Ma Amy Soo-Bin, McLachlan Andrew J, Abdel Shaheed Christina, Gnjidic Danijela, Penm Jonathan, Riley Toni, Mathieson Stephanie
Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Syst Rev. 2025 May 31;14(1):119. doi: 10.1186/s13643-025-02820-4.
Drug-related harm is a major cause of mortality, poisonings, hospitalisations and misuse. Reducing the availability of unused medicines is a component of ensuring medication safety. However, the current literature on how to increase the implementation of medicine disposal strategies needs to be clarified. This systematic review evaluated the effectiveness of strategies designed to promote medicine disposal.
Electronic databases and clinical trial registries were searched from inception to 16th February 2024 without restriction for randomised trials of any interventions aiming to increase medicine disposal compared to any control. Medicine disposal could be done using any method as reported by eligible studies. The primary outcome was the change in the proportion of participants who disposed of unused medicines. Secondary outcomes were changes in patient (e.g. knowledge of disposal strategies), population (e.g. poisonings), environmental (e.g. preventing going to landfill) and economic (e.g. cost-effectiveness) outcomes. The original Cochrane tool was used to assess the risk of bias. Random-effects meta-analysis was conducted on the primary outcome, and a narrative synthesis was performed on secondary outcomes due to heterogeneity. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence. PROSPERO registration: CRD42023491797.
Eighteen randomised trials were included (plus five ongoing, registered trials). All studies were conducted in North America, published from 2016 to 2023, targeted opioid analgesic disposal and included 5347 participants. Interventional strategies of providing disposal kits (risk ratio [RR] 1.42, 95% confidence Interval [CI] 1.13 to 1.79, moderate evidence), education alone (RR 1.47, 95% CI 1.03 to 2.09, low evidence), education plus reminder prompts (RR 2.51, 95% CI 1.30 to 4.83, moderate evidence) and education plus disposal kits (RR 2.00, 95% CI 1.03 to 3.87, moderate evidence) increased disposal compared to routine practice. Secondary outcomes were infrequently reported, including no studies reporting population-level (poisonings, hospitalisations) and environmental outcomes.
There is moderate quality of evidence supporting interventions of disposal kits, disposal kit and education and education with text reminders to increase the disposal of unused medicines compared to routine practice. The conclusions of this review should be interpreted following consideration on the quality of evidence and the number of trials conducted.
药物相关危害是导致死亡、中毒、住院和药物滥用的主要原因。减少未使用药物的可得性是确保用药安全的一个组成部分。然而，目前关于如何加强药物处置策略实施的文献尚需明确。本系统评价评估了旨在促进药物处置的策略的有效性。
检索电子数据库和临床试验注册库，检索时间从建库至2024年2月16日，不限定任何旨在增加药物处置的干预措施与任何对照相比的随机试验。药物处置可采用符合条件的研究报告的任何方法。主要结局是处置未使用药物的参与者比例的变化。次要结局包括患者（如处置策略知识）、人群（如中毒）、环境（如防止进入垃圾填埋场）和经济（如成本效益）结局的变化。使用原始的Cochrane工具评估偏倚风险。对主要结局进行随机效应荟萃分析，由于存在异质性，对次要结局进行叙述性综合分析。使用推荐分级评估、制定和评价（GRADE）来评估证据质量。PROSPERO注册号：CRD42023491797。
纳入了18项随机试验（另有5项正在进行的注册试验）。所有研究均在北美进行，发表于2016年至2023年，针对阿片类镇痛药处置，共纳入5347名参与者。与常规做法相比，提供处置试剂盒（风险比[RR]1.42，95%置信区间[CI]1.13至1.79，中等质量证据）、单纯教育（RR 1.47，95%CI 1.03至2.09，低质量证据）、教育加提醒提示（RR 2.51，95%CI 1.30至4.83，中等质量证据）和教育加处置试剂盒（RR 2.00，95%CI 1.03至3.87，中等质量证据）等干预策略增加了药物处置。次要结局报告较少，包括没有研究报告人群水平（中毒、住院）和环境结局。
有中等质量的证据支持与常规做法相比，使用处置试剂盒、处置试剂盒加教育以及带文字提醒的教育等干预措施可增加未使用药物的处置。本综述的结论应在考虑证据质量和所进行试验数量后进行解读。
