Storage and disposal of pharmaceuticals at home: a systematic review

Constantino, Viviane Macedo; Fregonesi, Brisa Maria; Tonani, Karina Aparecida de Abreu; Zagui, Guilherme Sgobbi; Toninato, Ana Paula Contiero; Nonose, Eliana Roldão dos Santos; Fabriz, Luciana Aparecida; Segura-Muñoz, Susana Inés

doi:10.1590/1413-81232020252.10882018

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Ciênc. saúde coletiva 25 (2) • Feb 2020 • https://doi.org/10.1590/1413-81232020252.10882018 copy

Storage and disposal of pharmaceuticals at home: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study’s objective was to analyze Brazilian and international scientific evidence on the reasons people store medication at home and the disposal methods used. This systematic literature review includes studies published from 2001 to 2016 and indexed in PubMed, Lilacs and Elsevier’s Scopus Database, using the following key words: Disposal of medicines in household, Disposal of drugs expired, Residential expired drugs, Management of expired medications in household. Thirty-three studies were selected after applying inclusion and exclusion criteria. The studies reveal that the main reasons people keep a stock of medicines at home include the possibility of future use, leftovers from previous treatments, and self-medication. Inappropriate disposal methods prevail, such as throwing medicines in the household trash or flushing them into the sewer. Some countries have adopted programs to educate on proper storage and disposal of medicines, though only one study describes a national program guiding these practices that is free of charge. Evidence shows there is a need to implement public policies intended to provide guidance on the proper storage and disposal of medicines at home.

Key words
Medication storage; Solid waste collection; Collection routes; Housing

Author(s) (Year) Periodical	Geographical location	Reason to store medications	Disposal methods
Bound; Voulvoulis¹⁹19 Bound JP, Voulvoulis N. Household disposal of pharmaceuticals as a pathway for aquatic contamination in the United Kingdom. Environ Health 2005; 113(12):1705-1711. (2005) Environ Health Perspect	United Kingdom	Did not address the storage of medications	Household trash; flushed into the sewer; pharmacies/health facilities.
Fanhani et al.²⁰20 Fanhani HR, Correa MI, Lourenço EB, Fernandes ED, Billó VL, Lorenson L, Spiguel PKS, Galoro JLF, Takemura OS, Andrade OG. Avaliação domiciliar da utilização de medicamentos por moradores do jardim Tarumã, município de Umuarama - PR. Arq Cienc Saúde da Unipar 2006; 10(3):127-131. (2006)Arq. Ciênc. Saúde UNIPAR	Brazil	Self-medication; leftover from previous treatment	Did not address disposal methods.
Ekedahl²¹21 Ekedahl ABE. Reasons why medicines are returned to Swedish pharmacies unused. Pharm World Sci 2006; 28:352-358. (2006)Pharm World Sci	Sweden	Expired medication; death; leftover from previous treatment; clinical improvement; change of treatment.	Did not address disposal methods.
Jiménez et al.²²22 Jiménez H, Guillermo L, Sáenz RB. Medicamentos subutilizados em el ámbito comunitario, área salud coronado, Costa Rica. Rev Costarric Salud Pública 2006; 15(28):50-61. (2006)Rev. costarric. salud pública	Costa Rica	Keep for future use; lack of adherence to treatment.	Regular trash flushed into the sewer; disposed in the soil;pharmacies/health facilities
Seehusen and Edwards²³23 Seehusen DA, Edwards J. Patient Practices and Beliefs Concerning Disposal of Medications. J Am Board Fam Med 2006; 19(6):542-547. (2006)J Am Board Fam Med	United States of America	Did not address the storage of medications	Household trash; flushed into the sewer; pharmacies/health facilities
Abahussain et al.²⁴24 Abahussain EA, Ball DE, Matowe WC. Practice and opinion towards disposal of unused medication in Kuwait. Med Princ Pract 2006; 15:352-357. (2006) Med Princ Pract	Kuwait	Changed or abandoned treatment.	Household trash; flushed into the sewer; pharmacies/health facilities.
Bound et al.²⁵25 Bound JP, Kitsou K, Voulvoulis N. Household disposal of pharmaceuticals and perception of risk to the environment. Environ Toxicol Phar 2006; 21(3):301-307. (2006) Environ Toxicol Phar	United Kingdom	Keep for future use.	Solo; flushed into the sewer; pharmacies/health facilities; and donations.
Musson et al.²⁶26 Musson SE, Townsend T, Seaburg K, Mosa J. A continuous collection system for household pharmaceutical wastes: a pilot project. J Air Waste Manag Assoc 2007; 57(7):828-835. (2007) J Air Waste Manag Assoc	United Kingdom	Did not address the storage of medications	Household trash; flushed into the sewer; pharmacies/health facilities.
Margonato et al.²⁷27 Margonato FB, Thomson Z, Paoliello MMB. Determinantes nas intoxicações medicamentosas agudas na zona urbana de um município do Sul do Brasil. Cad Saude Publica 2008; 24(2):333-341. (2008) Cad Saúde Pública	Brazil	Excess purchase/ Self-medication.	Did not address disposal methods.
Bueno et al.²⁸28 Bueno CS, Weber D, Oliveira KR. Farmácia caseira e descarte de medicamentos no bairro Luiz Fogliatto do município de Ijuí - RS. Rev Ciênc Farm Básica Apl 2009; 30(2):201-210. (2009) Rev Ciênc Farm Básica Apl	Brazil	Keep for future use; donation; self-medication.	Household trash; flushed into the sewer; disposal in the soil; pharmacies/health facilities.
Braund et al.²⁹29 Braund R, Gn G, Matthews R. Investigating unused medications in New Zealand. Pharm World Sci 2009; 31:664-669. (2009) Pharm World Sci	New Zealand	Change of treatment; lack of adherence to treatment.	Did not address disposal methods.
James et al.³⁰30 James TH, Helms ML, Braund R. Analysis of medications returned to community pharmacies. Ann Pharmacother 2009; 43:1631-1635. (2009) Ann Pharmacother	New Zealand	Excessive supply; change of treatment; lack of adherence to treatment; death; leftover from previous treatment.	Did not address disposal methods.
Kotchen et al.³¹31 Kotchen M, Callao’s J, Wheeler K, Wong C, Zahller M. Pharmaceuticals in wastewater: Behavior, preferences, and willingness to pay for a disposal program. J Environ Manag 2009; 90:1476-1482. (2009) J Environ Manag	United States of America	Did not address the storage of medications	Household trash; flushed into the sewer; pharmacies/health facilities.
Gupta et al.³²32 Gupta J, Alam N, Bhardwaj A, Amin F. Prospective survey study on assessment and education of home medicine cabinet in general population of community. Int J Pharm Sci Res 2011; 2(5):1237-1243. (2011) Int J Pharm Sci Res		Did not address the storage of medications	Household trash; flushed into the sewer.
Kheir et al.³³33 Kheir N, Hajj MSE, Wilbur K, Kaissi RML, Yousif A. An exploratory study on medications in Qatar homes. Drug Healthc Patient Saf 2011; 3:99-106. (2011) Drug Healthc Patient Saf	Qatar	Did not address the storage of medications	Household trash; flushed into the sewer; pharmacies/health facilities.
Sasu et al.³⁴34 Sasu S, Kümmerer K, Kranert M. Assessment of pharmaceutical waste management at selected hospitals and homes in Ghana. Waste Manag Res 2012; 30(6):625-630. (2012) Waste Manag Res	Africa	Keep for future use.	Household trash; flushed into the sewer; heat; pharmacies/health facilities.
Beckhauser et al.³⁵35 Beckhauser GC, Valgas C, Galato D. Perfil do estoque domiciliar de medicamentos em residências com crianças. Rev Ciênc Farm Básica Apl 2012; 33(4):583-589. (2012) Rev Ciênc Farm Básica Apl	Brazil	Leftover from previous treatments	Did not address disposal methods.
Laste et al.³⁶36 Laste G, Deitos A, Kauffmann C, Castro LC, Torres IS, Fernandes LC. Papel do agente comunitário de saúde no controle do estoque domiciliar de medicamentos em comunidades atendidas pela Estratégia de Saúde da Família. Cienc Saude Colet 2012; 17(5):1305-1312. (2012) Ciênc Saúde Colet	Brazil	Self-medication	Did not address disposal methods.
Kusturica et al.³⁷37 Kusturica MP, Sabo A, Tomic Z, Horvat O, Solak Z. Storage and disposal of unused medications: knowledge, behavior, and attitudes among Serbian people. Int J Clin Pharm 2012; 34:604-610. (2012) Int. J. Clin Pharm.	Serbia	Did not address the storage of medications	Household trash; flushed into the sewer; burned; pharmacies/health facilities.
Wieczorkiewicz et al.³⁸38 Wieczorkiewicz SM, Kassamali Z, Danziger LH. Behind closed doors: medication storage and disposal in the home. Ann Pharmacother 2013; 47(4):482-489. (2013) Ann. Pharmacother.	United States of America	Did not address the storage of medications	Household trash; flushed into the sewer; pharmacies/health facilities.
Iob et al.³⁹39 Iob GA. Análise da forma de descarte de medicamentos por usuários de uma unidade de saúde no município de Porto Alegre. Infarma Ciênc Farm 2013; 25(3):118-125. (2013) Infarma - Ciências Farm.	Brazil	Leftover from previous treatment; keeps for future use.	Household trash; flushed into the sewer; burn; pharmacies/health facilities.
Vellinga et al.⁴⁰40 Vellinga A, Cormican S, Driscoll J, Furey, M, O’sullivan M, Cormican M. Public practice regarding disposal of unused medicines in Ireland. Sci Total Environ 2014; 478:98-102. (2014) Sci. Total Environ.	Ireland	Keeps for future use; lack of knowledge about proper disposal; donation.	Household trash; flushed into the sewer; pharmacies/health facilities.
Lehardt et al.⁴¹41 Lenhardt EH, Sólis LJB, Cintra EVCS, Botelho EHL. O descarte de medicamentos no bairro Grande Terceiro, Cuiabá-MT. UNOPAR Cient Ciênc Biol Saúde 2014; 16(1):5-8. (2014) UNOPAR Cient Ciênc Biol Saúde.	Brazil	Keeps for future use.	Household trash; flushed into the sewer; pharmacies/health facilities.
Gracia-Vásquez et al.⁴²42 Gracia-Vásquez SL, Ramírez-Lara E, Camacho-Mora IA, Cantú-Cárdenas LG, GraciaVásquez YA, Esquivel-Ferriño PC, Ramírez-Cabrera MA, Gonzalez-Barranco P. An analysis of unused and expired medications in Mexican households. Int J Clin Pharm 2015; 37(1):121-126. (2014) Int J Clin Pharm	Mexico	Excessive prescription; self-medication; free samples; change of treatment or non-adherence to treatment; death.	Household trash; flushed into the sewer
Pinto et al.⁴³43 Pinto GMF, Silva KR, Pereira RFAB, Sampaio SI. Estudo do descarte residencial de medicamentos vencidos na região de Paulínia (SP), Brasil. Rev Eng Sanit Ambient 2014; 19(3):219-224. (2014) Eng. Sanit. Ambient.	Brazil	Did not address the storage of medications	Household trash; flushed into the sewer; pharmacies/health facilities; recyclable waste.
Lystlund et al. ⁴⁴44 Lystlund S, Stevens E, Planas LG, Marcy T. Patient participation in a clinic-based community pharmacy medication take-back program. J Am Pharm Assoc 2014; 54:280-284. (2014) J Am Pharm Assoc.	United States of America	Clinical improvement; change of treatment; free samples.	Household trash; flushed into the sewer; dispose in the soil.
kusturica et al.⁴⁵45 Kusturica MP, Tomic Z, Horvat O, Pavlovi N, Mikov M. Antibiotics in Serbian Households: a source of potencial health and environmental threats? Cent Eur J Public Health 2015; 23(2):114-118. (2015) Cent. Eur. J. Public Health	Serbia	leftover from previous treatment; self-medication.	Did not address disposal methods.
Piveta et al.⁴⁶46 Piveta LN, Silva LB, Guidoni CM, Girotto E. Armazenamento e descarte de medicamentos por acadêmicos da área da saúde de uma universidade pública paranaense. Semina : Ciências Biológicas e da Saúde 2015; 36(1):55-66. (2015) Semina: Ciências Biológicas e da Saúde	Brazil	Keep for future use.	Household trash; collection sites; flush into the sewer.
Bergen et al.⁴⁷47 Bergen PJ, Hussainy SY, George J, Kong DCM, Kirkpatrick CMJ. Safe dispo sal of prescribed medicines. Australian Prescriber 2015; 38(3):90-92. (2015) Australian Prescriber	Australia	Death; change of treatment; lack of confidence in the safety and efficacy of treatment.	Proper disposal: National take-back program and elimination of unwanted pharmaceuticals.
Quijano-Prieto et al.⁴⁸48 Quijano-Prieto D, Orozco-Díaz JG, Holguín-Hernández E. Patients’ knowledge and practices about unconsumed drugs disposal. An Approach to Ecopharmacovigilance. Rev Salud Publica 2016; 18(1):61-71. (2016) Rev Salud Pública	Colombia	Clinical improvement; treatment was suspended.	Household trash; collection sites.
Dias-Ferreira et al.⁴⁹49 Dias-Ferreira C, Valente S, Vaz J. Practices of pharmaceutical waste generation and discarding in households across Portugal. Waste Manag Res 2016; 34(10):1006-1013. (2016) Waste Manag Res	Portugal	Keep for future use; leftover from previous treatment; excessive prescription.	Pharmacies/health facilities; household trash; flushed into the sewer; recyclable waste.
Banwat et al.⁵⁰50 Banwat SB, Auta A, Dayom DW, Buba Z. Assessment of the storage and disposal of medicines in some homes in Jos north local government area of Plateau State, Nigeria. Trop J Pharm Res 2016 May; 15(5):989. (2016) Trop J Pharm Res	Nigeria	Self-medication; leftover from previous treatment; keep for future use.	Household trash; flushed into the sewer; burned.
Correia; Marcano⁵¹51 Correia A, Marcano L. Evaluación de las rutas de entrada de competes farmacêuticos de uso doméstico al ambiente caso estudio: município Valencia, Estado Carabobo, Venezuela. Rev. Int. Contam Ambie 2016; 32(1):77-86. (2016) Rev Int Contam Ambie	Venezuela	Self-medication; leftover from previous treatments; keep for future use.	Household trash; flushed into the sewer.

ABRASCO - Associação Brasileira de Saúde Coletiva Av. Brasil, 4036 - sala 700 Manguinhos, 21040-361 Rio de Janeiro RJ - Brazil, Tel.: +55 21 3882-9153 / 3882-9151 - Rio de Janeiro - RJ - Brazil
E-mail: cienciasaudecoletiva@fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Collaborations

VM Constantino, BM Fregonesi, KAA Tonani, GS Zagui, APC Toninate, ERS Nonose, LA Fabriz and SI Segura-Muñoz participated in all stages and relevantly in the design and development of the text.