Assessment of knowledge and awareness of safe disposal of unused or expired medication in Saudi Arabia: A cross-sectional study

BackgroundPoor waste management of unused or expired medications jeopardizes healthcare staff, employees who oversee medical waste, patients and their families, the neighboring population, and environmental contamination. In addition, the inappropriate treatment or disposal of that waste leads to. In addition, medical waste disposal exerts an intolerable burden on the economy of health care facilities. Currently, there is a lack of data in community settings regarding adequate methods of medication disposal in Saudi Arabia.Aim of the StudyThe current study aimed to evaluate current knowledge and awareness of the safe disposal of unused or expired medicines in the Saudi Arabia.MethodA survey study was conducted in Saudi Arabia within 5 months from October 2021–February 2022. The survey was distributed to participants via social media channels. The questionnaire was constituted of 16 items divided into three sections: demographic information, quantification, and characterization of unused and expired medication at home, and practice and attitude regarding the disposal of unused or expired medication.ResultsThe survey was taken by 1105 participants and 1100 (99.54%) participants completed the survey. The study found that (49.1%) of participants stored medicines at home and these medicines were mainly stored in the refrigerator (64.4%). Household trash was the most frequent method of disposal (79.5%). Non-prescribed medicines (67%) were mainly stored as unused or expiry medicines at home followed by prescribed medicines (51.9%). The main reason for the storage of unused/expired medicines at home was stopped medication after recovery (68.5%). Only 8.4% of participants had received appropriate education or training related to the correct disposal of medication. The best-practiced method to increase community awareness regarding the disposal of unused or expiry medicine was awareness through social networking (70.3%). In conclusion, patients’ education regarding safe medication disposal and availability of medication disposal program is necessary to improve appropriate medication waste methods and decrease possible environmental harm.     

Pharmaceuticals in drinking water: Local analysis of the problem and finding a solution through awareness

ObjectivesTo evaluate public awareness of pharmaceuticals in drinking water and to develop educational efforts to promote awareness in our community.MethodsA review of the literature was conducted to gain a full perspective of the current issue. Questionnaires, interviews, and website feedback were used to assess awareness of the problem and the most commonly used medication disposal methods. In addition, educational flyers were created to disseminate information to the public.ResultsThe questionnaires were completed by a total of 96 respondents. Of respondents employed in health care, 72% had previous knowledge of pharmaceutical medications being found in our local (Charleston, SC) water supply, and of respondents not employed in health care, 54% had previous knowledge. For those with previous knowledge, 7% disposed of medications in the toilet or sink, 38% used the trash, and 36% used multiple methods. Of respondents indicating no previous knowledge, 3% disposed of medications in the toilet or sink, 35% used the trash, and 42% used multiple methods.ConclusionPublic awareness of pharmaceuticals in drinking water and educational efforts focusing on proper disposal of medications are essential in helping to reduce drinking water contamination.     

Encouraging safe medication disposal through student pharmacist intervention

ObjectivesTo (1) determine the public's current method of medication disposal, (2) identify the public's knowledge of the environmental impact of inappropriate medication disposal, (3) determine whether student-facilitated education improves the public's awareness of safe medication disposal, and (4) determine whether the public recognizes student pharmacists as a public health information resource for issues such as safe disposal of medications.DesignCross sectional.SettingAlbany, NY, pharmacies during August and September 2009.Participants242 patrons at 13 Albany College of Pharmacy and Health Sciences Community Pharmacy Advanced Pharmacy Practice Experience (CPAPPE) sites (2 mass merchandiser, 5 community chain, and 6 grocery store pharmacies).InterventionNine-question baseline and five-question postintervention anonymous surveys were administered to a convenience sample of store patrons 18 years of age or older.Main outcome measuresMedication disposal practices before and after education, beliefs on the environmental importance of inappropriate disposal practices, and perceptions of student pharmacists as sources of information.ResultsStudents from CPAPPE sites completed 242 educational interventions. Respondents were primarily women (72%). At baseline, 12.8% of patients disposed of medication appropriately. Respondents frequently flushed medications down the toilet (27.2%) or incorrectly dumped medications in the trash (34.6%). Only 30.9% had received previous advice on safe medication disposal. Posteducation survey results indicated that 80.1% of respondents were willing to change their disposal methods. Increased numbers of respondents viewed inappropriate medication disposal as a moderate to substantial problem (from 57.2% preeducation to 83.9% posteducation). Of participants, 59.7% strongly agreed that student pharmacists were a good resource for information on safe medication disposal.ConclusionAdditional public education on safe medication disposal is needed. Student pharmacists produced positive outcomes toward reducing this environmental and potential public health risk.     

Investigating the disposal of expired and unused medication in Riyadh,Saudi Arabia: a cross-sectional study

Background Improper disposal of medication has several possible consequences such as childhood poisoning, environmental pollution, a negative impact on wildlife, and antibiotic resistance. The number of studies conducted to characterize pharmaceutical disposal practices is limited, particularly in the Middle East. Objective The aim of this cross-sectional study was to examine the behaviour of individuals with respect to the disposal of expired and unused medications. Furthermore, we aimed to identify the best methods of education regarding appropriate, safe disposal of medication. Setting The study was carried out in King Khalid University Hospital (KKUH), and King Saud University (KSU), during a 3-month period from February 2015 to April 2015. Method Twelve hundred patients were randomly selected from KKUH and KSU. Participants were invited to complete paper-based questionnaire with self enumeration. Pilot testing was conducted and involved 50 randomly selected participants. Main outcome measures The proportion of expired medications present in the home and their therapeutic groups, disposal methods of expired and unused medications, and preferred educational methods regarding safe and proper disposing of medications. Results A substantial proportion (79.15 %) of respondents disposed of unwanted medication via household waste, while a small proportion (1.70 %) returned unwanted medication to a pharmacy. Although currently practised disposal methods are undoubtedly unsuitable, 70.20 % of respondents considered finding appropriate, safe methods via which to dispose of unwanted medication their responsibility, and 78.6 % expressed an interest in receiving information concerning the correct disposal of unwanted medication. Conclusion We have demonstrated that a low percentage of respondents have ever received information regarding correct medication disposal. Moreover, the results have shown that over half of the respondents store antibiotics in their households. Additionally, respondents weren’t aware of the consequences of keeping expired medication at home. It is quite clear that the awareness of proper and safe drug disposal among the Saudi population is quite low making it a priority of concerned authorities to implement educational programs.     

Use of path modeling to inform a clinical decision support application to encourage osteoporosis medication use

BackgroundOsteoporosis medication use is suboptimal. Simple interventions personalized to a patients’ stage of readiness are needed to encourage osteoporosis medication use.ObjectivesTo estimate interrelationships of sociodemographic factors, perceived fracture risk, health literacy, receipt of medication information, medication trust and readiness to use osteoporosis medication; and apply observed relationships to inform design specifications for a clinical decision support application that can be used for personalized patient counseling.MethodsData from a national sample of older women (n = 1759) with self-reported history of fractures and no current use of osteoporosis medication treatment were used to estimate an acceptable path model that describes associations among key sociodemographic characteristics, health literacy, perceived fracture risk, receipt of osteoporosis medication information within the past year, trust in osteoporosis medications, and readiness to use osteoporosis medication. Path model results were used to inform an application for personalized patient counseling that can be easily integrated into clinical decision support systems.ResultsIncreased age (β = 0.13), trust for medications (β = 0.12), higher perceived fracture risk (β = 0.21), and having received medication information within the past year (β = 0.21) were all positively associated with readiness to use osteoporosis medication (p < 0.0001). Whereas, health literacy (β = ?0.09) was inversely associated with readiness to use osteoporosis medication (p < 0.0001). Using these results, a brief 6-item question set was constructed for simple integration into clinical decision support applications. Patient responses were used to inform a provider dashboard that integrates a patient's stage of readiness for osteoporosis medication use, predictors of readiness, and personalized counseling points appropriate to their stage of readiness.ConclusionContent of counseling strategies must be aligned with a patient's stage of readiness to use treatment. Path modeling can be effectively used to identify factors for inclusion in an evidenced-based clinical decision support application designed to assist providers with personalized patient counseling and osteoporosis medication use decisions.     

Knowledge and practices concerning the storage and disposal of home medications among people in the eastern region of Saudi Arabia: A cross-sectional study

BackgroundMedications are widely used and stored in people’s homes throughout the year. Inappropriate storage of home medications is a worldwide problem and may affect the effectiveness and stability of medications, which impacts the activity and capability of these medications to treat diseases. This study aimed to assess the awareness of the public in the eastern region of Saudi Arabia concerning the appropriate storage of used medications and the proper disposal of unwanted medications.MethodA cross-sectional survey was conducted in the eastern region of Saudi Arabia between February and June 2018. The study questionnaire tool was constructed based on several previous studies regarding medication storage, recycling, and the correct and safe disposal of expired, unwanted, or unused medication.ResultsA total of 820 responses was collected. The results showed that 91.0% of the respondents keep their medications in the original container, and only 4.5% of them write the expiry date on the new containers. While 47.1% of the respondents read the storage instructions written in the medication leaflet, only 16.2% of the respondents ask the pharmacist about the storage instructions. A majority of the respondents (84.4%) check the expiry date of medications before use, and 70.1% of them periodically check the expiry date of stored medications. Age, gender, and education level were important factors that affected medication storage practices.ConclusionThis work underpinned the lack of awareness among the public regarding the appropriate way to store home medications and the proper way to dispose of unwanted and expired medications.     

Development,translation, and validation of a bilingual questionnaire on unused medications in homes

BackgroundUnused medications in homes pose significant health, economic, and environmental risks. Patients are the medications end users and their knowledge, attitude, and practices (KAP) play an important role towards medication use, unuse and wastage. Thus, a valid instrument to reliably measure patients’ KAP towards unused medications in homes may help manage the associated risks.ObjectiveTo develop, translate, and validate a questionnaire for the assessment patients’ KAP towards unused medications in Qatar homes (i.e., QUM-Qatar).SettingThis cross-sectional validation study was conducted among randomly selected outpatients visiting various public and private pharmacies in Qatar between September 2019 and February 2020.MethodNine experts in the field of pharmacy practice with Qatar contextual background established the content validity of the instrument. The validity was quantified using content validity index (CVI). Furthermore, construct validity was performed using principal component analysis (PCA), whereas internal consistency reliability of items was determined using Cronbach’s alpha. Statistical analyses were performed using STATA 15 statistical software.Main outcome measureThe psychometric properties of the QUM-Qatar assessment instrument.ResultsAn English/Arabic questionnaire was developed and validated. Content validity in the form of scale-level-CVI (S-CVI)/Average and S-CVI/UA was 0.88 and 0.84, respectively, suggesting adequate relevant content of the questionnaire. Variation explained by the multivariate model was 85.0% for knowledge, 94.8% for attitude, and 89.8% for practice. Cronbach’s alpha coefficients were 0.68, 0.82, and 0.84, for knowledge, attitude, and practice domains, respectively. From the psychometric results obtained, the questionnaire's validity and reliability were attained.ConclusionThe QUM-Qatar instrument has acceptable psychometric properties and has the potential for future use in research and practice to assess KAP towards unused medications in Qatar and elsewhere. It may consequently help in improving medication use and mitigating the negative health, economic, and environmental impacts of unused medications.Impacts on practice.

• •There is now a valid and reliable English/Arabic language questionnaire to assess patients’ KAP towards unused medications.
• •Policymakers can utilize this questionnaire to develop evidence-based policies and strategies for managing unused medications and their disposal.
• •To improve medication use review, rational use of medicines, and adherence, it is necessary to consider patient-reported outcomes that may eventually reflect on saving health, economic resources, and environment.

     

Prescription drug disposal: Products available for home use

ObjectiveUnused medications in the home are often improperly stored and may lead to unintentional harm, misuse, and diversion. Single-use disposal systems products allow consumers to safely inactivate unused medication and provide an environmentally friendly alternative to flushing medication down the toilet or discarding in the trash. The objective of this commentary was to review current medication disposal options and inform pharmacists of new products that may be used by patients to dispose of medications in the home setting.Data sourcesCurrent recommendations on medication disposal from U.S. regulatory agencies (e.g., the Environmental Protection Agency) were reviewed and summarized comparatively. Information on the mechanism of action, price, and method of use of 8 new single-use disposal systems suitable for outpatient use were taken from each product manufacturer’s website.SummaryEight single-use disposal systems were identified. Seven products used chemical deactivation to render medication safe for disposal, and 1 product allowed consumers to mail medication to a central processing facility for incineration. Products ranged in size from 2 oz to 1 gal, offering consumers the ability to dispose of anywhere from 60 to 3000 tablets per unit, respectively. Unit costs varied widely from $5 per single-use pouch to $190 for a 40-gal box intended for incineration.ConclusionPharmacists and consumers must consider cost, effectiveness, and environmental impact when recommending and selecting products for medication disposal at home. More research is needed to understand the cost-effectiveness of each disposal system and to identify strategies to encourage uptake by health systems and use by consumers. Including content on home medication disposal in pharmacist–continuing education activities and raising workforce awareness of these products are critical to improving public safety.     

An assessment of the current practice of community pharmacists for the disposal of medication waste in the United Arab Emirates: A deep analysis at a glance

ObjectiveThe study aimed to identify the current practice carried out by community pharmacists to dispose of expired medications in their workplace and assess any practical steps utilized to reduce medication waste.MethodA cross-sectional study was conducted among community pharmacists in the United Arab Emirates (UAE). The participants were asked about their routine practice in disposing of different expired medications and the current actions taken to reduce the number of disposed medicines.ResultsThe study included (n = 418) community pharmacists. More than a third of expired liquid, solid, and semi-solid dosage forms were collected by licensed contractors. In addition, more than a third of the pharmacists disposed of different dosage forms via unauthorized methods (general garbage, sink and toilet). Most expired drugs were skin and hair products, antibiotics and analgesics. The majority of pharmacists (68.4 %, n = 286) agreed that expired pharmaceutical and non-pharmaceutical products, other than those disposed of via contractor, should be done through a specialized centre. This opinion was found to be strongly associated with years of practice as community pharmacists (P < 0.05).ConclusionPart of the existing disposal practices for expired pharmaceutical products in the UAE is carried out by contractors licensed by health authorities. However, concern remains regarding some pharmaceutical and non-pharmaceutical products that have not been disposed of correctly. Additionally, there is a need for a specialized center for medication disposal (p < 0.05). A stock limitation is the best practice for managing medication quantities in stock (p < 0.05).     

Trends in Opioid Use Disorder Diagnoses and Medication Treatment Among Veterans With Posttraumatic Stress Disorder

Objective: Despite long-standing interest in posttraumatic stress disorder (PTSD) and opioid use disorder comorbidity, there is a paucity of data on the prevalence of opioid use disorder in patients with PTSD. Therefore, there is limited understanding of the use of medications for opioid use disorder in this population. We determined the prevalence of diagnosed opioid use disorder and use of medications for opioid use disorder in a large cohort of patients with PTSD. Methods: We obtained administrative and pharmacy data for veterans who initiated PTSD treatment in the Department of Veterans Affairs (VA) between 2004 and 2013 (N = 731,520). We identified those with a comorbid opioid use disorder diagnosis (2.7%; n = 19,998) and determined whether they received a medication for opioid use disorder in the year following their initial clinical PTSD diagnosis (29.6%; n = 5,913). Using logistic regression, we determined the predictors of receipt of opioid use disorder medications. Results: Comorbid opioid use disorder diagnoses increased from 2.5% in 2004 to 3.4% in 2013. Patients with comorbid opioid use disorder used more health services and had more comorbidities than other patients with PTSD. Among patients with PTSD and comorbid opioid use disorder, use of medications for opioid use disorder increased from 22.6% to 35.1% during the same time period. Growth in the use of buprenorphine (2.0% to 22.7%) was accompanied by relative decline in use of methadone (19.3% to 12.7%). Patients who received buprenorphine were younger and more likely to be rural, White, and married. Patients who received methadone were older, urban, unmarried, from racial and ethnic minorities, and more likely to see substance abuse specialists. While use of naltrexone increased (2.8% to 8.6%), most (87%) patients who received naltrexone also had an alcohol use disorder. Controlling for patient factors, there was a substantial increase in the use of buprenorphine, a substantial decrease in the use of methadone, and no change in use of naltrexone across years. Conclusions: Opioid use disorder is an uncommon but increasing comorbidity among patients with PTSD. Patients entering VA treatment for PTSD have their opioid use disorder treated with opioid agonist treatments in large and increasing numbers. There is a need for research both on the epidemiology of opioid use disorder among patients with PTSD and on screening for opioid use disorder.