and
the lack of degradability of such pharmaceuticals has always
been a threat to living beings. The improper and unsafe dis-
posal of such pharmaceuticals causes various health and en-
vironmental concerns due to their toxic emissions [3, 4].
Being in a state of complete health for a lifetime is not pos-
sible for an individual; hence, the pharmaceuticals help in
improving the quality of life and minimize the discomfort

1574-8863/20 $65.00+.00 © 2020 Bentham Science Publishers

2 Current Drug Safety, 2020, Vol. 15, No. 0
and disability [5]. However, such pharmaceuticals also cause
significant health hazards and negative consequences on the
environment. The negative impact may range from minor
side effects to major health issues among humans and wild-
life [6, 7]. Due to the lack of regulations and awareness,
medicines are frequently thrown into the dust bins and treat-
ed as household waste. Careless disposal may lead to acci-
dental exposure of children or animals with pharmaceutical
waste and may bring serious health events. Also, due to the
improper site of the disposal, they can seep into the ground-
water and harm the consumer [8]. It is well accepted and
documented that sewage treated effluents containing the
pharmaceutical compound and its metabolites are the prima-
ry source of pollutants in the aquatic ecosystem [5, 9]. Many
surveys are conducted around the world regarding the waste
disposal practice of the unused and expired drug and the re-
sults are very poor [10]. The highly developed nations are
also not up to the mark as per standards regarding the phar-
maceutical drug disposal practice in the household as well as
commercial health care waste management [8]. Middle East-
ern nations, Asians, and almost all of the African countries
have faced the various health and environmental issues due
to improper disposal of pharmaceutical waste and are ex-
pected to rise in the coming days. More than 3 tons of un-
used and expired medications are wastefully discarded every
year in Taiwan [11]. The survey conducted in developed
countries like the United States of America (USA), New
Zealand, and Ireland also revealed the lack of knowledge and
unsafe methods to dispose of unused and expired medicines
[5]. Even the health care providers in South Asian countries
like pharmacists, nurses, and laboratory specialists are not
generally aware of the correct practices to dispose of the
unused and expired drugs [12]. At least 40 low and middle-
income nations, including some developed countries, accept-
ed that disposal procedures of medicinal waste are not up to
the mark as per the standards and considered it a real chal-
lenge to tackle in the future [13]. The existing healthcare
infrastructure is rarely adequate for even rudimentary Health
Care Waste Management (HCWM) in these countries [14].
In contrast, few countries like Germany and Sweden, drug
take-back practice in pharmacy, was practiced to a larger
extent.
The pharmaceutical industries are one of the major sites
that produce substantial volumes of pharmaceutical waste
[15]. Outdated and unused medicines can be handled in a
wide variety of ways at a consumer level. Drug take-back
programs and returning to the pharmacy or the donation of
the drugs to the hospital or any healthcare institution may
minimize drug disposal hazard to the environment, and simi-
lar practices were observed in Kabul [16]. The habit-forming
drugs or the drugs belonging to the schedule X (narcotic
drugs and psychotropic substances) can be flushed in toilets
or sink immediately when take-back options are not readily
available as per the instructions by the United States Food
and Drug Administration (USFDA) because of safety con-
cerns [17]. Arkaravichien W. et al. conducted a study in
South Asia, which shows most of the medicines are disposed
of in a common dust bin [18]. Simply throwing the outdated
and unused medications recklessly may lead to environmen-
tal pollution and harm to humans and animals [10].
Nepal et al.
2. PUBLIC DRUG DISPOSAL PRACTICE AND PER-
CEPTIONS OF UNUSED AND EXPIRED DRUGS
GLOBALLY
2.1. Drug Disposal Practice of Unused and Expired Med-
icines in the African Region
A survey study done in Ghana revealed that more than
50% of the total studied population admitted for having un-
used, outdated, and leftover medicines at their home and more
than 75% of study population disposed medicines as normal
waste in the trash bins and handled it as household waste [19].
In another study among 240 undergraduate pharmacy students
of the University of Jos, Nigeria, showed that common rea-
sons given by respondents for having medicines in their rooms
were that they were keeping leftover medicines for emergency
use or use in the event of similar illness. Shockingly more than
half of the respondents, 72.2% of the study, reported disposing
of their unused medicines in a trash can/dust bin [20]. Similar-
ly, a study done regarding unused medication disposal practice
in Gondar, Ethiopia, illustrates that around 89.1% of total re-
spondent in the study had outdated, leftover or unused medica-
tions and around 57.3% stated the resolve of the medical issue
was the major reason for leftover medications which shows
the lack of education among study participants regarding the
treatment regimen [21]. Similarly, a study carried out to know
household storage of medicines and associated factors in the
Tigray Region; Northern Ethiopia revealed that out of the total
households visited, 29% stored drugs. More than half of the
medications kept at homes were not adequately labeled, while
36% of the respondents reported drawer as the main place of
drug storage [22].
2.2. Drug Disposal Practice in Asia
Several studies were conducted in Asian countries among
students, medical professionals, and common people. Most of the
studies showed a lack of knowledge on safe disposal of expired
medications, and almost all of the respondents had poor and un-
safe practices for the disposal of expired drugs. The summary of
drug disposal practice in Asia is illustrated in Table 1.
2.3. Drug Disposal Practice in Middle East Countries
A random survey was conducted in northern Jordan that
reported that more than 34.7% of the population had unused
medicines in their home whereas, another study carried out
in Cairo reported around 97% of the population had some
pharmaceutical leftovers in their house, which was a surpris-
ing result. Most of which were outdated drugs, and they dis-
pose of the leftover medicines usually in household waste.
The same kind of study in Mashhadi households, in 2013,
illustrated a positive association between the family size and
occupation with the poor practice of drug disposal [31, 32].
A study conducted in Israel also showed a poor practice of
drug disposal, 86% used to dispose the waste in household
trash while only 14% returned it to pharmacy [33]. A survey
done in Romania among pharmacists, regarding unused and
expired medicines revealed that 16% of pharmacists refused
to take back the medicines due to the incomplete legislation,
lack of proper procedure, and cost involved in the procedure,
which signifies the lack of knowledge among the pharma-
cists [34].
Poor and Unsatisfactory Disposal of Expired and Unused Pharmaceuticals Current Drug Safety, 2019, Vol. 14, No. 0 3

Table 1. Drug disposal practices across various Asian countries.

S. No. Authors Study Design and study site Drug disposal practice Conclusion

Ashfaq Noor et Descriptive study in Gujarat Pharmaceutical waste was disposed of with
Disposed of with local waste in sewage.
al., 2017 [23]. and Pakistan municipal and local waste.

The most common unused drugs were anal-

Shamim J., 2018 A cross-sectional study in Throwing the unused drugs in the trash
gesics (26.9%) due to the change in prescrip-
[24]. Pakistan bin and household waste.
tion by physicians.

Gul A. et al., 2016 A cross-sectional study in Around 85% of prescribed medicines Satisfactory knowledge level of drug dispos-
[25]. Pakistan were wasted. al, but poor practice was observed.

Maximum respondents stored their

Ali S.E. et al., An observational study in Lack of knowledge and poor drug disposal
medication in the room even after expi-
2010 [26]. Malaysia practices.
ry.

Around 16.2% of the respondents re-

turned unused medicine to the pharma-
Fatokun O. et al., A cross-sectional survey study cy, while about 7.3% of respondents
2011 [27]. in Cheras, Malaysia gave leftover medicines to the family,
and approximately 3.5% of respondents
gave medicines to their friends.
Around 80% percent of people did not prac-
tice the proper method of drug disposal,
whereas only 16.2% of people were well
aware of drug disposal.

The majority (85%) were disposing of

Kristina SA., 2018 The majority of respondents lacked
A survey study in Yogyakarta household waste as common waste and
[28]. knowledge on safe drug disposal process.
3% returned to the pharmacy.

Arkaravichien W. Discarding the expired and leftover The majority of people had Poor knowledge
Descriptive study in Thailand
et al. 2014 [18]. medicines in the trash and rubbish bins. and practice of safe drug disposal.

The majority of drugs were stored in

Sharma A. et al., Prospective, Observational The majority of people had Poor knowledge
the room and later disposed of in trash
2012 [29]. study in Karnataka (India). and practice of safe drug disposal.
and bins.

Storing the medications in the kitchen,

Pankaj Kumar PD. An observational study in Satisfactory knowledge level of drug dispos-
bedroom, and bathroom and expired
et al., 2016 [30]. India among students. al, but the poor practice was found.
medication used to dump in the dustbin

2.4. Drug Disposal Practice in Developed Countries
A study done among the university student population in
the USA reported that the majority (94%) of the population
purchased at least one medicine in the last 12 months, and
more than 60% of the study population has leftover medi-
cines in the home [35]. Out of which, almost a quarter of
respondents were aware of take-back services, and another
quarter of respondents disposed of them unsafely in house-
hold trash [35]. In another study carried out to know disposal
practices for unwanted residential medications in the United
States illustrates that the majority of people will discard the
leftover medications after mixing with inert items and make
them difficult to view [36]. A need assessment survey con-
ducted among community pharmacy patients in Indiana con-
cerning Unused and Expired Medicine (UEM) beliefs and
behaviors reported that approximately half of the study pa-
tients had information on the UEM system and knew the
location in their region. Still, only very few (15%) people
practiced the same due to the difficulty in accessibility to
UEM centers [37]. Similarly, in another two-phased cross-
sectional, observational study, using a convenience sample
in Southern California, it was reported that throwing medica-
tions in the trash” was the predominant practice (63%) in
Phase I. Whereas returning to the pharmacy was the predom-
inant practice in Phase II after the suitable educational inter-
vention [38].
A survey from southeastern England stated, “Pharmaceu-
ticals pollution in fresh and marine waters and the rudimen-
tary practice of pharmaceuticals disposal was the primary
cause of such pollution” [39]. A study done to assess Phar-
maceutical Pathways to the Environment in Lithuania stated
that the most practiced way to dispose of the medicines was
throwing the medicines along with the household waste. In
Lithuania, a particular feature is the burning of pharmaceuti-
cals (50%), especially in the less developed areas follow
these patterns. Only 3% of town residents have delivered
medicines to pharmacies. The main reason for the improper
disposal of medicines is a lack of information [40, 41]. A
report from Ireland illustrates the unsuitable method of drug
storage and drug disposal commonly as household waste
(88%) [42].
Among Swedish people, the majority of the study popu-
lation (85%) knew the correct disposal was to return unused
medicines to a pharmacy, and the majority of the respond-
ents were following the proper returning system. They were
well educated and aware of the health and environmental
impact of pharmaceuticals [41]. Similarly, data from Spain,
to assess the returned medicines in community pharmacies of
4 Current Drug Safety, 2020, Vol. 15, No. 0
Barcelona, shows that 54.6% of women returned medicines
to the pharmacy healthcare centers [43].
2.5. Unused and Expired Medicine in Arabian Countries
A KAP study among Kuwaiti patients concerning safe
disposal of unwanted medicines illustrates that 76.5% of the
study population dispose of them by dumping in the bins
and11.2 % of them by flushing down in the basins and toi-
lets. Half (54.0%) of the respondents agreed with the favora-
ble system of pharmacy take-back program, but very fewer
respondents practiced it [44]. A similar survey carried out in
Riyadh, Saudi Arabia, revealed that the majority of the study
population (79.15 %) treat pharmaceuticals as household
waste. In comparison, very few <2% percent of participants
actually practiced returning to the pharmacy [45]. Another
study was carried out regarding unused, deteriorated, or ex-
pired medicines among the household in Saudi Arabia and
other Gulf countries, respectively, revealed that medication
wastage was estimated to be 25.8% (Saudi Arabia) and
41.3% (other Gulf countries) [46].
2.6. Outdated and Unused Drug Disposal Practice in De-
veloping Countries
Nepal is a developing country, and the pharmacy field is
in the stage of a neonate. Significant improvement is going
on in the field of medicine manufacture and use. Still, com-
paratively, the drug disposal practice is yet to be enforced in
a significant manner as compared to the global perspective.
Limited research is being conducted in Nepal. The develop-
ment and rational practice regarding drug disposal are going
on steadily. Most of the hospital generated biomedical waste
is being thrown away in municipal waste and being treated in
an unsafe manner without adopting the proper rules for the
disposal of biomedical waste [47].
Improper disposal of syringes and incidences of Needle
Stick Injuries (NSIs) illustrates the lack of knowledge, train-
ing and suitable practice among the waste handlers; hence
the perception of health hazards due to unsafe biomedical
and pharmaceutical waste disposal and behavioral changes
are required which can be accomplished by an adequate edu-
cation, proper training, and regular supervision. A study
conducted in Civil hospital, Kathmandu, reported lack of
Healthcare waste management committee (HCWM), specific
rules for waste handling, documented procedure, and ab-
sence color-coding system for handling and disposing of
biomedical waste (BMW). There were no trained personals
for handling BMW. During the intervention period, all the
lacunas were fulfilled by suitable means, and education and
awareness were given among all the medical and non-
medical staff in the entire hospital. All the policies and rules
were framed. Suitable and well-trained staff was hired to
handle BMW. A surprisingly poor pre-intervention score of
26% was later transformed into an excellent 86% post-
intervention score [48].
Another study reported a large stock of additional and
unused drugs by university students for future purposes. In-
creasing awareness among the community people, easy ac-
cess to the take-back pharmacy, and pro-active approach of
environment protection, suitable pharmaceutical behaviors
Nepal et al.
could minimize future pharmaceutical pollution. Pharmacists
are an integral part of reducing unused medicines through
quality assurance of the drug [49]. Lack of knowledge and a
high rate of improper drug disposal practices emphasize the
need for continuing education to the health care profession-
als and the public [50-52]. Hence, Pharmacists are better
options to create awareness for proper storage and safe dis-
posal of unused and expiry medicines by educating the pub-
lic [53].
3. RECOMMENDATIONS
Identification of populations who are lacking knowledge
on disposal of unused and expiry drugs and providing
awareness about pharmaceutical waste disposal practices,
provision of emphasis group discussions, access to take back
pharmacies, education to public about the disposal of unused
medication, education in school, university and public cam-
paign may help in addressing these problems. Unused and
expired pharmaceutical products policy should be framed
and followed meticulously. Perceived knowledge of drug
disposal practices, awareness of consequences, and promot-
ing behavioral change about medication use are some other
responsible measures to tackle pharmaceutical pollution. A
governmental and organizational initiative to reach out to the
larger population groups is in a greater need. As there are
inadequacies in the implementation of regulations framed by
the national and international associations, the participation
of an individual, local and regional authority is another ef-
fective way along with national authorities. A sensible ap-
proach for the fragmentation of barriers and delegation of the
responsibility to the citizens of a nation helps in sustaining a
safe environment. Discouraging the practices like ‘pushing’
various ‘short-dated’ medications onto their patients to use
up stock may help in reducing the pharmaceutical waste.
CONCLUSION
Disposing of the unused, leftover, and outdated medica-
tions as household waste was the most practiced method
across the world, including all lower, middle, and high-
income countries. There were no documented differences
between developing and developed countries among drug
disposal practices. Disposing of the drugs in the trash bin
was the most common practice followed by flushing in the
sewage system and both were considered as the cheapest and
easiest method despite their huge health and environmental
hazards. Only very few countries have strict policies on
pharmaceuticals waste, and a majority of countries are now
framing rules and regulations for the treatment and disposal
of pharmaceutical waste. Financial and lack of resources are
major obstacles to the implementation of such regulations.
Only in few countries like Germany and Sweden, drug take-
back practice in pharmacy was practiced to a larger extent.
Drug regulation and effective drug policy are essential to
protect public health. In the context of Nepal, there is a ray
of hope in the improvement of the drug disposal practice of
unused and expired medicine from the national perspective.
The knowledge, interventions, training, and advertisements
may contribute to the improvement of drug disposal among
the Nepalese. Thus, it is concluded from the literature review
Poor and Unsatisfactory Disposal of Expired and Unused Pharmaceuticals Current Drug Safety, 2019, Vol. 14, No. 0 5

that the practice among the Nepalese regarding the drug dis- http://dx.doi.org/10.1108/JGR-03-2014-0009
posal practice of unused and expired medicines is poor in [8] Day S. Composition for disposing of unused medicines United
States; US 7,918,776 B2, 2011.
comparison with the global scene, but there is a room of im- [9] Dahlén L, Lagerkvist A. Evaluation of recycling programmes in
provement, and in the near future, the research and studies household waste collection systems. Waste Manag Res 2010;
will surely contribute in the rational drug disposal practice of 28(7): 577-86.
the expired and unused medicines in Nepalese scenario. http://dx.doi.org/10.1177/0734242X09341193 PMID: 19748961
[10] Seehusen DA, Edwards J. Patient practices and beliefs concerning
disposal of medications. J Am Board Fam Med 2006; 19(6): 542-7.
LIST OF ABBREVIATIONS http://dx.doi.org/10.3122/jabfm.19.6.542 PMID: 17090787
[11] Chien HY, Ko JJ, Chen YC, et al. Study of medication waste in
USA = United States of America Taiwan. J Exp Clin Med 2013; 5(2): 69-72.
http://dx.doi.org/10.1016/j.jecm.2013.02.003
HCWM = Health-care Waste Management [12] Bari QH, Mahbub Hassan K, Haque R. Scenario of solid waste
reuse in Khulna city of Bangladesh. Waste Manag 2012; 32(12):
USFDA = United States Food and Drug Administration 2526-34.
UEM = Unused and Expired Medicines http://dx.doi.org/10.1016/j.wasman.2012.07.001 PMID: 22871492
[13] Harhay MO, Halpern SD, Harhay JS, Olliaro PL. Health care waste
KAP = Knowledge Attitude and Practice management: a neglected and growing public health problem
worldwide. Trop Med Int Health 2009; 14(11): 1414-7.
NSIs = Needle-stick Injuries http://dx.doi.org/10.1111/j.1365-3156.2009.02386.x PMID:
19735368
BMW = Bio-Medical Waste [14] Joshi HD. Health care waste management practice in Nepal. J Ne-
pal Health Res Counc 2013; 11(23): 102-8.
CONSENT FOR PUBLICATION PMID: 23787539
[15] Agamuthu P, Fauziah SH. Pharmaceuticals in the environment, a
Not applicable. prescription for disaster? Waste Manag Res 2011; 29(4): 349-50.
http://dx.doi.org/10.1177/0734242X11402536 PMID: 21444587
[16] Bashaar M, Thawani V, Hassali MA, Saleem F. Disposal practices
FUNDING
  of unused and expired pharmaceuticals among general public in
Kabul. BMC Public Health 2017; 17(1): 45.
None.
  http://dx.doi.org/10.1186/s12889-016-3975-z PMID: 28061902
[17] Mitka M. FDA: flush certain unused medications. JAMA 2009;
302(19): 2082-2.
CONFLICT OF INTEREST http://dx.doi.org/10.1001/jama.2009.1634 PMID: 19920229
[18] Arkaravichien W, Ruchipiyarak T, Thawinwan W, et al. A Threat
The authors declare no conflict of interest, financial or to the Environment from Practice of Drug Disposal in Thailand.
Environ Asia 2014; 7(1): 13-8.
otherwise. [19] Sasu S, Kümmerer K, Kranert M. Assessment of pharmaceutical
waste management at selected hospitals and homes in Ghana. Wa-
ACKNOWLEDGMENT ste Manag Res 2012; 30(6): 625-30.
http://dx.doi.org/10.1177/0734242X11423286 PMID: 22081380
[20] Auta A, Banwat S, Sariem C, Shalkur D, Nasara B, Atuluku M.
Authors want to thank the Department of Clinical Phar- Medicines in pharmacy students’ residence and self-medication
macy, School of Health and Allied Sciences, Pokhara Uni- practices. J Young Pharm 2012; 4(2): 119-23.
versity, for encouraging and guidance throughout the study. http://dx.doi.org/10.4103/0975-1483.96627 PMID: 22754265
[21] Atinafu T, Takele A, Kassie A, et al. Unused medications disposal
practice: The case of Patients visiting university of Gondar specia-
REFERENCES lized teaching Hospital, Gondar, Ethiopia. Int J Pharm Sci Res
2014; 5(12): 999-1005.
[1] Koshy S. Disposal of unwanted medications: throw, bury, burn or [22] Wondimu A, Molla F, Demeke B, et al. Household storage of
just ignore? Int J Pharm Pract 2013; 21(2): 131-4. medicines and associated factors in Tigray Region, Northern
http://dx.doi.org/10.1111/j.2042-7174.2012.00249.x PMID: Ethiopia. PLoS One 2015; 10(8)e0135650
23419056 http://dx.doi.org/10.1371/journal.pone.0135650 PMID: 26275057
[2] Hunt S. Quality use of medicines: policy and practice. Medication [23] Ashfaq M, Noor N. Determination of Commonly used pharmaceu-
Management in Older Adults 2010; pp. 11-27. ticals in Hospital waste of Pakistan and evaluation of their ecologi-
[3] Chand S, Shastry CS, Hiremath S, et al. Water, sanitation, hygiene cal risk assessment. CLEAN–Soil, Air. Water 2017; 45(6)1500392
and biomedical waste disposal in the healthcare system: A review. [24] Shamim J. Public awareness about safe drug disposal: a cross-
Biomedicine (Taipei) 2020; 40(1): 14-9. sectional study at karachi, pakistan. APJHS 2018; 5(2): 92-5.
[4] Eissen M, Backhaus D. Pharmaceuticals in the environment: an http://dx.doi.org/10.21276/apjhs.2018.5.2.18
educational perspective. Environ Sci Pollut Res Int 2011; 18(9): [25] Gul A, Nazish S, Sabir S, et al. Expired Drugs-Awareness and
1555-66. Practices of Outdoor Patients. Journal of Rawalpindi Medical Col-
http://dx.doi.org/10.1007/s11356-011-0512-6 PMID: 21573924 lege Students Supplement 2016; 20(S-1): 45-8.
[5] Thomas KV, Langford KH. Point sources of human pharmaceuti- [26] Ali SE, Ibrahim MI, Palaian S. Medication storage and self-
cals into the aquatic environment. Green and Sustainable Pharmacy medication behaviour amongst female students in Malaysia. Pharm
2010; pp. 211-23. Pract (Granada) 2010; 8(4): 226-32.
http://dx.doi.org/10.1007/978-3-642-05199-9_14 http://dx.doi.org/10.4321/S1886-36552010000400004 PMID:
[6] Aryal S, Shastry CS, Chand S, Bhandari R, Rawal KB, Voora L. 25126145
The linkage between occupation and stress among community [27] Fatokun O, Chang AW, Wah NN, et al. Unused and expired medica-
health workers: An Indo-global perspective. Biomedicine (Taipei) tions disposal practices in the community: a cross-sectional survey in
2019; 39(03): 388-93. Cheras, Malaysia. Arch Pharm Pract (Mumbai) 2011; 2(3): 82-3.
[7] Singleton Junidh A. The global public health issue of pharmaceuti- [28] Kristina SA. A Survey on Medicine Disposal Practice among Hou-
cal waste: what role for pharmacists? J Glob Responsib 2014; 5(1): seholds in Yogyakarta. Asian Journal of Pharmaceutics 2018;
126-37. 12(03): S955-8.
 6 Current Drug Safety, 2020, Vol. 15, No. 0
[29] Sharma A, Madaan A, Nagappa AN, et al. Medication storage and
self medication practice among the youth in Karnataka Region, In-
dia. Int J Pharm Sci Res 2012; 3(8): 2795-800.
[30] Pankajkumar PD, Chako S, Prakashkumar BS, et al. Storage and
Disposal of Medicines In Home Among Students. J Pharm Res
2016; 10(6): 343-50.
[31] Al-Azzam S, Khader Y, Rawashdeh S, et al. An assessment of the
Extent of Medication Wastage among Families in Jordan. Jordan J
Pharm Sci 2012; 5(1): 65-73.
[32] Dadgarmoghaddam M. Unused Medicines in Households. Razavi
International Journal of Medicine 2016; 4(1)
http://dx.doi.org/10.17795/rijm34351
[33] Barnett-Itzhaki Z, Berman T, Grotto I, et al. Household medical
waste disposal policy in Israel. Israel Journal of Health Policy Re-
search 2016; 5(1): 8. Article 48
http://dx.doi.org/10.1186/s13584-016-0108-1
[34] Bungau SG, Tit DM, Fodor IK, et al. Aspects Regarding the Phar-
maceutical Waste Management in Romania. Sustainability 2018;
10(8): 2788.
http://dx.doi.org/10.3390/su10082788
[35] Vatovec C, Van Wagoner E, Evans C. Investigating sources of
pharmaceutical pollution: Survey of over-the-counter and prescrip-
tion medication purchasing, use, and disposal practices among uni-
versity students. J Environ Manage 2017; 198(Pt 1): 348-52.
http://dx.doi.org/10.1016/j.jenvman.2017.04.101 PMID: 28494423
[36] Glassmeyer ST, Hinchey EK, Boehme SE, et al. Disposal practices
for unwanted residential medications in the United States. Environ
Int 2009; 35(3): 566-72.
http://dx.doi.org/10.1016/j.envint.2008.10.007 PMID: 19081631
[37] Kozak MA, Melton JR, Gernant SA, Snyder ME. A needs assess-
ment of unused and expired medication disposal practices: A study
from the Medication Safety Research Network of Indiana. Res So-
cial Adm Pharm 2016; 12(2): 336-40.
http://dx.doi.org/10.1016/j.sapharm.2015.05.013 PMID: 26143488
[38] Law AV, Sakharkar P, Zargarzadeh A, et al. Taking stock of medi-
cation wastage: Unused medications in US households. Res Social
Adm Pharm 2015; 11(4): 571-8.
http://dx.doi.org/10.1016/j.sapharm.2014.10.003 PMID: 25487420
[39] Bound JP, Voulvoulis N. Household disposal of pharmaceuticals as
a pathway for aquatic contamination in the United kingdom. Envi-
ron Health Perspect 2005; 113(12): 1705-11.
http://dx.doi.org/10.1289/ehp.8315 PMID: 16330351
[40] Kruopienė J, Dvarionienė J. Pharmaceutical Pathways to the Envi-
ronment in Lithuania. Environ Res Eng Manag 2007; 41(3): 41-7.
[41] Persson M, Sabelström E, Gunnarsson B. Handling of unused pre-
scription drugs--knowledge, behaviour and attitude among Swedish
people. Environ Int 2009; 35(5): 771-4.
http://dx.doi.org/10.1016/j.envint.2008.10.002 PMID: 19013646
[42] Vellinga A, Cormican S, Driscoll J, Furey M, O’Sullivan M, Cor-
mican M. Public practice regarding disposal of unused medicines in
Ireland. Sci Total Environ 2014; 478: 98-102.
DISCLAIMER: The above article has been published in Epub (ahead of print) on the basis of the materials provided by the author. The Edito-
rial Department reserves the right to make minor modifications for further improvement of the manuscript.
View publication stats
Nepal et al.
http://dx.doi.org/10.1016/j.scitotenv.2014.01.085 PMID: 24530589
[43] Coma A, Modamio P, Lastra CF, Bouvy ML, Mariño EL. Returned
medicines in community pharmacies of Barcelona, Spain. Pharm
World Sci 2008; 30(3): 272-7.
http://dx.doi.org/10.1007/s11096-007-9177-0 PMID: 18008178
[44] Abahussain EA, Ball DE, Matowe WC. Practice and opinion to-
wards disposal of unused medication in Kuwait. Med Princ Pract
2006; 15(5): 352-7.
http://dx.doi.org/10.1159/000094268 PMID: 16888392
[45] Al-Shareef F, El-Asrar SA, Al-Bakr L, et al. Investigating the
disposal of expired and unused medication in Riyadh, Saudi Ara-
bia: a cross-sectional study. Int J Clin Pharm 2016; 38(4): 822-8.
http://dx.doi.org/10.1007/s11096-016-0287-4 PMID: 27001407
[46] Abou-Auda HS. An economic assessment of the extent of medica-
tion use and wastage among families in Saudi Arabia and Arabian
Gulf countries. Clin Ther 2003; 25(4): 1276-92.
http://dx.doi.org/10.1016/S0149-2918(03)80083-8 PMID:
12809973
[47] Gyawali S, Rathore DS, Adhikari K, Shankar PR, K C VK, Basnet
S. Pharmacy practice and injection use in community pharmacies in
Pokhara city, Western Nepal. BMC Health Serv Res 2014; 14(1):
190.
http://dx.doi.org/10.1186/1472-6963-14-190 PMID: 24774195
[48] Sapkota B, Gupta GK, Mainali D. Impact of intervention on heal-
thcare waste management practices in a tertiary care governmental
hospital of Nepal. BMC Public Health 2014; 14(1): 1005.
http://dx.doi.org/10.1186/1471-2458-14-1005 PMID: 25261099
[49] Graudins LV. National medicines symposium: pharmacists are an
integral component of quality use of medicines. Journal of Pharma-
cy Practice and Research 2004; 34(3): 201-2.
http://dx.doi.org/10.1002/jppr2004343201
[50] Fernandes MR, Figueiredo RC, Silva LGRD, Rocha RS, Baldoni
AO. Storage and disposal of expired medicines in home pharma-
cies: emerging public health problems. Einstein (Sao Paulo) 2020;
18eAO5066
http://dx.doi.org/10.31744/einstein_journal/2020AO5066 PMID:
32074222
[51] Karki S, Niraula SR, Yadav DK, et al. Risk perception towards
healthcare waste among community people in Kathmandu, Nepal.
PLoS ONE 2020; 15(3): e0230960. .
[52] Michael I, Ogbonna B, Sunday N, Anetoh M, Matthew O. Assess-
ment of disposal practices of expired and unused medications
among community pharmacies in Anambra State southeast Nigeria:
a mixed study design. J Pharm Policy Pract 2019; 12: 12.
http://dx.doi.org/10.1186/s40545-019-0174-1 PMID: 31016021
[53] Sivasankaran P, Mohammed EB, Ganesan N, Durai R. Storage and
Safe Disposal of Unwanted/Unused and Expired Medicines: A De-
scriptive Cross-Sectional Survey among Indian Rural Population. J
Young Pharm 2019; 11(1): 97-100.
http://dx.doi.org/10.5530/jyp.2019.11.20