## 4 Results and Discussion
### Knowledge of RPs about RL of Medicines
The Brazilian data showed that there is no integrated system for the RL of expired medicines, post-consumption, and the RPs have a minimum knowledge about the waste management to support the customers. As already pointed out, the role of the RP extends beyond the pharmaceutical assistance to the patients to guidance related to the rational use of drugs and concern with the final life cycle of medicines, to ensure the safety of both patients and the environment [33]. The RPs (42.9%) interviewed were not sure about the execution of postconsumer waste collection due to obligations of the NSWP. These results found in the Sao Paulo city were in accordance with those of [PERSON] et al., who interviewed five hundred and twenty-one pharmacists regarding their opinions and attitudes regarding the system of collecting and disposing off pharmaceutical wastes from the consumers, in Romania. According to the authors of the surveyed pharmacists of Romania, 16% worked in pharmacies that did not collect unused/expired drugs from the population, and 33% have refused, at least once, to take the unused medicines from the consumers [53]. The most important reasons given by the pharmacists, for refusing to collect pharmaceutical waste, were the lack of procedures, incomplete legislation, the amount that were contracted for with the operators, and the high costs. The results showed that pharmacies in Romania have several deficiencies in  
Figure 4: Responses of the RPs to Questions 9 and 10.  
pharmaceutical waste collection services, like in Brazil. The lack of implemented programs has contributed considerably to the lower standards found in pharmaceutical waste management in Romania [53]. A study in Thailand determined how villagers stored and disposed their medicines and showed that 89.4% of people kept some kind of drugs in their houses [15]. [PERSON] and colleagues [54] reported that, in China, 78.6% of families keep unused drugs in case of emergency, which has resulted in a dramatic increase in the number of expired drugs (15,000 tons per year). Therefore, the implementation of an RL system implies not only a recognition of responsibilities carried by responsible pharmacists but also the establishment of partnerships. It presupposes the involvement of manufacturers, distributors, consumers, and public authorities in a participative dimension. Government, customers, and the competition, exert positive pressures on the position of companies regarding the implementation of the reverse logistics systems [55]. Given the high competition and challenges faced by the pharmaceutical industry, to attempt to constantly improve traditional logistics systems and the RL, there is a need to take action and adopt strategies for the reverse flow of drugs. Often, stringent regulations may affect the supply chain performance, but not enough to meet the demands of the direct logistics or the RL. The industries require that the supply chain operate highly sophisticated circuits to remain competitive and focus on measures that ensure that medicines will not be incorrectly disposed of in the environment [56; 57]. Thus, public policies, the consumer population of medicinal products and the pharmaceutical market can stimulate the implementation of medicinal RL programs. [PERSON] et al. [29] also highlighted the fundamental participation of the society, the government agencies, and the actors in the production chain, since they participate directly, as protagonists, in this context [30]. According to [PERSON] et al., in order to recycle and dispose off expired drugs, the government should design a subsidy policy that would stimulate users to return their expired drugs, and drugstores should be responsible for recycling the expired drugs and should serve as recycling stations [54]. According to [PERSON] et al.