KNOWLEDGE, ATTITUDES, AND PRACTICES RELATED TO THE DISPOSAL OF EXPIRED AND UNUSED MEDICATIONS IN HOUSEHOLD IN DUHOK CITY, KURDISTAN REGION, IRAQ

Authors

  • Najmaldin Ezaldin Hassan 1College of Engineering, Civil and Environment Department, University of Zakho, Kurdistan region, Iraq
  • Sonia Khalil City, University of London, United Kingdom

DOI:

https://doi.org/10.25271/sjuoz.2025.13.1.1388

Keywords:

Unused/Unwanted, Expired Medicines, Household medicine disposal, Environment, Duhok city

Abstract

Unused, unwanted, and expired household medications can accumulate and be improperly disposed of, posing a major national and international public health and environmental concern. This problem is primarily caused by a lack of awareness and understanding of appropriate medicine disposal techniques. This study aimed to assess the knowledge, attitudes, and practices regarding the disposal of unused, unwanted, or expired household medicines among the general public in Duhok city, in the Kurdistan Region of Iraq. Between March 6 and June 6, 2023, 250 participants were interviewed in person using a pre-validated structured questionnaire for this cross-sectional study. The accuracy of the returned questionnaires was verified multiple times. Descriptive statistics were calculated for the sample population's characteristics, and the findings were presented in tables as percentages. Out of the 250 respondents included in the study, 115 (46%) were females, and 165 (66%) were married. A total of 205 (82%) of the respondents had formal education. The most commonly used disposal practice for unused medicines was throwing them in household garbage, as reported by 137 (54.8%). Interestingly, 127 (61.95%) of the participants who disposed of medicines in the garbage had formal education. About 68 (27.2%) of the participants kept unused or unwanted medicines at home for future use or until expiration, followed by giving them to friends and relatives (23, or 18.07%), while a few (12, or 9.27%) burned medicines at home. Significantly, 206 (82.4%) of the respondents did not check the expiry date before taking medicine. A majority of respondents, 155 (62%), held the government responsible for creating awareness about proper medicine disposal. Almost all participants (220, or 88%) felt that improper disposal of unused and expired medicines can affect the environment and health. This study revealed that the most common ways to dispose of unused, unwanted, and expired medication were tossing them in the trash and storing them for later use. There is an urgent need to address the fact that most study participants disposed of medicine in unsafe ways. Nonetheless, the majority of participants agreed that improper disposal of medications poses a threat to public health and the environment. Therefore, both national and local stakeholders urgently need to implement tailored interventions to address the situation.

References

‏Abahussain, E. A., & Ball, D. E. (2007). Disposal of unwanted medicines from households in Kuwait. Pharmacy world & science, 29, 368-373.‏ https://doi.org/10.1007/s11096-006-9082-y

Abahussain, E.,Waheedi, M., & Koshy, S.(2012).Practice, awareness and opinion of pharmacists toward disposal of unwanted medications in Kuwait. Saudi Pharmaceutical Journal,20(3),195201.‏https://doi.org/10.1016/j.jsps.2012.04.001

Abou-Auda, H. S. (2003). An economic assessment of the extent of medication use and wastage among families in Saudi Arabia and Arabian Gulf countries. Clinical therapeutics, 25(4),1276-1292.‏https://doi.org/10.1016/S0149-2918(03)80083-8

Akici, A., Aydin, V., & Kiroglu, A. (2018). Assessment of the association between drug disposal practices and drug use and storage behaviors. Saudi Pharmaceutical Journal, 26(1), 7-13.‏ https://doi.org/10.1016/j.jsps.2017.11.006

AlAzmi, A., AlHamdan, H., Abualezz, R., Bahadig, F., Abonofal, N., & Osman, M. (2017). Patients' knowledge and attitude toward the disposal of medications. Journal of pharmaceutics,2017.‏https://doi.org/10.1155/2017/8516741

Al-Naggar, R. A., & Alareefi, A. (2010). Patients’ opinion and practice toward unused medication disposal in Malaysia: a qualitative study. The Thai Journal of Pharmaceutical Sciences,34(3),117123.‏https://digital.car.chula.ac.th/tjps/vol34/iss3/3

Alnahas, F., Yeboah, P., Fliedel, L., Abdin, A. Y., & Alhareth, K. (2020).Expired medication: Societal, regulatory and ethical aspects of a wasted opportunity. International journal of environmental research and public health, 17(3), 787. https://doi.org/10.3390/ijerph17030787‏

Al-Shareef, F., El-Asrar, S. A., Al-Bakr, L., Al-Amro, M., Alqahtani, F., Aleanizy, F., & Al-Rashood, S. (2016). Investigating the disposal of expired and unused medication in Riyadh, Saudi Arabia: a cross-sectional study. International journal of clinical pharmacy, 38, 822-828.‏ https://doi.org/10.1007/s11096-016-0287-4

Angi’enda, S. A., & Bukachi, S. A. (2016). Household knowledge and perceptions on disposal practices of unused medicines in Kenya. J Anthropol Archaeol, 4(2), 1-20.‏ https://doi.org/10.15640/jaa.v4n2a1

Ariffin, M., & Zakili, T. S. T. (2019). Household pharmaceutical waste disposal in Selangor, Malaysia—policy, public perception,and current practices.Environmental management,64(4),509519.‏https://doi.org/10.1007/s00267-019-01199-y

Ayele, Y., & Mamu, M. (2018). Assessment of knowledge, attitude and practice towards disposal of unused and expired pharmaceuticals among community in Harar city, Eastern Ethiopia. Journal of Pharmaceutical Policy and Practice,11,1-7.‏https://doi.org/10.1186/s40545-018-0155-9

Azmi Hassali, M., & Shakeel, S. (2020). Unused and expired medications disposal practices among the general public in Selangor,Malaysia.Pharmacy,8(4),196. https://doi.org/10.3390/pharmacy8040196

Bashaar, M., Thawani, V., Hassali, M. A., & Saleem, F. (2017). Disposal practices of unused and expired pharmaceuticals among general public in Kabul.BMC public health,17,1-8.‏https://doi.org/10.1186/s12889-016-3975-z

Bettington, E., Spinks, J., Kelly, F., Gallardo-Godoy, A., Nghiem, S., & Wheeler, A. J. (2018). When is a medicine unwanted, how is it disposed, and how might safe disposal be promoted? Insights from the Australian population. Australian Health Review, 42(6), 709-717.‏ https://doi.org/10.1071/AH16296

Boxall, A. B. (2004). The environmental side effects of medication: How are human and veterinary medicines in soils and water bodies affecting human and environmental health?. EMBO reports, 5(12), 1110-1116.‏ https://doi.org/10.1038/sj.embor.74003

Braund, R., Peake, B. M., & Shieffelbien, L. (2009). Disposal practices for unused medications in New Zealand. Environment international,35(6),952-955.‏ https://doi.org/10.1016/j.envint.2009.04.003

Daughton, C. G. (2003). Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. II. Drug disposal, waste reduction, and future directions. Environmental Health Perspectives,111(5),775785.‏https://doi.org/10.1289/ehp.5947

Daughton, C. G., & Ruhoy, I. S. (2008). The afterlife of drugs and the role of pharmEcovigilance. Drug safety, 31, 1069-1082.‏https://doi.org/10.2165/0002018-200831120-00004

Dias-Ferreira, C., Valente, S., & Vaz, J. (2016). Practices of pharmaceutical waste generation and discarding in households across Portugal.Waste Management & Research,34(10),10061013.‏https://doi.org/10.1177/0734242X16639388

Frimpter, G. W., Timpanelli, A. E., Eisenmenger, W. J., Stein, H. S., & Ehrlich, L. I. (1963). Reversible Fanconi syndrome caused by degraded tetracycline. Jama, 184(2), 111-113.‏ https://doi.org/10.1001/jama.1963.03700150065010

Gagnon, E. (2009). Pharmaceutical disposal programs for the public: A Canadian perspective. Ottawa, Ontario: Health Canada,Environmental Impact Initiative.‏ https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=5a9536eb8067ffeedbcbae570ef6c79e2f9bc1df

Gidey, M. T., Birhanu, A. H., Tsadik, A. G., Welie, A. G., & Assefa, B. T. (2020). Knowledge, attitude, and practice of unused and expired medication disposal among patients visiting Ayder Comprehensive Specialized Hospital.BioMed research international,2020.‏ https://doi.org/10.1155/2020/9538127

Glassmeyer, S. T., Hinchey, E. K., Boehme, S. E., Daughton, C. G., Ruhoy, I. S., Conerly, O., ... & Thompson, V. G. (2009).Disposal practices for unwanted residential medications in the United States.Environment international,35(3),566572.‏https://doi.org/10.1016/j.envint.2008.10.007

Götz, K., & Keil, F. (2007). Drug disposal in private households: does the disposal of pharmaceuticals via domestic sanitary devices contribute to water contamination?. Umweltwissenschaften und Schadstoff-Forschung, 19, 180-188.‏ https://doi.org/10.1065/uwsf2007.07.201

Gupta, R., Gupta, B. M., & Gupta, A. (2019). A study on awareness regarding disposal of unused medicines among consumers at a tertiary care teaching hospital of North India. International Journal of Advances in Medicine,6(1),91.‏http://dx.doi.org/10.18203/2349-3933.ijam20190111

Hassali, M. A., & Shakeel, S. (2020). Unused and expired medications disposal practices among the General Public in Selangor, Malaysia. Pharmacy: Journal of Pharmacy EducationandPractice,8(4).‏https://doi.org/10.3390/pharmacy8040196

Hassan, N. E. (2023). An investigation of heavy metals concentration in rainwater and their effects on human healthinKurdistanRegion,Iraq.‏https://doi.org/10.30574/gscarr.2023.17.2.0451

Hassan, N. E., & Mohammed, S. J. (2023). Assessment of Ground Water Pollution by Heavy Metals in Some Residential Areas in Kurdistan Region of Iraq. Environ SciArch,2,3544.https://doi.org/10.5281/zenodo.7625078

Husain, T., Farooqi, S., Khan, M., Humayoon, R., & Jabeen, S. (2017). MEDICATION DISPOSAL;: HOUSEHOLD PRACTICES IN KARACHI, PAKISTAN. NEED FOR A MEDICATION TAKE-BACK PROGRAM. The Professional Medical Journal, 24(09), 1380-1386.‏ https://doi.org/10.17957/TPMJ/17.3858

Insani, W. N., Qonita, N. A., Jannah, S. S., Nuraliyah, N. M., Supadmi, W., Gatera, V. A., ... & Abdulah, R. (2020). Improper disposal practice of unused and expired pharmaceutical products in Indonesian households. Heliyon,6(7).‏https://doi.org/10.1016/j.heliyon.2020.e04551

Jobling, S., Williams, R., Johnson, A., Taylor, A., Gross-Sorokin, M., Nolan, M., ... & Brighty, G. (2006). Predicted exposures to steroid estrogens in UK rivers correlate with widespread sexual disruption in wild fish populations. Environmental health perspectives, 114(Suppl 1), 32-39.‏ https://doi.org/10.1289/ehp.8050

Kahsay, H., Ahmedin, M., Kebede, B., Gebrezihar, K., Araya, H., & Tesfay, D. (2020). Assessment of knowledge, attitude, and disposal practice of unused and expired pharmaceuticals in community of Adigrat City, Northern Ethiopia. Journal of environmental and public health, 2020.‏ https://doi.org/10.1155/2020/6725423

Kampamba, M., Cheela, T., Hikaambo, C. N. A., Mudenda, S., Saini, K., & Chabalenge, B. (2021). Knowledge, attitude, and practices on disposal methods of expired and unused medicines among students in public academic institutions in Lusaka, Zambia. Int J Basic Clin Pharmacol, 10(7), 774780.‏https://dx.doi.org/10.18203/23192003.ijbcp20212371

Kish, L. (1949). A procedure for objective respondent selection within the household. Journal of the American statistical Association,44(247),380387.‏https://doi.org/10.1080/01621459.1949.10483314

Kotchen, M., Kallaos, J., Wheeler, K., Wong, C., & Zahller, M. (2009).Pharmaceuticals in wastewater:Behavior, preferences, and willingness to pay for a disposal program. Journal of Environmental Management, 90(3), 1476-1482.‏ https://doi.org/10.1016/j.jenvman.2008.10.002

Kozak, M. A., Melton, J. R., Gernant, S. A., & Snyder, M. E. (2016). A needs assessment of unused and expired medication disposal practices:A study from the Medication Safety Research Network of Indiana. Research in Social and Administrative Pharmacy, 12(2), 336-340.‏ https://doi.org/10.1016/j.sapharm.2015.05.013

Kristina, S. A. (2018). A survey on medicine disposal practice among households in Yogyakarta. Asian Journal of Pharmaceutics(AJP),12(03).‏https://doi.org/10.22377/ajp.v12i03.2633

Kusturica, M. P., Sabo, A., Tomic, Z., Horvat, O., & Šolak, Z. (2012). Storage and disposal of unused medications: knowledge, behavior, and attitudes among Serbian people. International journal of clinical pharmacy, 34, 604-610.‏ https://doi.org/10.1007/s11096-012-9652-0

Kusturica, M. P., Tomas, A., Tomic, Z., Bukumiric, D., Corac, A., Horvat, O., & Sabo, A. (2016). Analysis of expired medications in Serbian households. Slovenian Journal of PublicHealth,55(3),195201.‏https://doi.org/10.1515/sjph-2016-0025

Latunji, O. O., & Akinyemi, O. O. (2018). Factors influencing health-seeking behaviour among civil servants in Ibadan, Nigeria. Annals of Ibadan postgraduate medicine, 16(1), 5260.‏https://www.ajol.info/index.php/aipm/article/view/174662

Levinson, W., Kallewaard, M., Bhatia, R. S., Wolfson, D., Shortt, S., & Kerr, E. A. (2015). ‘Choosing Wisely’: a growing international campaign. BMJ quality & safety, 24(2), 167-174.‏ https://doi.org/10.1136/bmjqs-2014-003821

Maeng, D. D., Snyder, R. C., Medico, C. J., Mold, W. M., & Maneval, J. E. (2016). Unused medications and disposal patterns at home: Findings from a Medicare patient survey and claims data. Journal of the American Pharmacists Association,56(1),41-46.‏ https://doi.org/10.1016/j.japh.2015.11.006

Mahlaba, K. J., Helberg, E. A., Godman, B., Kurdi, A., & Meyer, J. C. (2022). Patients’ knowledge and practice on disposal of medicines kept in households in South Africa: Findings and implications. Journal of Research in PharmacyPractice,11(1),13.‏https://doi.org/10.4103/jrpp.jrpp_85_21

Makki, M., Hassali, M. A., Awaisu, A., & Hashmi, F. (2019). The prevalence of unused medications in homes. Pharmacy, 7(2), 61.‏ https://doi.org/10.3390/pharmacy7020061

Manocha, S., Suranagi, U. D., Sah, R. K., Chandane, R. D., Kulhare, S., Goyal, N., & Tanwar, K. (2020). Current disposal practices of unused and expired medicines among general public in Delhi and national capital region, India. Current drug safety, 15(1), 13-19.‏ https://doi.org/10.2174/1574886314666191008095344

Marwa, K. J., Mcharo, G., Mwita, S., Katabalo, D., Ruganuza, D., & Kapesa, A. (2021). Disposal practices of expired and unused medications among households in Mwanza, Tanzania.PloSone,16(2),e0246418.‏https://doi.org/10.1371/journal.pone.0246418

McCullagh, M. C., Schim, S., & Ortner, P. (2012). Drug disposal among hospice home care nurses: a pilot study of current practice and attitudes. Journal of pain and symptom management,43(2),287292.https://doi.org/10.1016/j.jpainsymman.2011.03.024

Najmaldin Ezaldin Hassan, “Statistical Analysis of Rainfall Variations in Duhok City and Semel District, Kurdistan Region of Iraq", International Journal of Research in Environmental Science (IJRES), vol. 9, no. 3, pp. 31-38, 2023. http://dx.doi.org/10.20431/2454-9444.0903004

Naser, A. Y., Amara, N., Dagash, A., & Naddaf, A. (2021). Medications disposal and medications storage in Jordan: A cross‐sectional study. International Journal of Clinical Practice,75(3),e13822.‏https://doi.org/10.1111/ijcp.13822

Oaks, J. L., Gilbert, M., Virani, M. Z., Watson, R. T., Meteyer, C. U., Rideout, B. A., ... & Ahmed Khan, A. (2004). Diclofenac residues as the cause of vulture population decline in Pakistan. Nature, 427(6975), 630-633.‏ https://doi.org/10.1038/nature02317

Okoro, R. N., & Peter, E. (2020). Household medicines disposal practices in Maiduguri,North-Eastern Nigeria. International Journal of Health and Life Sciences, 6(1).‏ https://doi.org/10.5812/ijhls.5709

Paut Kusturica, M., Tomas, A., & Sabo, A. (2017). Disposal of unused drugs: Knowledge and behavior among people around the world.Reviews of Environmental Contamination and Toxicology Volume 240, 71-104.‏ https://doi.org/10.1007/398_201

Peake, B. M., Braund, R., Tong, A., & Tremblay, L. A. (2015). The Life-cycle of Pharmaceuticals in the Environment. Elsevier.‏ https://lib.ugent.be/catalog/ebk01:3710000000514528

Persson, M., Sabelström, E., & Gunnarsson, B. (2009). Handling of unused prescription drugs—knowledge, behaviour and attitude among Swedish people.Environment international,35(5),771774.‏https://doi.org/10.1016/j.envint.2008.10.002

Rogowska, J., Zimmermann, A., Muszyńska, A., Ratajczyk, W., & Wolska, L. (2019). Pharmaceutical household waste practices:preliminary findings from a case study in Poland. Environmental management,64,97-106.‏ https://doi.org/10.1007/s00267-019-01174-7

Ross-Durow, P. L., McCabe, S. E., & Boyd, C. J. (2013). Adolescents' access to their own prescription medications in the home. Journal of Adolescent Health, 53(2),260264.‏https://doi.org/10.1016/j.jadohealth.2013.02.012

Ruhoy, I. S., & Daughton, C. G. (2007). Types and quantities of leftover drugs entering the environment via disposal to sewage—revealed by coroner records. Science of the totalenvironment,388(1-3),137148.‏https://doi.org/10.1016/j.scitotenv.2007.08.03

Sahoo, K. C., Tamhankar, A. J., Johansson, E., & Lundborg, C. S. (2010). Antibiotic use, resistance development and environmental factors:a qualitative study among healthcare professionals in Orissa, India. BMC Public health, 10, 1-10.‏ https://doi.org/10.1186/1471-2458-10-629

Seehusen, D. A., & Edwards, J. (2006). Patient practices and beliefs concerning disposal of medications. The Journal of the American Board of Family Medicine, 19(6), 542-547.‏ https://doi.org/10.3122/jabfm.19.6.542

Shaaban, H., Alghamdi, H., Alhamed, N., Alziadi, A., & Mostafa, A.(2018).Environmental contamination by pharmaceutical waste: assessing patterns of disposing unwanted medications and investigating the factors influencing personal disposal choices.J Pharmacol PharmRes,1(1),003.http://www.thebiomedica.org/articles/jppr.003.pdf

Shamim, J. (2018). Public awareness about safe drug disposal: a cross-sectional study at Karachi, Pakistan. Asian Pacific Journal of Health Sciences,5(2),92-95.‏ https://doi.org/10.21276/apjhs.2018.5.2.18

Shivaraju, P. T., & Gangadhar, M. (2017). Knowledge and awareness of disposal of unused and expired medications among medical undergraduates of a tertiary care teaching hospital at BG Nagar: A cross-sectional observational study. National Journal of Physiology, Pharmacy and Pharmacology,7(11),12681273.‏https://njppp.com/fulltext/28-1500559626.pdf

Smith, C. A. (2002). Managing pharmaceutical waste. Journal of the Pharmacy Society of Wisconsin,5,17-22.‏ https://www.gecap.info/pdf/managing_pharmaceutical_waste.pdf

Tong, A. Y., Peake, B. M., & Braund, R.(2011). Disposal practices for unused medications around the world. Environment international,37(1),292-298.‏ https://doi.org/10.1016/j.envint.2010.10.002

Vellinga, A., Cormican, S., Driscoll, J., Furey, M., O'Sullivan, M., & Cormican, M. (2014). Public practice regarding disposal of unused medicines in Ireland. Science of the Total Environment,478,98-102.‏ https://doi.org/10.1016/j.scitotenv.2014.01.085

Vollmer, G.(2010).Disposal of pharmaceutical waste in households–a European survey. Green and sustainable pharmacy, 165-178.‏ https://doi.org/10.1007/978-3-642-05199-9_11

Watkins, S., Barnett, J., Standage, M., Kasprzyk-Hordern, B., & Barden,R.(2022).Household disposal of pharmaceuticals: attitudes and risk perception in a UK sample. Journal of Material Cycles and Waste Management,24(6),24552469.‏https://doi.org/10.1007/s10163-022-01494-7

Wieczorkiewicz, S. M., Kassamali, Z., & Danziger, L. H. (2013). Behind closed doors: medication storage and disposal in the home. Annals of Pharmacotherapy, 47(4), 482-489.‏ https://doi.org/10.1345/aph.1R706

Wu, M., Atchley, D., Greer, L., Janssen, S., Rosenberg, D., & Sass, J. (2009). Dosed without Prescription: Preventing Pharmaceutical.Natural Resources Defense Council (NRDC),Inc.‏https://www.nrdc.org/sites/default/files/hea_10012001a.pdf

Zargarzadeh, A. H., Tavakoli, N., & Hassanzadeh, A. (2005). A survey on the extent of medication storage and wastage in urban Iranian households. Clinical therapeutics, 27(6), 970-978.‏ https://doi.org/10.1016/S0149-2918(05)00122-0

Zeilinger, J., Steger‐Hartmann, T., Maser, E., Goller, S., Vonk, R., & Länge, R. (2009). Effects of synthetic gestagens on fish reproduction.Environmental toxicology and chemistry,28(12),2663-2670.‏ https://doi.org/10.1897/08-485.1

Downloads

Published

2025-01-05

How to Cite

Ezaldin Hassan, N., & Sonia Khalil. (2025). KNOWLEDGE, ATTITUDES, AND PRACTICES RELATED TO THE DISPOSAL OF EXPIRED AND UNUSED MEDICATIONS IN HOUSEHOLD IN DUHOK CITY, KURDISTAN REGION, IRAQ. Science Journal of University of Zakho, 13(1), 25–32. https://doi.org/10.25271/sjuoz.2025.13.1.1388

Issue

Section

Science Journal of University of Zakho