Pharmacy offices, actors in the cluster and inadequate disposal of medications: A Systematic Review

Abstract

Objective: To analyze, through a systematic review of the literature, the association between pharmacy-adjacent medical offices and the accumulation and improper disposal of medicines, as well as the implications of this phenomenon for public health and the environment.

Materials and methods: A structured search was conducted in PubMed for articles published in English and Spanish during the last ten years, following the PRISMA 2020 guidelines and applying the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Eligible studies included original research and reviews addressing practices of medication storage and disposal in households, the role of pharmacy offices in prescription patterns and drug accumulation, and the social, health, and environmental effects derived from these practices.

Results: Out of 16 studies initially identified, 14 met the inclusion criteria. The findings were grouped into three main themes: (1) disposal practices of expired medications in households and health services, predominantly through household waste and sewage systems; (2) the influence of pharmacy-adjacent medical offices on overprescription and the growth of household medicine cabinets, linked to labor and market incentives; and (3) the socio-environmental consequences of improper disposal, including bacterial resistance, household poisonings, and contamination of water and soil.

Conclusions: The review highlights that pharmaceutical marketing models and the working conditions of physicians in pharmacy-adjacent medical offices indirectly contribute to the accumulation and inadequate disposal of medicines. This scenario constitutes an emerging issue of public health and environmental justice. Priority areas identified include the promotion of eco-pharmacovigilance programs, the development of specific regulations for the final disposal of medicines, and the implementation of health education campaigns aimed at responsible use and the donation of medicines with remaining shelf life.