Healthcare, Vol. 11, Pages 75: Factors Influencing Public Willingness to Reuse the Unused Stored Medications in Jordan: A Cross-Sectional Study

In Jordan, medicines are obtained from community and hospital pharmacies [1]. In hospital settings, minimal interaction occurs between the pharmacist and the patient. Most hospital pharmacies still have antiquated dispensing windows where medicines are placed for patients to pick up [2]. Admitting that the Jordanian Food and Drug Administration (JFDA) drug classification and law regarding drug dispensing is quite similar to those in the West, these laws are not strictly enforced or followed in the community pharmacies in Jordan [2,3]. At the community pharmacy, the patient can buy any medicine without a prescription, except for misoprostol, sedative-hypnotics, controlled narcotics, and major tranquilizers (e.g., benzodiazepines), which can only be dispensed upon the issue of a special prescription signed by a registered physician [4]. These would all add to the accumulation of unused stored medicines referred to as medicines waste. Medicines waste has environmental and economic impacts, and poses risks to human health [5]. Healthcare professionals in Jordan do not require or even educate people about returning unused stored medicines, and there is scarce evidence about the disposal practices of unused stored medicine in Jordan [6]. A recent Jordanian study reported that a high percentage of the population improperly disposes of their unused stored medications by throwing in general household waste and flushing down the sink or the toilet, which would impact the wildlife and human environments [6]. Although anecdotal observations confirm these practices [1,6,7], there is a lack of evidence or research investigating the environmental impacts of these unfavorable disposal practices of unused medicinal waste in Jordan. The economic impacts of the unused stored medicines are possibly more destructive to the brittle Jordanian economy [7]. A study conducted in 2012 reported that the total extrapolated cost of unused medicines stored in patients’ homes in Jordan was around $30 million [7]. One year later, another study reported that the total cost of unused medicines stored in patients’ homes from Amman (the capital city of Jordan) was $12 million [1]. Lastly, unused stored medicines pose a risk to human health [5,8]. The risk to human health in Jordan was evidenced by two studies [1,9]. One study referred to inappropriate storage conditions, with around 50% of unused medicines stored outside pharmacy cabinets in places considered unsafe, accessible to children, and with the potential risk of accidental poisoning, especially with children [1]. Another study described the high risk of antibiotic resistance as a result of self-medicating unused stored antibiotics [9]. The unused stored medicines’ impact on the environment, economy, and its risk to human health warrant a solution. One potential solution for medicines waste would be reissuing or redispensing the returned unused stored medicines [5,10,11]. The reissuing, redispensing, redistributing, or even recycling of the returned unused stored medicines is referred to as medicine reuse [8,10]. Medicine reuse has different interpretations and definitions. For example, patients reuse their own medicines during hospital admission [12,13,14], recycle unused stored medicines, or repackage for manufacturing processes [10]. Additionally, medicines reuse can be referred to as repurposing unused stored medicines for new diseases or conditions [10]. These definitions and interpretations are important, but exceed the focus of this study. The term “medicine reuse” is utilized in this study in the context of the community pharmacy and was referred to as the reissue of medicines returned unused to the community pharmacies [8]. This study focuses on the Jordanian context, where community pharmacists yet cannot reissue the returned unused stored medicines [2,7]. Stakeholders from different countries have reported concerns about medicine reuse [5,10]. These concerns are about (i.e., but not limited to) the quality and the safety of the returned unused medicines, their storage conditions, the risks of contamination or sabotage, and the practicality and financial worthiness of medicine reuse based on pharmacological types and the pharmaceutical formulations of the unused stored medicines [5,8,10]. Additionally, the technology that would be used to trail the medicine’s storage conditions, and the manufacturing and expiry date to manage resupply should reasonably be cost-effective [15,16]. These concerns are significant and would affect the implementation of medicine reuse as a scheme in Jordan and globally. However, this exceeds our focus in this study. A limited number of global studies have examined people’s views on the concept of medicine reuse [5,11,17,18,19,20]. This study aims primarily to explore the public’s willingness to reuse unused stored medicines in the future and the factors affecting their decisions, as well as to assess the pharmacological types and formulations of the unused stored medicines by the public.

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