Inappropriate disposal practices of unwanted or expired medications can result in serious harm to nature, animals, and humans in turn [1] [2]. Although disposal of medications is generally thought of as the discarding of a medicinal product, households may also pass on their previously-stored, unwanted medications to other patients such as friends and family members. Such a practice may be the result of patient non-compliance to therapy, excessive prescribing by physicians, a change in the treatment course, improvement of patient health, or their death [3] [4].

Recycling unused medications returned by patients is discouraged by the World Health Organization (WHO) in their guidelines for medicine donation [5]. The justification for the lack of recycling is that the quality of returned medicines cannot be guaranteed. This could be especially accurate when household storage conditions are subject to hot and humid climates [6] [7] [8]. In a previous study, the author investigated various medication storage conditions adopted by households across the country [9]. Unless stored in a refrigerator, most medications were frequently exposed to temperatures above the manufacturer instructed ranges. Such temperature excursions cause degradation of Active Pharmaceutical Ingredients (APIs), leading to the production of harmful degradation products [6]. Alternatively, the partial loss of APIs or the degradation of excipients results in diminished product specifications and thus drug effectiveness [10] [11]. Therefore, storing medicinal products outside the recommended temperature range can result in a shortening of shelf-life, and medicine decay prior to the expiry date printed by the manufacturer, rendering drugs unsuitable for re-use [12]. Nevertheless, recent advancements in smart packaging, and the use of time-temperature indicators, as well as time-temperature humidity sensors, have potential in providing visual indications of product expected quality based on the accumulated thermal history the product has been exposed to. Hence, offering consumers and healthcare providers the ability to assess the quality of medicinal products [13] and preventing the use of less-than-effective medications. This is in alignment with the objectives of “The Quality of Life Program 2020” published by the Council of Economic and Development Affairs (CEDA), as part of the Saudi Vision 2030 [14].

The absence of take-back drug programs and the lack of published studies on disposal and wastage of medications in Saudi Arabia [3], have made it very difficult to monitor and investigate disposal practices of households. The results of such investigations can give insight into the degree of patient compliance and the rate of drug wastage. Abou-Auda [15] estimated the wastage of medications in the country, based on a cross-sectional questionnaire, to amount to approximately $150 million annually; unfortunately, more recent publications were not found. Although this may be a small portion of the Ministry of Health’s (MOH) annual budget (approximately $2.5 billion) for medical products and services [16], the reduction of medication wastage may lead to more cost-effective expenditures, a goal the MOH strives to achieve in alignment with the Saudi 2030 vision of economic reforms [17]. Furthermore, investigating the types of dosage forms disposed of, and their storage history, may provide the MOH and related governmental bodies with vital information on the possibility of initiating safe drug recycling programs.

This study investigated practices of medicine disposal and recycling by households in Saudi Arabia. In addition, this study discusses the potential benefits of introducing drug take-back programs.

More than 900 households participated in answering the cross-sectional questionnaire (Table 1). The sampled population included participants of both genders, different age groups and levels of education. Participants also included households from all regions of the country, with the majority residing in the Makkah, Madinah, and Riyadh regions (Table 1). Based on the sample size, the margin of error equaled 3.2% [20].

Households in Saudi Arabia dispose of unwanted medications through several methods. Although a great percentage claimed to follow SFDA guidelines of throwing unwanted medicinal products in the wastebasket, a significant percentage of households (≈60%) implemented disposal practices that may result in harm to the environment. Additionally, the sharing of medications with friends and family can directly damage others’ health, as in many cases this takes place without consultation with medical experts [26] [27] [28]. Not only could this lead to the use of unsuitable medications for patients, but their use may also cause symptoms to worsen through potential complications [26] [29]. The medication “donors” are unlikely to be aware of the possible repercussions of wrong dosage or wrong medication for the recipient patient. Ensuring the right medicinal products are dispensed via a pharmacist is essential, after referral to a doctor or a medical expert for correct treatment [26].

The recycling of medications by donating unused medicinal products to charities could be unsafe. Results from this study and others show that a great proportion of households rarely receive advice on appropriate storage conditions for medicinal products. In addition, more than 60% of participants reported indoor storage temperatures above 25˚C, which exceeds most manufacturer recommended temperature ranges for safe storage of solid pharmaceutical dosage forms [23] [30]. Even though this is in agreement with previous findings [9], it further confirms that a high proportion of home-stored medicinal products are exposed to harmful conditions, which may lead to the loss of performance specifications. In a previous study, temperatures inside a parked car can rapidly exceed 70˚C [9], and leaving medicines such temperatures even for a few hours, can induce the degradation of its active pharmaceutical ingredients or excipients, and potentially harmful products. In the absence of reliable assurance that the quality of a donated medicinal product is intact, it may not be safe for administration it to other patients.

It is worth noting that the short-term return of medicinal products to pharmacies, within 3 to 7 days from the dispensing date, can take place in accordance with the return and exchange policies of major pharmacy retailers in Saudi Arabia [31] [32]. However, this is subject to the type of product. Refrigerator-stored products for example, are not accepted due to potential risks. Furthermore, policies need to be created to safely regulate the return of medications.

Ensuring the quality of returned products via performing quality control (QC) tests may not be a feasible or cost effective option, as returned drugs from one household must be treated as a single batch. Nevertheless, recent advancements in smart packaging may allow reliable information of the storage conditions that returned products have been kept under to be recorded. This is possible through continuous monitoring of storage conditions of products stored by households [13]. Time-temperature indicators are smart packaging solutions extensively researched in the food industry [33] [34] [35] [36] [37]. Such tools may come in the form of cost-effective labels that present clear indication of the accumulated thermal history for a medicinal product. Hui et al. [13] recently published a novel design for a time temperature and humidity indicator, which was proposed as a key technology in quality assurance of returned medications. Their design was based on an “Internet of Pharmaceutical Things” concept, where storage conditions may be monitored via smart sensors with cloud connectivity [13]. Such solutions may help improve confidence in drug recycling programs and in turn minimize drug wastage.

Although it may take several years to implement smart packaging solutions, it may be appropriate to launch drug take-back services for safe disposal now. Not only would such a service minimize the harmful disposal practices that some households have adopted, but it may also provide governing bodies with vital information to investigate medicinal wastage caused by mismanagement and improve patients’ lack of awareness and/or non-compliance [38]. Such actions could lead to a clear consensus by governing bodies and healthcare providers on patient guidance for a safe disposal policy. Privacy and confidentiality of health records of patients are of concern, but must be assured in drug take-back programs to avoid discouragement of participation from the public. The general information gleaned from these programs can help the MOH to better utilize their budget as well as understanding and improvement of patient compliance through pharmacy counselling and awareness campaigns.

Disposal of medicinal products by households in Saudi Arabia include practices that may lead to harm to the patient and/or environmental damage. Households reported sharing or donating previously dispensed medications, which may have been stored outside manufacturer-recommended conditions. Hot and humid climate settings observed in Saudi Arabia could result in drug degradation which may be harmful to patients. Performing quality control tests to guarantee returned product quality may not be a cost-effective solution. Nevertheless, the utilization of smart packaging solutions, such as time-temperature indicators and time-temperature and humidity indicators based on the “Internet of Pharmaceutical Things” concept may allow continuous monitoring of storage conditions, thus paving the way for quality monitoring of returned or donated drugs and the possibility of safe recycling of unused medications. Although the recycling or re-dispensing of returned, unused medications may not be a feasible option in the interim, drug take-back programs for safe disposal are a more immediate possibility. A clear policy by governing bodies and healthcare providers must be implemented to oversee such programs, as well as the regulation of safe, short term return of medications.

Data was collected using online platforms which limits the study to households with access to the internet. While this may represent a great proportion of the population, it does not take into consideration households with limited resources.

The author of this study declares no competing financial interests or personal relationships that may have influenced the study performed and described in this paper.

The author would like to thank Mrs Faida Al-jawhari, Dr. Fatma Alqudsi, Mr. Yahya Alqurashi, Mr. Saad Alqurashi, Mr. Moath Alqurashi and Mr. Muhanad Algamdi for their tremendous input in designing and optimising the questionnaire. The author is also very thankful to Drs. Osamah M. Albassam YaserAlahmadi, Abdullah Almatrafi, Mahmud Fahmy, AbdulnasirBatouk, and Mohammed Alghanmi for their input and contributions in the conduct of phone interviews. Finally, the author is very appreciative to all who have participated in distributing and completing the questionnaire.

The author declares no conflicts of interest regarding the publication of this paper.

Alqurshi, A. (2020) Household Disposal and Recycling of Medication in Saudi Arabia: A Call for Introducing Drug Take-Back Programs. Pharmacology & Pharmacy, 11, 316-329. https://doi.org/10.4236/pp.2020.1111026