‘Do the public and community pharmacists support the introduction of medication reuse as a means to reduce pharmaceutical waste?’

Problem

Wasted medicines cost the NHS an estimated £300 million every year, of which £110 million is generated in the community. Additionally, the pollution to which they contribute has a damaging impact on the environment, contaminating water courses, disrupting ecosystems, and promoting antimicrobial resistance. In spite of efforts to reduce inappropriate prescribing and over-ordering through medication reviews, some waste remains inevitable. A small body of literature has suggested medicine reuse - retrieval of unwanted prescription medication from the original recipient and re-dispensing to another patient - could reduce the financial and environmental impact of waste. Already practised in the USA and Greece for altruistic reasons, in the UK barriers currently exist in the form of legislation, quality assurance, and acceptability to the public and professionals. This study evaluates the attitudes of a sample of the public towards reusing medicines. Additionally, for the first time, community pharmacists are surveyed to ascertain their professional opinions about the potential benefits of, and barriers to, reusing returned medicines.

Approach

Two self-administered online questionnaires, one recruiting a convenience sample of 192 members of the general public in the south west of England, and the other given to 27 community pharmacists. The data were analysed with descriptive statistics and thematic analysis to determine attitudes and identify areas of concern that might be amenable to further research.

Findings

There was strong support from the public regarding medicines reuse for both financial and environmental purposes, an increase on earlier surveys, reflecting increased public awareness of environmental issues and cost pressures on the NHS. This is the first study to specifically seek the opinion of community pharmacists who would be instrumental in any such scheme, so their positive response is particularly significant. However concerns were identified about safety and efficacy of returned medicines, particularly by pharmacists. The use of technology to improve safety, such as temperature and humidity sensors applied to packaging to ensure appropriate storage, was popular amongst the professionals, and the idea of centralised collection and redistribution that emerged from the qualitative pharmacist responses would allow economies of scale and help to alleviate their concerns about individual liability.

Consequences

The concept of medicines reuse received strong support from the public and professionals, possibly due to its high visibility as a source of medicinal waste. However the logistical complexity of implementing such a scheme in the UK is high, and would require new legislation, the repurposing of technology, a shift in approval from regulatory bodies, engagement with the pharmaceutical industry, and patient education. Further research is recommended, perhaps a pilot study to model reuse from a care home via a community pharmacy, to obtain estimates of the time required to verify returns, which would inform the financial feasibility of such a scheme.