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Medicines Reuse
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Medicines Reuse

A special issue of Pharmacy (ISSN 2226-4787).

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 75854

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editor

Prof. Dr. Parastou Donyai

E-Mail Website
Guest Editor
Department of Pharmacy, University of Reading, Reading RG6 6AP, UK
Interests: pharmacy practice; the social psychology of medication taking and medicine reuse

Special Issue Information

Dear Colleagues,

‘Medicines reuse’ is gaining popularity around the world, either as an existing scheme or as an idea to be explored. In the pharmacy setting, medicines reuse is about re-dispensing unused medication returned by one patient for use by another. Medicines reuse can help to reduce the waste and environmental pollution created by unused medicines and/or help save money and provide medicines to people who cannot otherwise afford them. Medicines reuse might also be a way of dealing with drug shortages.

In this Special Issue of Pharmacy, we are seeking contributions from researchers from all over the world dealing with a variety of questions such as:

  • The case for considering medicines reuse;
  • How medicines reuse works in practice;
  • The impact of medicines reuse on the economy/the environment;
  • Beliefs and attitudes toward medicines reuse;
  • Storage conditions, stability and quality assurance considerations.

Contributions can be in the form of reviews or original research papers. We also welcome case studies and insightful commentaries.

Pharmacy (ISSN 2226-4787) is an international, scientific, open-access journal on pharmacy education and practice published quarterly online by MDPI. The journal has already been indexed by PubMed, ESCI (Emerging Sources Citation Index), and Web of Science. Furthermore, Pharmacy is a member of the Committee on Publication Ethics (COPE), and accordingly, submissions are peer reviewed rigorously to ensure that they conform to the highest standards in their field.

If the Special Issue contains more than 10 papers, the publishers will print a book edition, which will be made available in digital (open-access) and paperback format (ordered via Amazon) on the MDPI website, http://books.mdpi.com. Please help us to reach this goal!

Prof. Dr. Parastou Donyai
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Medicines reuse
  • Medicine waste
  • Medicine use
  • Pharmaceutical policy
  • Pharmacy practice
  • Sustainability
  • Waste management
  • Recycling

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Published Papers (10 papers)

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Research

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20 pages, 938 KiB  
Article
Medication Use and Storage, and Their Potential Risks in US Households
by SuHak Lee and Jon C. Schommer
Pharmacy 2022, 10(1), 27; https://doi.org/10.3390/pharmacy10010027 - 9 Feb 2022
Cited by 3 | Viewed by 5372
Abstract
Background: Medications stored in US households may pose risks to vulnerable populations and the environment, potentially increasing societal costs. Research regarding these aspects is scant, and interventions like medication reuse may alleviate negative consequences. The purpose of this study was to describe medications [...] Read more.
Background: Medications stored in US households may pose risks to vulnerable populations and the environment, potentially increasing societal costs. Research regarding these aspects is scant, and interventions like medication reuse may alleviate negative consequences. The purpose of this study was to describe medications stored in US households, gauge their potential risk to minors (under 18 years of age), pets, and the environment, and estimate potential costs of unused medications. Methods: A survey of 220 US Qualtrics panel members was completed regarding medications stored at home. Published literature guided data coding for risks to minors, pets, and the environment and for estimating potential costs of unused medications. Results: Of the 192 households who provided usable and complete data, 154 (80%) reported storing a medication at home. Most medications were taken daily for chronic diseases. The majority of households with residents or guests who are minors and those with pets reported storing medications with a high risk of poisoning in easily accessible areas such as counters. Regarding risk to the aquatic environment, 46% of the medications had published data regarding this risk. For those with published data, 42% presented a level of significant risk to the aquatic environment. Unused medications stored at home had an estimated potential cost of $98 million at a national level. Implications/Conclusions: Medications stored at home may pose risks to vulnerable populations and the environment. More research regarding medications stored in households and their risks is required to develop innovative interventions such as medication reuse to prevent any potential harm. Full article
(This article belongs to the Special Issue Medicines Reuse)
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12 pages, 1994 KiB  
Article
The Effect of Quality Indicators on Beliefs about Medicines Reuse: An Experimental Study
by Yasmin Lam, Rachel McCrindle, Terence K. L. Hui, R. Simon Sherratt and Parastou Donyai
Pharmacy 2021, 9(3), 128; https://doi.org/10.3390/pharmacy9030128 - 21 Jul 2021
Cited by 12 | Viewed by 4600
Abstract
Background: A number of studies have examined beliefs about medicines reuse. Although the practice is prohibited in UK community pharmacy, it does take place elsewhere in the world where it relies on visual checks of returned medicines as an indicator of their quality. [...] Read more.
Background: A number of studies have examined beliefs about medicines reuse. Although the practice is prohibited in UK community pharmacy, it does take place elsewhere in the world where it relies on visual checks of returned medicines as an indicator of their quality. One proposal is to integrate sensor technology onto medication packaging as a marker of their quality instead. Our aim was to gauge people’s beliefs about medicines reuse, in an experiment, with or without sensor technology and with or without the promise of visual checks completed by a pharmacist, as experimental conditions, should the practice be sanctioned in the UK in the future. Methods: A between participant study was designed with two independent factors testing the hypothesis that sensors and visual checks would increase pro-medicines-reuse beliefs. A questionnaire was used to measure medicines reuse beliefs and collect qualitative comments. Results: Eighty-one participants took part. Attitudes toward medication offered for reuse, participants’ perceived social pressure to accept the medication, and their intention to take part in medicines reuse all increased with the presence of sensors on packaging and with the promise of pharmacist visual checking, with the former causing a greater increase than the latter, and the combination of both making the greatest increase. People’s qualitative comments explained their concerns about medicines reuse, validating the findings. The use of sensors on medication packaging warrants further investigation if regulators are to consider approving medicines reuse in the UK. Full article
(This article belongs to the Special Issue Medicines Reuse)
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12 pages, 476 KiB  
Article
Medicines as Common Commodities or Powerful Potions? What Makes Medicines Reusable in People’s Eyes
by Monica Chauhan, Hamza Alhamad, Rachel McCrindle, Terence K. L. Hui, R. Simon Sherratt and Parastou Donyai
Pharmacy 2021, 9(2), 88; https://doi.org/10.3390/pharmacy9020088 - 20 Apr 2021
Cited by 7 | Viewed by 5040
Abstract
Background: Medicines reuse involves dispensing quality-checked, unused medication returned by one patient for another, instead of disposal as waste. This is prohibited in UK community pharmacy because storage conditions in a patient’s home could potentially impact on the quality, safety and efficacy of [...] Read more.
Background: Medicines reuse involves dispensing quality-checked, unused medication returned by one patient for another, instead of disposal as waste. This is prohibited in UK community pharmacy because storage conditions in a patient’s home could potentially impact on the quality, safety and efficacy of returned medicines. Our 2017 survey examining patients’ intentions to reuse medicines found many favoured medicines reuse. Our aim was to analyse the qualitative comments to explore people’s interpretations of what makes medicines (non-)reusable. Methods: Thematic analysis was used to scrutinize 210 valid qualitative responses to the survey to delineate the themes and super-ordinate categories. Results: Two categories were “medicines as common commodities” versus “medicines as powerful potions”. People’s ideas about medicines aligned closely with other common commodities, exchanged from manufacturers to consumers, with many seeing medicines as commercial goods with economic value sanctioning their reuse. Fewer of the comments aligned with the biomedical notion of medicines as powerful potions, regulated and with legal and ethical boundaries limiting their (re)use. Conclusion: People’s pro-medicines-reuse beliefs align with perceptions of medicines as common commodities. This helps explain why patients returning their medicines to community pharmacies want these to be recycled. It could also explain why governments permit medicines reuse in emergencies. Full article
(This article belongs to the Special Issue Medicines Reuse)
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16 pages, 294 KiB  
Article
Public Attitudes towards Medicinal Waste and Medicines Reuse in a ‘Free Prescription’ Healthcare System
by David McRae, Abigail Gould, Rebecca Price-Davies, Jonathan Tagoe, Andrew Evans and Delyth H. James
Pharmacy 2021, 9(2), 77; https://doi.org/10.3390/pharmacy9020077 - 8 Apr 2021
Cited by 9 | Viewed by 4944
Abstract
This study investigates public attitudes towards medicinal waste and medicines reuse within a ‘free prescription’ healthcare system. A quantitative online survey was employed in a sample drawn from the population of Wales, where prescription medicines have been ‘free’ since 2007. Qualitative interviews informed [...] Read more.
This study investigates public attitudes towards medicinal waste and medicines reuse within a ‘free prescription’ healthcare system. A quantitative online survey was employed in a sample drawn from the population of Wales, where prescription medicines have been ‘free’ since 2007. Qualitative interviews informed the content of the attitude statements with categorical or ordinal response options assigned. The questionnaire was hosted on the HealthWise Wales platform for 1 year from October 2017. Of the 5584 respondents, 67.2% had at least one medicine on repeat prescription. Overall, 89.1% held strong concerns about medicinal waste. High acceptance for the reuse of prescription medicines which have been returned unused by patients to pharmacies was reported for tablets (78.7%) and capsules (75.1%) if the medicine is checked by a pharmacist first (92.4% rated essential). Concerns identified related to tampering of packs (69.2%) and the need for hygienic storage (65.4%). However, those working in healthcare had less concern about the safety of reusing medicines. The level of public acceptance for the reuse of medication was higher than previously reported. This is the largest survey to capture these views to date, which has implications for the future design of medicines reuse schemes. Full article
(This article belongs to the Special Issue Medicines Reuse)
20 pages, 4053 KiB  
Article
Intentions to “Reuse” Medication in the Future Modelled and Measured Using the Theory of Planned Behavior
by Hamza Alhamad and Parastou Donyai
Pharmacy 2020, 8(4), 213; https://doi.org/10.3390/pharmacy8040213 - 12 Nov 2020
Cited by 24 | Viewed by 4740
Abstract
Background: A range of pro-environmental behaviors are recognized, promoted, and investigated, but urgent action is also needed to tackle the direct and indirect environmental impact of medication waste. One solution is to reissue medicines, returned unused to pharmacies (i.e., reuse medicines). Yet, if [...] Read more.
Background: A range of pro-environmental behaviors are recognized, promoted, and investigated, but urgent action is also needed to tackle the direct and indirect environmental impact of medication waste. One solution is to reissue medicines, returned unused to pharmacies (i.e., reuse medicines). Yet, if medicines reuse is to be formally introduced in the UK, it is imperative also to understand people’s willingness to take part in such a scheme and importantly, the underpinning drivers. This study aimed to develop, validate, and evaluate a Theory of Planned Behavior model aimed at predicting medicines reuse behavioral intentions. Methods: The behavior of interest, medicines reuse, was defined according to its Target, Action, Context, and Time. Then themes from an existing qualitative study were used in order to draft, validate and pilot a Theory of Planned Behavior-based questionnaire before its completion by a representative sample (n = 1003) of participants from across the UK. Results: The majority expressed pro-medicines reuse intentions. The three direct measures accounted for 73.4% of the variance in relation to people’s intention to reuse medicines in the future, which was statistically significant at p < 0.001. People’s specific beliefs about medicines reuse and how they evaluate other people’s expectations of them had a substantial impact on their intentions to reuse medication in the future, mediated in an intricate way via attitudes, subjective norms and perceived behavioral control (PBC). Conclusions: This study shows how people could embrace medicines reuse via practical measures that illustrate the safety and quality assurance of reissued medicines, educational interventions that bolster beliefs about the pro-environmental benefits, and norm-based interventions encouraging doctors and pharmacists to endorse the practice. The findings add to the emerging work on medicines reuse and, significantly, provide a theoretical framework to guide policymakers and other organizations looking to decrease the impact of medication waste through medicines reuse schemes. Full article
(This article belongs to the Special Issue Medicines Reuse)
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18 pages, 1609 KiB  
Article
Enhancing Pharmaceutical Packaging through a Technology Ecosystem to Facilitate the Reuse of Medicines and Reduce Medicinal Waste
by Terence K. L. Hui, Bilal Mohammed, Parastou Donyai, Rachel McCrindle and R. Simon Sherratt
Pharmacy 2020, 8(2), 58; https://doi.org/10.3390/pharmacy8020058 - 31 Mar 2020
Cited by 25 | Viewed by 11602
Abstract
Background: The idea of reusing dispensed medicines is appealing to the general public provided its benefits are illustrated, its risks minimized, and the logistics resolved. For example, medicine reuse could help reduce medicinal waste, protect the environment and improve public health. However, [...] Read more.
Background: The idea of reusing dispensed medicines is appealing to the general public provided its benefits are illustrated, its risks minimized, and the logistics resolved. For example, medicine reuse could help reduce medicinal waste, protect the environment and improve public health. However, the associated technologies and legislation facilitating medicine reuse are generally not available. The availability of suitable technologies could arguably help shape stakeholders’ beliefs and in turn, uptake of a future medicine reuse scheme by tackling the risks and facilitating the practicalities. A literature survey is undertaken to lay down the groundwork for implementing technologies on and around pharmaceutical packaging in order to meet stakeholders’ previously expressed misgivings about medicine reuse (’stakeholder requirements’), and propose a novel ecosystem for, in effect, reusing returned medicines. Methods: A structured literature search examining the application of existing technologies on pharmaceutical packaging to enable medicine reuse was conducted and presented as a narrative review. Results: Reviewed technologies are classified according to different stakeholders’ requirements, and a novel ecosystem from a technology perspective is suggested as a solution to reusing medicines. Conclusion: Active sensing technologies applying to pharmaceutical packaging using printed electronics enlist medicines to be part of the Internet of Things network. Validating the quality and safety of returned medicines through this network seems to be the most effective way for reusing medicines and the correct application of technologies may be the key enabler. Full article
(This article belongs to the Special Issue Medicines Reuse)
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Review

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11 pages, 1460 KiB  
Review
The Validity of the Theory of Planned Behaviour for Understanding People’s Beliefs and Intentions toward Reusing Medicines
by Hamza Alhamad and Parastou Donyai
Pharmacy 2021, 9(1), 58; https://doi.org/10.3390/pharmacy9010058 - 9 Mar 2021
Cited by 25 | Viewed by 10882
Abstract
Background: many factors can impact a person’s behaviour. When the behaviour is subject to prediction, these factors can include, for example, the perceived advantages and disadvantages of performing the behaviour, normative beliefs, and whether the behaviour is thought to be achievable. This paper [...] Read more.
Background: many factors can impact a person’s behaviour. When the behaviour is subject to prediction, these factors can include, for example, the perceived advantages and disadvantages of performing the behaviour, normative beliefs, and whether the behaviour is thought to be achievable. This paper examines intentions to engage in medicines reuse, i.e., to accept medicines that are returned unused to a pharmacy to be reused. The paper aims to outline the validity of the Theory of Planned Behaviour (TPB) for understanding people’s intentions to engage in medicines reuse by examining this against other long-standing health-related psychological theories of behavioural change. Thus, the Health Belief Model (HBM), Protection Motivation Theory (PMT), Trans-Theoretical Model of Health Behaviour Change (TTM/SoC), Theory of Reasoned Action (TRA), and TPB are examined for their application in the study of medicines reuse. Discussion: the HBM, PMT, TTM/SoC, TRA, and TPB were assessed for their relevance to examining medicines reuse as a behaviour. The validity of the TPB was justified for the development of a Medication Reuse Questionnaire (MRQ) to explore people’s beliefs and intention toward reusing medicines. Conclusion: TPB has been widely used inside and outside of health-related research and it was found to have more accurately defined constructs, making it helpful in studying medicines reuse behaviour. Full article
(This article belongs to the Special Issue Medicines Reuse)
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40 pages, 1313 KiB  
Review
Towards Medicines Reuse: A Narrative Review of the Different Therapeutic Classes and Dosage Forms of Medication Waste in Different Countries
by Hamza Alhamad, Nilesh Patel and Parastou Donyai
Pharmacy 2020, 8(4), 230; https://doi.org/10.3390/pharmacy8040230 - 1 Dec 2020
Cited by 12 | Viewed by 5968
Abstract
Background: Medicines reuse, the idea of re-dispensing returned medicines to others following quality control, is yet to be implemented in the UK. This practice is potentially a sustainable way of dealing with returned medicines, which are otherwise classed as medication waste and destroyed. [...] Read more.
Background: Medicines reuse, the idea of re-dispensing returned medicines to others following quality control, is yet to be implemented in the UK. This practice is potentially a sustainable way of dealing with returned medicines, which are otherwise classed as medication waste and destroyed. To inch towards medicines reuse, it is important to know more about the different therapeutic classes and dosage forms that make up medication waste. For example, it is helpful to know if medicines being returned are mostly solid-dosage forms and thus have the potential to be reused or are from therapeutic classes that would make medicines reuse cost-effective. Little is known about the therapeutic classes and the dosage forms of wasted medicines. This study aimed to narratively review and report findings from the international literature on the different therapeutic classes and the dosage forms of medicines that are returned by patients to community pharmacies, hospitals, general practitioners’ clinics, or collected through waste campaigns. Studies based on surveys without physically returning medicines were also included where relevant. Methods: A comprehensive electronic search of databases, including PubMed and Google Scholar, was carried out over one month in 2017 and updated by 5 November 2020, using a combination of carefully created keywords. Results: Forty-five studies published in English between 2002 and 2020, comprising data from 26 countries were included and reviewed. Oral solid dosage forms (mostly tablets) were the commonly reported dosage form of all wasted medicines in 14 studies out of the 22 studies (64%) that described the dosage form, with percentages ranging from 40.6% to 95.6% of all wasted medicines. Although there was variability among the levels of medication waste reported in different countries, findings from the UK and Ethiopia were relatively consistent; in these, medicines for the cardiovascular system and anti-infective medicines, respectively, were the most common therapeutic classes for medication waste. Conclusion: This narrative review provides insights about the different therapeutic classes and dosage forms of medication waste either returned by patients, collected through waste campaigns, or indicated in survey responses. The findings could help policy makers understand the potential implications of treating most unused medicines as medication waste and whether therefore pursuing a medicines reuse scheme could be environmentally or financially logical. The quality and the safety of these returned medicines using criteria related to the storage conditions (such as heat and humidity), physical shape (such as being sealed, unopened, unused, and in blister packaging), and tampering are other important considerations for a medicines reuse scheme. Full article
(This article belongs to the Special Issue Medicines Reuse)
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22 pages, 4379 KiB  
Review
Can We Create a Circular Pharmaceutical Supply Chain (CPSC) to Reduce Medicines Waste?
by Abdullah Alshemari, Liz Breen, Gemma Quinn and Uthayasankar Sivarajah
Pharmacy 2020, 8(4), 221; https://doi.org/10.3390/pharmacy8040221 - 18 Nov 2020
Cited by 39 | Viewed by 12926
Abstract
Background: The increase in pharmaceutical waste medicines is a global phenomenon and financial burden. The Circular Economy, as a philosophy within the pharmaceutical supply chain, aims to promote waste reduction, maximise medicines value, and enable sustainability within this supply chain (increasing circularity). Circularity [...] Read more.
Background: The increase in pharmaceutical waste medicines is a global phenomenon and financial burden. The Circular Economy, as a philosophy within the pharmaceutical supply chain, aims to promote waste reduction, maximise medicines value, and enable sustainability within this supply chain (increasing circularity). Circularity strategies for pharmaceuticals are not currently implemented in many countries, due to quality and safety barriers. The aim of this study was to determine whether the application of circular economy principles can minimise pharmaceutical waste and support sustainability in the pharmaceutical supply chain; Methods: a detailed narrative literature review was conducted in order to examine pharmaceutical waste creation, management, disposal, and the application of circular economy principles; Results: the literature scrutinised revealed that pharmaceutical waste is created by multiple routes, each of which need to be addressed by pharmacists and healthcare bodies through the Circular Economy 9R principles. These principles act as a binding mechanism for disparate waste management initiatives. Medicines, or elements of a pharmaceutical product, can be better managed to reduce waste, cost, and reduce negative environmental impacts through unsafe disposal. Conclusions: the study findings outline a Circular Pharmaceutical Supply Chain and suggests that it should be considered and tested as a sustainable supply chain proposition. Full article
(This article belongs to the Special Issue Medicines Reuse)
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8 pages, 204 KiB  
Commentary
Stakeholder Views on the Idea of Medicines Reuse in the UK
by Parastou Donyai, Rachel McCrindle, Terence K. L. Hui and R. Simon Sherratt
Pharmacy 2021, 9(2), 85; https://doi.org/10.3390/pharmacy9020085 - 16 Apr 2021
Cited by 8 | Viewed by 4607
Abstract
People’s views about medicines reuse are being examined in a handful of qualitative studies and this commentary adds to that work by drawing on our own discussions with groups of stakeholders in the UK in the past two years. The reuse of medicines [...] Read more.
People’s views about medicines reuse are being examined in a handful of qualitative studies and this commentary adds to that work by drawing on our own discussions with groups of stakeholders in the UK in the past two years. The reuse of medicines within the community pharmacy setting is not permitted in the UK but our multidisciplinary team anticipates that this position will change in the coming years as medication shortages and worries about environmental waste and financial losses from the destruction of unused medicines are brought to the fore. Indeed, for many stakeholders, the issue of waste is a strong feature of conversations about medicines reuse. In addition to this, stakeholders identify the numerous barriers to medicines reuse in the UK. This includes the current uncertainty about the quality of unused medicines returned to pharmacies, which could otherwise be reused. However, stakeholders have also been very willing to propose solutions to a range of existing barriers. Our commentary draws on stakeholder meetings to elaborate the range of views about medicines reuse within a UK context. The challenge is to move forward from these views to advance the technologies that will facilitate medicines reuse practically as well as legally. Full article
(This article belongs to the Special Issue Medicines Reuse)
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