Journal of Biomedical Engineering and Medical Devices
Open Access

Assessment of Unused and Expired Medication Disposal Practice in Gujarat

Bhoomi Arora^{* *}Correspondence: Bhoomi Arora, Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India, Tel: + 9824847368, Email:

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Introduction

Discovery in medical science has extremely increased the quality and life span of the human being. The astound development in the healthcare sector has been seemed by an increase in the wastage of pharmaceutical products, due to rise in increase in a number of patients who failed to complete all the medications prescribed by clinicians because of change in dose and strength, adverse event, which turns into an increase in many left-over medication and prescriptions with them [1]. Moreover, the majority of patients and families are a contributor of unused and expired medications due to non-compliance to the medication which gained attention across the world [2]. Subsequently, this pharmaceutical waste create pitfall in ecology, economy and ethics concerns which needs to be understood by every individual from all the perspective [3].

Shreds of evidence from the previous few years of literature have suggested the presence of pharmaceutical waste in groundwater, rivers, and drinking water which is the prime reason for deleterious effects on human health. Moreover, reports suggested that the disposal of antibiotics in water causes antibiotic resistance and genetic effect in human and aquatic life in the long term which has gained national and international attention [2]. Till today, no defined guidelines have been designed by the regulatory authorities for the proper disposal of medications especially, antibiotics.

This study was thus, planned with the objective to assess and compare the current practices, attitudes towards the disposal of unused/expired medications along with knowledge about techniques of disposal especially antibiotics among the population of Gujarat.

Materials and Methods

In April 2021, a descriptive, cross-sectional survey was conducted on the general population of Gujarat between the ages of 18 to 70 years, irrespective of their profession. The questionnaires were designed based on a literature study. Content rationality and supremacy of questions were accomplished by specialists who were not involved in this research. The legitimacy of the feedback form was accomplished by an experienced evaluator. The study was approved by the institutional ethics committee of SAL hospital, Ahmedabad in April 2021. The study applicants were selected based on convenience sampling. A pre‑tested questionnaire was then distributed through a Google form link which was sectioned into three parts: 1. Informed consent form 2. Demographic detail 3. Questions regarding knowledge, attitude, and practices related to the disposable of unused/expired medications. Open‑ended questions were avoided to evade bias in interpretations and investigation. Equally, the responses collected were confidential for the unbiased result interpretation. Google form retorts were assembled for 1 month. For increasing the response rate, the students of B. Pharm final year were trained and enrolled in the survey to collect data from an urban and rural area of Gujarat. The data collection process was supervised on daily basis. The study participants were segregated into diverse groups based on their education, work profile, and income per month. The frequency and rate of responses for the overall study population and different classes were considered and equated. The responses obtained were authenticated for precision prior to analysis. The data were analysed using Microsoft Excel for descriptive statistics. As this was a cross‑sectional study, no further continuation of the experiment was required.

Results

All the approached 537 individuals agreed to participate in the study and none declined. Hence, the rate of participant response was 100%. Of the 537 respondents, 265 (49.34%) were of urban area whereas the other half (n=272, 50.65%) were of rural area. Two hundred and eighty-seven respondents (53.44%) were male and 250 (46.55%) were female. Maximum respondents (n=310, 57.72%) were of age 18-30 years. Two hundred and seventy-eight (51.76%) respondents were married while 245 (45.62%) were single. Nearly half of them were university graduates (n=228, 42.45%) and around one-third have completed secondary education (n=206, 38.36%). A large proportion of the respondents were students (n=148, 27.56%) and self-employed (n=143, 26.62%) following private employees, housewives, and government employees. More than half of the respondents (n=348, 64.80%) had a monthly income of more than Rs 7533 (Table 1).

Table 1: Demographic characteristics of the respondents (n=537).

Regarding knowledge about ‘medical waste”, a significant proportion of the respondents (n=412, 76.72%) said yes. The most common source for the knowledge of disposal of unused and expired medication was TV and other media (n=381, 70.94%) followed by the internet (n=272, 50.65%), while the pharmacist (n=117, 21.78%) as a source of information was least reported by respondents. The majority of the respondents (n=390, 72.62%) checked the expiry date of medications, before purchasing. More than half of the respondents agreed to inappropriate disposal of unused or expired medication can cause harm (n=315, 58.65%) and affect the environment and health (n=325, 60.52%). Nearly half of the respondents (n=285, 53.07%) responded that inappropriate medication disposal can contaminate the environment, whereas one-third (n=168, 31.28%) responded it can cause accidental swallow by children. A significant proportion of the respondents agreed that providing proper guidance to the consumer could help to minimize or control the hazardous effect of unused and expired medications. Higher proportion (n=137, 25.51%) of respondents cited 1 to 5 unused/leftover medications at home. Medication for fever (n=376, 70.01%), pain (n=333, 62.01%) and antibiotics (n=287, 53.44%) were reported available at home by the majority of the respondents. A large majority of the sample (n=474, 88.26%) reported that among all the dosage forms, tablets were the most common dosage form left unused at home. A slim majority of interviewed respondents claimed doctor changed treatment (n=299, 55.67%) and self-discontinuation after condition resolved (n=291, 54.18%) were the main reasons for leftover unused medications at home. The most common pattern for disposal of unused (n=317, 59.03%) and expired (n=400, 74.48%) medications were thrown away in household garbage. Among the respondents, nearly half of the respondents (n=253, 47.11%) said that government should be responsible to create awareness for the proper disposal of unused or expired medications. A fairly high proportion of interviewed participants (n=197, 36.68%) reported that the department of public health should be responsible for safe medication disposal. A greater number of respondents (n=157, 29.23%) claimed that flushing down a toilet is an acceptable method to dispose of medication (Table 2).

Table 2: Knowledge, attitude and practice of disposal of unused or expired
medication (n=537).

Discussion

Currently, medication disposal and management are in the spotlight which grabs the attention around the world. The current study and research have been conducted to find the solution to the above-mentioned major issue. Efforts have to be implemented by the regulatory authorities for guiding the proper method and way of disposal for unused/ expired medication to the patient. This will aid in equilibrium the earth life in terms of economy, ecology, and human health. Very few studies have been conducted to highlight this issue especially in Gujarat.

The current study found that most of the respondents heard about the disposal of unused/expired from TV, other media, and the internet. Whereas, the only smaller number of respondents reported that they have received information about the proper disposal of medical waste from the pharmacist and doctors. This is not expected as the majority of the healthcare workers do not provide proper guidance to their patients on proper disposal of medication after completing treatment [4].

In the present study, we found that a large proportion of respondents were aware of improper disposal of unused/expired medications may cause environmental harm. According to their understanding, improper disposal can contaminate the environment, can cause accidental swallow by children, and can kill wildlife. Surprisingly, though they were well aware of environmental harm, the current study shows that the common method used by the study participants to dispose of the unused/expired medication was to throw them into household garbage. This could be the prime reason for their presence in the environment and water source. This finding is matched with earlier reported reports of different regions. The pharmacist plays a vital role in counselling the patients on rational use of medications that may improve patient adherence and reduces medication waste.

Astonishingly, the current study revealed that more than 70% of patients check the expiry date before procuring the medication from the drug store which indicates that in the present era patients are becoming proactive if they will guide in the right direction.

We found that the most common unused medication was for fever, followed by for pain, antibiotics, and topical drugs. Nearly half of the respondents had antibiotics at their homes. It’s advisable to store medications for recurring symptoms at home, but keeping antibiotics and consuming without the guidance of clinicians for different infections may lead to antibiotic resistance and failure of therapeutic effectiveness [5]. The most common leftover dosage form responded was tablets, followed by creams/ ointments/lotions and syrups. Our study is in support of the study conducted by Shivaraju PT, et al. [6] and differs from the study where the syrup was the most unused or leftover dosage form the most common reasons for unused medications at home in the current study were clinicians changed the treatment and selfdiscontinuation after the disease condition was resolved. These findings were similar to the studies conducted by Maharana S, et al. [7]. Self-discontinuation of medications as the illness improved indicates that medications are not used correctly as prescribed by the clinicians and discontinuation of therapy in between may result in harmful consequences, predominantly resistance issue.

The study results suggest that the government is responsible to create awareness for the proper disposal of unused and expired medications, which is consistent with the study conducted by Bashaar M, et al. [2]. It is further noted that in the present study the respondents claimed, the department of public health is mainly responsible for safe medication disposal followed by the pharmacist who dispenses the medications and the pharmaceutical companies. Hence, to guide the community on proper disposal of unused/expired medications, the government, pharmacists, and pharmaceutical companies should increase awareness by providing appropriate training and conducting seminars or campaigns.

Conclusion

The present study brought out the unfairness in medications disposal practice was due to lack of knowledge about, and awareness of proper disposal methods of medications waste and their consequences. The establishment of national policy and legal guidelines, along with implementing awareness creation campaigns on the appropriate medications disposal practice is crucial to protect human health and the ecosystem.

Acknowledgment

The authors of this study are highly grateful to Panchal Bindu, Patel Sweta, Parmar Gayatri, and Jadav Zeel, the students of final year B.Pharm for their support and involvement in the completion of the study.

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