Alhamad Hamza, Patel Nilesh, Donyai Parastou
Department of Pharmacy, University of Reading, Reading RG6 6AP, UK.
Department of Pharmacy, Zarqa University, 132222 Zarqa, Jordan.
Pharmacy (Basel). 2020 Dec 1;8(4):230. doi: 10.3390/pharmacy8040230.
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.
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.
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.
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.
药品再利用，即在质量控制后将退回的药品重新调配给他人的想法，在英国尚未实施。这种做法可能是处理退回药品的一种可持续方式，否则这些药品会被归类为药品废弃物并被销毁。为了向药品再利用迈进，了解构成药品废弃物的不同治疗类别和剂型非常重要。例如，了解退回的药品是否大多为固体剂型，因此有可能被再利用，或者是否来自那些使药品再利用具有成本效益的治疗类别，会有所帮助。关于废弃药品的治疗类别和剂型知之甚少。本研究旨在对国际文献中关于患者退回社区药房、医院、全科医生诊所的药品，或通过废品回收活动收集的药品的不同治疗类别和剂型的研究结果进行叙述性综述和报告。相关情况下，也纳入了基于未实际退回药品的调查的研究。
2017年对包括PubMed和谷歌学术在内的数据库进行了为期一个月的全面电子检索，并于2020年11月5日更新，使用了精心创建的关键词组合。
纳入并综述了2002年至2020年期间以英文发表的45项研究，这些研究包含来自26个国家的数据。在描述剂型的22项研究中的14项（64%）中，口服固体剂型（大多为片剂）是所有废弃药品中常见的剂型报道，占所有废弃药品的比例在40.6%至95.6%之间。尽管不同国家报告的药品废弃物水平存在差异，但英国和埃塞俄比亚的研究结果相对一致；在这些国家中，心血管系统用药和抗感染药分别是药品废弃物中最常见的治疗类别。
本叙述性综述提供了关于患者退回、通过废品回收活动收集或在调查回复中指出的药品废弃物的不同治疗类别和剂型的见解。这些发现有助于政策制定者了解将大多数未使用药品视为药品废弃物的潜在影响，以及因此推行药品再利用计划在环境或经济上是否合理。对于药品再利用计划而言，使用与储存条件（如温度和湿度）、物理形状（如密封、未开封、未使用且在泡罩包装中）以及篡改相关的标准来考量这些退回药品的质量和安全性是其他重要因素。
