J Young Pharm, 2019;11(4):410-416

A multifaceted peer reviewed journal in the field of Pharmacy Original Article

www.jyoungpharm.org | www.phcog.net

Assessment of Knowledge and Awareness on the Disposal of

Expired and Unused Medicines among Medication Consumers
Logesh Kumar S, Logeshwaran, Nagasubramanian Vanitha Rani*, Thennarasu P, Keerthana M, Lavanya M
Department of Pharmacy Practice, Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Porur, Chennai,
Tamil Nadu, INDIA.

ABSTRACT
Objectives: Safe disposal of expired, unwanted, or unused medications posed unused or expired medicines in the garbage. There was a statistically
by the consumers is a major challenge worldwide. The knowledge, attitude significant association between educational, occupational and so-
and practice of consumers on disposal of unused and expired medicines cio economic status, purchase of drugs and awareness on consequences
were assessed. Methods: Data on demographics, educational, occupation, of improper drug disposal (P<0.05). Conclusion: Most of the participants
socioeconomic status, drugs purchased, number of unused or expired had leftover of unused or expired drugs in their households and there was
drugs were obtained from medicine consumers. Knowledge, attitude and lack of awareness on safe disposal of medicines.
practice of safe disposal methods, number, most common class, dosage Key words: Drug disposal, Unused drugs, Expiry drugs, Knowledge,
forms of leftover drugs and the reasons were assessed using a questionnaire. Awareness, Medicine consumers.
Effect of educational, occupational, socioeconomic status on purchase of
Correspondence
drugs, awareness on the consequences of improper disposal of drugs were
assessed using chi square test. Results: Of 145 participants, 46 % were Dr. Nagasubramanian Vanitha Rani,
females and 54% were males with a mean age of 36.76 + 13.60 years. 66 Assistant Professor, Department of Pharmacy Practice, Faculty of Pharmacy,
participants stated 1-5 drugs as leftover at home and the reason for posses- Sri Ramachandra Institute of Higher Education and Research (Deemed to be
sion of unused medicines as self-discontinuation after the condition was University), Porur, Chennai-600116, Tamil Nadu, INDIA.
resolved. Most common drugs left unused at home were analgesics and
Phone: +91 9444584588
the dosage form was tablets. 76.6% were unaware of the consequences
of improper drug disposal. 65.5% stated the acceptable method to dispose Email: [email protected]
medicines as collection of unused drug by Municipality. Majority (88%) dis- DOI: 10.5530/jyp.2019.11.84

INTRODUCTION
Medicine consumption is increasing day by day globally, especially in Disposal practice of unused medicines has become a worldwide challenge
countries like India and China.1 Use of drugs for humans and veterinary for the policy makers, health professionals, pharmaceuticals companies
practices is increasing daily and most consumers are left with some and the community in general. Many developed countries like Australia
unused medicine at one time or other.2 Then the disposal of unwanted and Canada have programs supported by government and Pharmaceutical
medicines from households is also becoming an increasing problem for industries aiming at disposal of unused medicines like the “National
local and natural health environmental authorities.3 More emphasis is Return and Disposal of Unwanted Medicines Project”. United Kingdom
made on the rational use of medicine such that patients should receive and Sweden encourages the drug take-back programs.12 Creating awareness
the right medicines at the right time and use them appropriately.4 There among medicine users about proper disposal method would be a prom-
is a lack of knowledge on how to dispose expired, unwanted and unused ising step to protect the environment from this kind of pharmaceutical
medications among our participant population. Studies done across the waste.13
globe have stated that most patients stored their medications unwilling
Evidence-based guidelines was published by the World Health Organiza-
to waste them, never read and checked the expiry date, were unaware of
tion (WHO) in 1996, 1999 and 2010 to and empower drug recipients and
the proper and safe way to dispose medicines, all of which might result
control the practice of drug donations. As the quality of donated drugs
in undesirable effects or unintentional risks.5
cannot be guaranteed, the guidelines clearly prohibited donating of
A substantial environmental risk may arise from improper disposal of drugs that have been issued to patients and then returned to a pharmacy
medications and a long term environmental exposure to pharmaceuticals
or elsewhere, or were given to health professionals as free samples.14
could lead to harmful effects especially on vulnerable population,
including pregnant women, newborn and children.6 Furthermore, there Another method of disposal suggested by WHO was to return expired,
are greater chances for misuse and abuse of unwanted or unused medi- unwanted, or unused medication to a local pharmacy and clinic or to a
cations when stored in the household.7 Studies conducted in Kenya8 healthcare provider for safe disposal. Though such practices are in practice
and Nigeria9 identified the most preferred method of unused medicines in some countries, patients are seldom aware of the existence of service
disposal as throwing in garbage bins followed by flushing in the toilets. as they rarely show interest to get proper information on the safe and
Some studies also identified that the unused medicines were kept in the appropriate ways to dispose medications.15
household due to unawareness of methods to dispose them, providing an Ecopharmacovigilance is of significant concern as the adverse impact
opportunity to share to friends and families.10,11 of human pharmaceuticals is on the rise in environment in the recent

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Journal of Young Pharmacists, Vol 11, Issue 4, Oct-Dec, 2019 410

 Kumar, et al.: Knowledge on Medicine Disposal

years especially in surface water. There is a dire need to address the chal- Syrups, Respules, Lozenges, Creams/ointments/ lotions and others to be
lenges related to the improper disposal of unused and expired medicines specified. The seventh question focuses on “Methods of drug disposal
immediately to minimize the hazardous effect of improper disposal of adopted for solids, semisolids and liquids” and the responses are catego-
medicines on the environment.16 rized into 3 options as toilet, sink and garbage.
Despite being a major consumer of medicines, there are no stringent The data collected were entered in an excel spreadsheet and analyzed
regulatory policies for the consumers towards safe disposal of medicines using SPSS statistical software version 21.0. Categorical data were
in India and drug take‐back programs are not functional/effective as in expressed as frequency, percentage and continuous data were expressed
other countries. The National Formulary of India, specifies guidelines for as mean, standard deviation. The responses to the questions reflecting on
the proper disposal of medicines. However most of the people in India the knowledge and attitude of the study participants were also expressed
are not aware of these guidelines and the importance to follow them. This as frequency and percentage. The effect of educational, occupational and
is also substantiated by the recommendations given by an Indian study socioeconomic status on the ways of purchasing drugs, awareness of the
on the knowledge, attitude and belief of dental students about the participants about the consequences of improper disposal of drugs was
disposal methods of expired and leftover medicines on the need to assessed using chi square test. A P value of <0.05 was considered statisti-
improve the awareness about safe and judicious disposal methods.17 It cally significant.
is, thus, important to assess the knowledge, attitude and practice of
consumers of medicines about the disposal of unused and expired RESULTS
medicines. The study included 145 medicine consumers of which, 66 (46 %) were
females and 79 (54%) were males. The mean age of the study partici-
MATERIALS AND METHODS pants was 36.76 + 13.60 years. There were 23 (15.83%) males and 22
A questionnaire based study was conducted in the consumers of medi- (15.172%) females in the age range of 18 – 28 years; 26 (17.93%) males
cines from the outpatient pharmacy of a tertiary care hospital with the and 21 (14.48%) females in the age range of 29 – 38 years; 12 (8.275%)
approval of the Institutional Ethics Committee (CSP/18/NOV/74/312). males and 12 (8.275%) females in the age range of 39 – 48 years; 12
Based on the literature,18,19 sample size was determined using Epi. (8.275%) males and 8 (5.517%) females in the age range of 49 – 58 years;
Software 3 version with a power of 80 and the confidence interval of 2 (1.379%) males and 2 (1.379%) females in the age range of 59 – 68
95%. The calculated sample size was 132 and with 10% as attrition rate years; 4 (2.758%) males and 1 (0.689%) female in the age range of >68
(132+13) the sample size was finalized as 145. Therefore, the study years.
randomly included 145 medicine consumers of either sex, aged above Table 1 explains the characteristics of study population which include
18 years and were willing to participate in the study. Those with language the marital status, educational status, occupational status, income and
barriers, difficulty in understanding the questions and did not consent to socioeconomic status. The drugs purchased and possessed by the study
participate in the study were excluded. Data on the demographics (age participants at the time of interview were as follows: 44 (30.3%) of them
in years, sex), marital status, educational status, occupation and income had purchased NSAIDs; 42 (28.96%) of them had purchased antibiotics;
per annum, socio economic status as per modified Kuppuswamy scale,20 18 (12.4%) of them had purchased Cough suppressants, 17 (11.7%) of
drugs purchased, number of unused or expired drugs available in their them had purchased Anti-pyretics; 15 (10.3%) of them had purchased
home as leftovers and the reasons for leftovers were all obtained from the Anti-histamine and Anti-emetic; 12 (8.2%) of them had purchased
study participants by direct interview and entered in the data collection Anti-hypertensives; 10 (6.8%) of them had purchased Muscle relaxants;
form designed for the study. 8 (5.5%) of them had purchased vitamin supplements; 5 (3.4%) of them
A pre-validated interviewer administered Questionnaire developed by had purchased Anti-depressants and Hormones; 4 (2.7%) of them had
Shivaraju, et al.21 was used with the permission of the author to evaluate purchased lipid lowering drugs and Anti-gout drugs each; 3 (2.06%) of
the knowledge, attitude of the study participants on safe disposal methods them had purchased Anti-ulcers. At the time of survey, 78 (53.7%) of
of unused and expired drugs and their practice of drug disposal. The them had purchased 0-5 number of drugs; 39 (26.8%) of them had
questionnaire contains seven questions to obtain data on number of purchased 6-10 number of drugs; 22 (15.1%) of them had purchased
leftover drugs, reasons for leftover, most common class of leftover drugs 11-25 number of drugs; 6 (4.4%) of them had purchased more than 25
and dosage form. The first question is “Number of unused/left over drugs number of drugs. Mean no. of drugs purchased by the study participants
at home” and the responses are categorized into five options as 0, 1-5. was 5 ± 1.2.
6-10, 11-25 and >25. The second question is “Awareness regarding Table 2 explains the responses of the study participants for Questions 1
consequences of improper drug disposal” and the responses are catego- to 6. For Question 1 (Number of unused/leftover drugs at your home),
rized into two options as Aware and unaware. Questions 3 to 6 have of 145 study participants, 66 (37.9%) of them answered they had 1-5
seven options for responses. The third question is “Reasons for possession unused/leftover drugs at your home; 42 (26.9%) of them answered they
of unused medications at home” and the responding options are doctor had 6-10 unused/leftover drugs at your home; 28 (15.9%) of them
changed treatment, prescribed more than needed, self-discontinuation answered they had 11-25 unused/leftover drugs at your home; 6 (4.1%)
after condition resolved, leftover from previous over-the counter drug of them answered they had more than 25 unused/leftover drugs at your
purchase, passed expiry date, adverse effects to prescribed drugs and home; 2 (15.2%) of them answered they had no unused/leftover drugs at
others to be specified. The fourth question is “Acceptable method to your home. For Question 2 (Awareness regarding consequences of
dispose medication” and the responding options are rinsing down a sink, improper drug disposal), of 145 study participants, 111 (76.6%) of them
flushing down a toilet, returning to pharmacist, Municipality collection answered they were unaware of consequences of improper drug disposal;
at home, giving away to friends, relatives etc. and others to be specified. 34 (23.4%) of them answered they were aware of consequences of
The fifth question is “Classes of unused/expired drugs present at home” improper drug disposal.
and the options are Antibiotics, Antipyretics, Analgesics, Antacids, Anti- For Question 3 (Reasons for possession of unused medications at home),
histamines, Vitamin supplementation, Topical drugs (eye drops, creams, of 145 study participants, 66 (45.5%) of them stated that they had unused
ointments, sprays, etc.). The sixth question is “Most common leftover medication because of Self discontinuation after condition resolved; 44
dosage form at home” and the responding options are Tablets, Capsules, (30.3%) of them stated that they had unused medication because those

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 Kumar, et al.: Knowledge on Medicine Disposal

Table 1: Characteristics of Study Population. answered as Returning to pharmacist; 14 (9.6%) of them answered
Characteristics Frequency Percentage (%) flushing down a toilet; 10 (6.8%) of them answered as Rinsing down a
(N=145) sink; 2 (1.3%) of them answered as Giving away to friends, relatives, etc.
Marital status For Question 5 (Classes of unused/expired drugs present at your home),
Married 83 57.2 of 145 study participants, 45 (31%) of them answered as Analgesics;
Unmarried 62 42.8
38 (26.2%) of them answered as Antibiotics; 26 (17.9%) of them as
answered Antipyretics; 20 (13.8%) of them answered as Antacids; 19
Educational status
(13.1%) of them answered as Vitamin supplementation; 12 (8.2%) of
Diploma 10 6.9 them answered as Topical drugs; 11 (7.5%) of them answered as Antacids.
Graduate 23 15.9 For Question 6 (Most common leftover dosage form at home), of 145
High school 17 11.7 study participants, 70 (48.2%) of them answered as Tablets; 6 (4.3%) of
Intermediate 10 6.9 them answered as Capsules; 1 (0.6%) of them answered as Syrups and
Middle school 21 14.5 Respules.
Primary school 27 18.6 The responses of the study participants for the options of Question 7
Illiterate 37 25.5 were as follows: For Question 7. I (Methods of drug disposal adopted
Occupational status for Solids), of 145 study participants, 137 (94.5%) of them answered
Semi Profession 21 14.5
as Garbage; 5 (3.4%) of them answered as Toilet; 3 (2.1%) of them
answered as Sink. For Question 7. II (Methods of drug disposal adopted
Semi-Skilled 43 29.7
for Semisolids), of 145 study participants, 131 (90.3%) of them answered
Shop 11 7.6
as Garbage; 9 (6.2%) of them answered as Sink; 5 (3.4%) of them
Skilled Workers 18 12.4 answered as Toilet. For Question 7. III (Methods of drug disposal
Unemployed 47 32.4 adopted for liquids), of 145 study participants, 128 (88.3%) of them
Unskilled workers 5 3.4 answered as Garbage; 12 (8.3%) of them answered as Sink; 5 (3.4%) of
Income (Rs.) them answered as Toilet.
>30,000 67 46.2 On summarizing the total responses of all individuals, 66 participants
>60,000 47 32.5 (45.5%) stated that 1-5 drugs were leftover at home. 76.6% participants
<10,000 31 21.3 were unaware of the consequences of the improper drug disposal. The
reasons for possession of unused medicines at home was stated by
Socioeconomic status
majority (45.5%) as self-discontinuation after the condition was resolved
Upper lower 66 45.7 and then by 30.3% participants as passed expiry date. Majority (65.5%)
Lower middle 39 26.8 stated that the acceptable method to dispose medicines was collection of
Upper middle 18 12.4 unused drug from home by the Municipality. Analgesics were the drugs
Lower 22 15.1 left unused at home by majority of participants (31%) and 80% partici-
Ways of procuring medicines pants stated tablets as the common dosage form of the leftover drugs and
Purchase on prescription 59 40.68 this was followed by syrups. Majority (88%) stated that they disposed the
Purchase over the counter 41 28.27 unused or expired medicines either as tablets, liquids or semi solids in
the garbage.
Receive from friend/ colleague 13 8.9
Purchase based upon the advice of a 32 22.06 Table 3 explains the impact of educational, occupational and socio
relative or friend economic status of the study participants on the ways of purchase of
drugs. Majority of participants with graduation and diploma as level of
Checking of Expiry dates at the time of
purchasing
education purchased drugs based on prescription followed by purchase
over the counter where as participants with primary and middle school
Yes 37 25.6 education and illiterates purchased drugs mostly over the counter. Like-
No 28 19.3 wise professionals and semi-skilled workers purchased drugs based
Not always 80 55.1 on prescription and those skilled workers, unemployed participants
Checking of expiry dates at the time of purchased drugs over the counter. Similarly participants belonging to
consuming medicines lower and lower middle class purchased drugs mostly over the counter
Yes 48 33.1 than with prescription. There was a statistically significant association
No 35 24.1 between the educational status (P=0.02), occupational status (P=0.014)
Not always and socioeconomic status (P=0.036) and the ways of purchase of drugs
62 42.8
by the study population.
The impact of educational, occupational and socioeconomic status of
medicines passed the expiry date; 20 (13.8%) of them stated that they had the study participants on the awareness of the consequences of improper
unused medications as leftovers from previous over-the-counter drugs disposal of drugs (Q 2) is expressed in Table 4. Majority of participants
purchase treatment; 17 (11.7%) of them stated that they had unused who stated that they were aware of the consequences of improper drug
medication because Adverse effect to prescribed drug; 14 (9.7%) stated disposal were graduates and diploma holders. Participants with level of
that they had unused medication because the doctor changed treatment; education at primary and middle school level and the illiterates were not
13 (9%) of them stated that they had unused medication because the aware of the consequences of improper drug disposal. Similarly partici-
doctor had prescribed more than needed. For Question 4 (Acceptable pants who were semi-professionals and semi-skilled workers had better
method to dispose medication), of 145 study participants, 95 (65.5%) awareness than the unemployed and unskilled workers. Participants in
of them answered as Municipality collection at home; 21 (14.4) of them the lower, lower middle and upper lower socioeconomic class stated

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 Kumar, et al.: Knowledge on Medicine Disposal

Table 2: Responses of the study participants for Questions 1 to 6.

No. of Responses
QUESTIONS Responses %
(N=145)
0 2 15.2
1-5 66 37.9
Q1
6-10 42 26.9
Number of unused/leftover drugs at your home
11-25 28 15.9
>25 6 4.1
Q2 Aware 34 23.4
Awareness regarding consequences of improper drug Unaware 111 76.6
disposal?
Q3 Doctor changed treatment 14 9.7
Reasons for possession of unused medications at home Prescribed more than needed 13 9
Self-discontinuation after condition resolved 66 45.5
Leftover from previous over-the-counter drug purchase 20 13.8
Passed expiry date 44 30.3
Adverse effect to prescribed drug 17 11.7
Others 2 1.3
Q4 Rinsing down a sink 10 6.8
Acceptable method to dispose medication flushing down a toilet 14 9.6
Returning to pharmacist 21 14.4
Municipality collection at home 95 65.5
Giving away to friends, relatives, etc. 2 1.3
Others 8 5.5
Q5 Antibiotics 38 26.2
Classes of unused/expired drugs present at your home Antipyretics 26 17.9
Analgesics 45 31
Antacids 20 13.8
Antihistamines 11 7.5
Vitamin supplementation 19 13.1
Topical drugs (eye drops, creams, ointments, sprays, etc.) 12 8.2
Q6 Tablets 116 80
Most common leftover dosage form at home Capsules 39 26.8
Syrups 41 28.27
Respules 0 0
Lozenges 0 0
Creams/ ointments/ lotions 13 8.9
Other 1 0.6

that they were unaware of the consequences of improper drug disposal. conducted in 145 consumers of medicines to assess their knowledge,
There was a statistically significant association between the educational attitude and practice on the disposal of unused medicines. Majority of
status (P=0.026), occupational status (P=0.032) and socio economic sta- the participants were males (54%) with a mean age of 36.76 + 13.60
tus (P=0.021) and the awareness of the study participants on the conse- years. The younger mean age in the study was attributed to younger male
quences of improper drug disposal. patients being more forthcoming in their providing consent to partici-
pate in the study.
DISCUSSION In the present study, educational, occupational and socio economic
status had a significant impact on the ways in which the participants
Medicine waste management and disposal is grabbing attention in the purchased drugs and their awareness on the consequences of improper
recent years because it has been realized that improper disposal can drug disposal. Better the level of education, occupation and those with
contaminate the environment and pollute the nature, alter the food a better socio economic status had better awareness and purchased drug
chain and harm the living beings.22 A questionnaire based study was mostly with the prescription as they were aware of the potential health

Journal of Young Pharmacists, Vol 11, Issue 4, Oct-Dec, 2019 413

 Kumar, et al.: Knowledge on Medicine Disposal

Table 3: Educational/occupational and socioeconomic status Vs Ways of purchasing medicine.

Purchase based upon P
Purchase on Purchase over Receive from
Characteristics the advice of a relative Significance
prescription the counter friend/ colleague
or friend
Educational status
Diploma 3 4 1 2
Graduate 13 6 2 2 0.02*
High school 8 4 3 2
Intermediate 2 6 1 1
Middle School 9 7 3 2
Primary School 3 17 5 2
Illiterate 5 21 5 6
Occupational status
Semi Profession 15 5 1 0
Semi-Skilled 11 22 6 4 0.014*
Shop 2 6 1 2
Skilled workers 3 12 1 2
Unemployed 4 33 6 4
Unskilled workers 1 4 0 0
Socioeconomic status
Upper lower 22 28 7 9
Lower middle 12 18 4 5 0.036*
Upper middle 5 7 3 3
Lower 2 11 3 6

*P value of < 0.05 was considered statistically significant

Table 4: Educational, occupational and socioeconomic status Vs Awareness of consequences of improper Drug disposal.
Q. 2: Awareness regarding consequences of improper drug disposal (N=145) P
Characteristics Aware (n=34) Unaware(n=111) Significance
Educational status
Diploma 4 6
Graduate 21 2
High school 7 10
0.026*
Intermediate 1 9
Middle school 1 20
Primary school 0 27
Illiterate 0 37
Occupational status
Semi Profession 17 4
Semi-Skilled 13 30
Shop 2 9
0.032*
Skilled Workers 2 16
Unemployed 0 47
Unskilled workers 0 5
Socioeconomic status
Upper lower 18 48 0.021*
Lower middle 4 35
Upper middle 12 6
Lower 0 22

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 Kumar, et al.: Knowledge on Medicine Disposal

risks associated with purchase of drugs Over the Counter (OTC) and hazards. It is imperative for the drug regulating bodies and government
using the drugs from their friends and family. Their better economic authorities should prioritize to implement educational programs that
status also enabled them to visit the clinicians for ailments. Participants would create an awareness among the common man on safe disposal of
belonging to lower class, with low level of education or with illiteracy medicines.
were not much aware of the risks of taking drugs over the counter and
also their economic status hindered in consulting a physician for minor ACKNOWLEDGEMENT
ailments. These findings are in concordance with those reported in the The authors wish to acknowledge the Management of Sri Ramachandra
literature.23,24 Hospital for granting permission and providing with facilities for the
The common leftover drugs in most of the participants’ home were conduct of the study.
analgesics and antibiotics. This could be attributed to the over the counter
purchase of these drugs for minor ailments. This was followed by cough CONFLICT OF INTEREST
suppressants which is a common phenomenon among the public with all
The authors declare no conflict of interest.
levels of education. Antibiotics being leftover in a household should be
considered as a significant threat to antimicrobial resistance. ABBREVIATIONS
In the present study, 53.7% participants purchased around 1-5 drugs
WHO: World Health Organization; OTC: Over the Counter.
and 45.5% stated that they had 1-5 drugs let unused at home. This is in
accordance with the report given by Shivaraju, et al.21 which stated that
43.37% participants had 1-5 drugs left over at home and self -discon- REFERENCES
tinuation as the most common reason for this leftover of drugs at home. 1. Derksen JG, Rijs GB, Jongbloed RH. Diffuse pollution of surface water by
The present study also identified self-discontinuation as the major cause pharmaceutical products. Water Sci Technol. 2004;49(3):213-21.
2. World Health Organization. The world medicines situation 2011‐Rational use of
of having leftover medicines at home. Similar reports are also stated by
medicines. (WHO/EMP/MIE/2011.2.2). 3rd Edition. Geneva: WHO. 2011;1-22.
Maharana, et al.25 The reason for self-discontinuation is stopping of the 3. Atinafu T, Takele A, Kassie A, Yehualaw A, Tesfaw G, Desseno T, et al.
drug intake following the improvement in illness. Unused medications disposal practice: The case of Patients visiting university
of Gondar specialized teaching Hospital, Gondar, Ethiopia. Int J Pharm Sci Res.
In the present study, when asked about their opinion on the acceptable 2014;5(12):995-1005.
method of disposal of unused medicines, 65.5% stated that the munici- 4. Abou AHS. An economic assessment of the extent of medication use and
pality should collect the unused/ expired drugs from home. Around 14% wastage among families in Saudi Arabia and Arabian Gulf countries. Clin Therap.
2003;25 (4):1276-92.
said that it is better to return to the pharmacist. Some participants stated
5. Garey KW, Johle ML, Behrman K, Neuhauser MM. Economic consequences of
the acceptable methods were rinsing the medicines in the sink or flushing unused medications in Houston, Texas. Ann Pharmacother. 2004;38(7-8):1165-8.
them in the toilet. A study done by Akici, et al.19 stated that some saved 6. Daughton CG. Cradle-to-cradle stewardship of drugs for minimizing their envi-
the medicines that were leftover following completion or discontinuation ronmental disposition while promoting human health. II. Drug disposal, waste
reduction and future directions. Environ Health Perspect. 2003;111(5):775-85.
of therapy for their friends and family with the intention of not wanting
7. Beirens TM, Beeck EFV, Dekker R, Brug J, Raat H. Unsafe storage of poisons in
to waste them. Tablet was the most common dosage form identified as homes with toddlers. Accid Anal Prev. 2006;38(4):772-6.
leftovers in the present study which was followed by the syrups. But a 8. Angi’enda SA, Bukachi SA. Household knowledge and perceptions on disposal
study done by Sirisha, et al.26 identified topicals and syrups as the most practices of unused medicines in Kenya. J Anthropol Archaeol. 2016;4(2):1-20.
common leftovers. 9. Auta A, Omale S, Shalkur D, Abiodun AH. Unused medicines in Nigerian
households: Types and disposal practices. J Pharmacol Pharmacother.
In the present study, most of the participants (>89%) adopted disposal of 2011;2(3):195-6.
unused medicines by throwing them in the garbage irrespective of their 10. Osei-Djarbeng SN, Larbi GO, Abdul-Rahman R, Osei-Asante S, Owusu-Antwi R.
Household acquisition of medicines and disposal of expired and unused
dosage forms. Studies done in USA, UK and Kuwait identified the medicines at two suburbs (Bohyen and Kaase) in Kumasi – Ghana. Pharma
practice of flushing of medicines which was acceptable previously. Innov J. 2015;4(8):85-8.
However flushing in the toilet/sink also poses a major hazard to the 11. Bashaar M, Thawani V, Hassali MA, Saleem F. Disposal practices of unused and
environment and life. In countries like Sweden, Korea, Canada etc. there expired pharmaceuticals among general public in Kabul. BMC Public Health.
2017;17(1):45.
are Medication return or Take-back programs of unused drugs by the 12. Tong AY, Peake BM, Braund R. Disposal practices for unused medications
pharmacy which is the correct and eco-friendly way of drug disposal.27 around the world. Environ Int. 2011;37(1):292-8.
In the present study, majority of the participants were unaware of the 13. Persson M, Sabelstrom E, Gunnarsson B. Handling of unused prescription
drugs--knowledge, behaviour and attitude among Swedish people. Environ Int.
potential consequences of leftover drugs and improper disposal of drug. 2009;35(5):771-4.
Therefore proper education on safe drug disposal is the need of the hour 14. World Health Organization (WHO). Guidelines for Medicine Donations - Revised
as ecovigilance is being talked about in larger proportion. This can be 2010, 1996, 1st edition 1996, 2nd edition 1999 and 3rd edition 2011. 2010;1-20.
implemented by the governing bodies in collaboration with the profes- 15. West LM, Diack L, Cordina M, Stewart D. A systematic review of the literature
on ‘medication wastage’: an exploration of causative factors and effect of inter-
sional bodies through media, awareness camps, rallies regarding safe ventions. Int J Clin Pharm. 2014;36(5):873-81.
disposal of drug. 16. Seehusen DA, Edwards J. Patient practices and beliefs concerning
disposal of medications. Journal of the American Board of Family Medicine.
CONCLUSION 2006;19(6):542-7.
17. Aditya S, Singh H. Safe medication disposal: Need to sensitize undergraduate
The present study was conducted to assess the knowledge and practice students. Int J of Pharm and Life Sci. 2013;4(3):2475-80.
of the medicine consumers on the methods of disposal of unused or 18. Ayele Y, Mamu M. Assessment of knowledge, attitude and practice towards
disposal of unused and expired pharmaceuticals among community in Harar
expired medicines. The study identified that most of the participants had city, Eastern Ethiopia. J Pharm Policy Pract. 2018;11(1):27.
more number of unused or expired drugs leftover in their households 19. Akici A, Aydin V, Kiroglu A. Assessment of the association between drug disposal
and there was lack of awareness among the medicine consumers on safe practices and drug use and storage behaviors. Saudi Pharm J. 2018;26(1):7-13.
20. Saleem S. Modified Kuppuswamy Scale Updated For Year 2018. Paripex-Indian
disposal of medicines and most of them opined that disposal in garbage J Research. 2018;7(3):217-8.
as the acceptable method. Hence there is a dire need to develop guide- 21. Shivaraju PT, Gangadhar M. Knowledge and awareness of disposal of unused
lines on safe disposal of un used medicines and reduce the risk of health and expired medications among medical undergraduates of a tertiary care

Journal of Young Pharmacists, Vol 11, Issue 4, Oct-Dec, 2019 415

 Kumar, et al.: Knowledge on Medicine Disposal

teaching hospital at BG Nagar: A cross-sectional observational study. Natl J 25. Maharana SP, Paul B, Dasgupta A, Garg S. Storage, reuse and disposal of
Physiol Pharm Pharmacol. 2017;7(11):1268-73. unused medications: A cross-sectional study among rural households of Singur,
22. Sonowal S, Desai C, Kapadia JD, Desai MK. A Survey of Knowledge, Attitude West Bengal. Int J Med Sci Public Health. 2017;6(7):1185-90.
and Practice of Consumers at a Tertiary Care Hospital Regarding the Disposal
26. Sirisha A, Janardhan M, Sree PK, Rao YV, Raikar SR, Patil S, et al. Knowledge,
of Unused Medicines. J Basic Clin Pharmacol. 2017;8(1):4-7.
attitude and practice on safe disposal of medicines among medical and dental
23. Zorpas AA, Dimitriou M, Voukkali I. Disposal of household pharmaceuticals
undergraduates. J Basic Clin Res. 2016;3(1):5-9.
in insular communities: social attitude, behaviour evaluation and prevention
activities. Environ Sci Pollut Res Int. 2018;25(27):26725-35. 27. Al-Shareef F, El-Asrar SA, Al-Bakr L, Al-Amro M, Alqahtani F, Aleanizy F, et al.
24. Abahussain EA, Ball DE, Matowe WC. Practice and opinion towards disposal of Investigating the disposal of expired and unused medication in Riyadh, Saudi
unused medication in Kuwait. Med Prin Pract. 2006;15(5):352-7. Arabia: A cross-sectional study. Int J Clin Pharm. 2016;38(4):822-8.

Article History: Submission Date : 23-07-2019; Revised Date : 06-09-2019; Acceptance Date : 01-10-2019.
Cite this article: Kumar LS, Logeshwaran, Rani NV, Thennarasu P, Keerthana M, Lavanya M. Assessment of Knowledge and Awareness on the Disposal of
Expired and Unused Medicines among Medication Consumers. J Young Pharm. 2019;11(4):410-6.

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