The public’s perceptions and behaviours towards household disposal of medicines and its effect on the environment: a cross-sectional survey study
Authors: Herrera H , Mistry T , Mansour G , Ali Vakil M , Warren N , Rutter P 
Published: April 2024

Abstract

Introduction
Over a billion National Health Service (NHS) prescription medicines are issued by pharmacists in England every year at a cost of over £9 billion; however, a substantial proportion of these are never taken, with an estimated wastage of approximately £300 million. [1]
Unwanted medicines should be returned to pharmacies for their disposal via a suitable waste contractor. This prevents inappropriate disposal which can lead to surface water contamination, harm to aquatic life and antimicrobial resistance, with pharmaceuticals also being present in drinking water worldwide. [2] Due to the magnitude of medicines which are never used by patients and their potential to impact negatively on the environment, there is a need to better understand the public’s perceptions and behaviours towards medicines disposal.

Aim
This study aimed to identify the public’s perceptions and behaviours related to the disposal of unwanted household medicines.

Methods
Data was collected through an anonymous self-completion on-line questionnaire containing closed questions distributed via X (formally Twitter). This was open for answers from the 19th December 2018 to 6th March 2019 to participants over the age of 18. Responses were coded and analysed using descriptive statistics.

Results
A total of 447 respondents completed the questionnaire, of which 65.5% (n=293) were female and 34.5% (n=154) were male. The age of participants ranged from 37.6% (n=164) being 18 - 34, 68.2% (n=207) being 35 - 54 years, and 17 % (n=76) being 55 years old and over.
Unwanted medicines were returned to pharmacies by 30.5% (n=136) of respondents with a further 34% (n=152) disposing of these alongside household waste. Of the latter, 43.4% (n=66) threw solid preparations in the rubbish bin, with the disposal of liquids down the sink or toilet being carried out by 30.2% (n=46).
Only 37.1% (n=168) of respondents reported receiving information on safe disposal of medicines, with almost half of these (49.4%, n=83) having this from a pharmacist. However, while 64.4% (n=292) were aware that they could return medicines to pharmacies, only 48.6% (n=142) of these reported to do so.
Most participants (61.7%, n=275) stated that they would be interested in learning more about the impact of medicines on the environment, with 19.9% (n=89) being somewhat interested, and 16.3% (n=72) having no interest.

Conclusion
This study identified that the public’s behaviour when disposing of unwanted medicines contributes to pollution caused by pharmaceuticals. Returning medicines to pharmacies avoids this and could be better promoted by raising awareness and educating those who want to learn more about medicines and the environment. Pharmacists are a source of information about disposal of medicines and providers of a service to enable the public to do so, and can contribute to managing the way that pharmaceuticals are disposed of and their environmental impact. A small sample size and geographical area were limitations of this study, which could be overcome by further researching issues identified in this survey.

References
1. Prescriptions Dispensed in the Community - Statistics for England, 2007-2017 - NHS Digital. 2019. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/prescriptions-dispensed-in-the-community/prescriptions-dispensed-in-the-community-england-2007-2017
2. Bound JP, Voulvoulis N. Household disposal of pharmaceuticals as a pathway for aquatic contamination in the United Kingdom. Environ Health Perspect. 2005;113(12):1705-11.