Amount, type and storage of medicines in households – A survey for medicine users

Abstract

With increasing medicine use, more medicines are being stored at home, yet the understanding of household medicines remains limited. This study aimed to assess the amount, type and storage practices of medicines in households. It also explored the reasons for unnecessary or expired medicines, as well as the factors associated with the presence of expired medicines in a household. The online survey was conducted among loyal customers of University Pharmacy in June 2023 (n = 5004). The data were analysed for frequencies and percentages, and binary logistic regression was used to examine the association between background factors and expired medicines in households. On average, one household had 13.9 active, 2.8 unnecessary and 2.2 expired medicine packs. Medicines were typically stored in the kitchen (67.0%) and in cabinets (58.7%), and 40% were to be stored safely. The main reasons for unnecessary or expired medicines were improved health (39.2%), medication changes (31.9%) and oversized packs (28.0%). Households returning medicines biennially (odds ratio (OR): 2.85; 95% confidence interval (CI): 2.13–3.82) and those with many active medicines (OR: 2.14; 95% CI: 1.79–2.54) had expired medicines more often. The study showed that households had many medicines, highlighting the need for better storage and optimized packaging to improve safety, reduce waste and enhance rational pharmacotherapy.

Plain English Summary.

In this study, 5004 Finnish medicine users answered an online questionnaire about medicines in households. The results show that households store many medicines, mostly in use. The main reasons for unnecessary and expired medicines were improved health, medication changes or oversized packages. Medicines were typically stored in the kitchen cupboard, and less than half stored medicines safely. Households returning medicines every 2 years or using many medicines are more likely to have expired ones. The findings highlight the need for better storage practices and optimized packaging sizes to enhance safety, reduce waste, and support rational pharmacotherapy.

1. INTRODUCTION

Globally, the use of medicines has increased significantly, ¹ resulting in more medicines being stored in households. However, a significant proportion of medicines remain unused, have expired and eventually become waste. ² According to EU directive 2004/27/EC, unused and expired medicines are pharmaceutical waste that must be disposed of separate from other waste. Nevertheless, studies from different countries indicate that many people keep unnecessary and expired medicines in their households. ³ , ⁴ , ⁵ , ⁶ , ⁷ , ⁸ For instance, according to a Serbian study, nearly half of households kept medicines that had expired. ⁶ Likewise, in a US study, the ratio of unused to medicines in use in households was 2:3. ⁹ Rational pharmacotherapy means using medicines that are safe, effective, of high quality, cost‐effective and equal. ¹⁰ It ensures that the right patient receives the right medicines, at the right time, for the right condition and at the right dose. For the successful implementation of rational pharmacotherapy, households have a responsibility to use and discontinue using medication appropriately, independently or in collaboration with a physician or other healthcare professionals. ¹¹ Proper and safe storage and the proper disposal of unused medicines are also part of rational pharmacotherapy.

Unnecessary and expired medicines in households are problematic in several ways. Generally speaking, society makes a significant contribution to citizens' medicine costs as a third‐party payer by reimbursing a portion of these costs. ¹ , ¹² , ¹³ Consequently, unnecessary and expired medicines result in economic losses for both society and medicine users. ¹⁴ , ¹⁵ , ¹⁶ In addition, unnecessary and expired medicines represent resource wastage from an environmental perspective. ¹⁷ Moreover, the accumulation of unnecessary and expired medicines in households poses a risk to medication safety, especially if there are children or pets at home. ¹⁸ , ¹⁹ Keeping unnecessary and expired medicines increases the likelihood of inappropriate self‐medication or the sharing of medicines with relatives or friends, which goes against the principles of rational pharmacotherapy. ¹¹

In households, medicines are typically stored in the kitchen, bathroom or bedroom. ³ , ⁵ , ⁹ , ²⁰ , ²¹ , ²² , ²³ In one study focusing on households with children, only 3% of homes stored all medicines in secure locations, and more than half had at least one medicine within a child's reach. ¹⁸ According to previous studies, factors influencing the presence of unnecessary or expired medicines in households include the respondent's level of education, age and household size. ⁶ , ²⁴ , ²⁵ Also, the presence of children under 12 years old in the household means more expired medicines are kept. ⁶

The presence of unnecessary and expired medicines results from various factors, such as large medicine pack sizes, improvement in the condition treated or symptoms and the short shelf life of the product after the pack has been opened. ⁹ , ¹⁵ , ²⁶ , ²⁷ , ²⁸ Preventing medicine wastage completely is not feasible. ² However, reducing the quantities of unnecessary and expired medicines would improve rational pharmacotherapy by enhancing medication safety. It would also converse benefit the environment and result in savings on medicine costs for both society and those who use medicines. Reducing the wastage of medicines is the goal of governments in many countries, including Finland. ²⁹ , ³⁰

The essence of this study is rooted in the need for comprehensive research into household medicines in Finland, both those in active use and those that remain unused. This study specifically aims to determine the amount, type and storage of medicines that are currently in use, unnecessary or have expired in households. It also examines the association between background factors and the presence of expired medicines and the reasons for unnecessary or expired medicines in households. While prior research, such as that conducted by Louhisalmi et al. (2024), has investigated the issue of unused and expired medicines returned to pharmacies, a specific focus on household medicines is clearly lacking. Therefore, this study seeks to fill this research void, with the goal of identifying effective strategies for the management of household medicines. In addition to reducing pharmaceutical waste, the potential impact of this study could lead to improved practices in medication management at the household level, thereby contributing to safer and more rational pharmacotherapy, as well as enhancing public health.

2. METHODS

2.1. Data collection

An online survey was conducted in June 2023. The target population was medicine users, people who are most likely to be customers of the community pharmacy. An invitation and link to the questionnaire were sent as an email newsletter to 247 000 legal‐age loyal customers of University Pharmacy who had agreed to receive electronic marketing messages. University Pharmacy is a pharmacy chain owned by the University of Helsinki. It has 17 pharmacy branches across Finland, a nationwide online pharmacy and a medicine information centre. University pharmacy dispenses 10% of all prescriptions in Finland and has in total over 900 000 loyal customers. ³¹ It has similar duties to private pharmacies, but under the Medicines Act, it is also tasked with manufacturing compounded medicines, training pharmacy students and researching pharmaceutical services. ³² Loyal customers of University Pharmacy were selected as the study population as this made it possible to reach a large sample of medicine users. The link to the questionnaire was open for 2 weeks: from 13 June to 27 June 2023. No reminder email was sent about the study, but University Pharmacy posted information about the study on X (formerly Twitter) on 14 June 2023.

2.2. Questionnaire

The questionnaire comprised a covering text and six question sections (Appendix 1) encompassing a total of 41 questions. The six sections were as follows: (1) background information on the respondent, (2) health and use of medicines, (3) household medicines, (4) the storage of medicines, (5) practices regarding medicines and (6) proper medicine disposal practices. This study reports the finding from two sections of the questionnaire, namely those concerning household medicines (Section 3) and the storage of medicines (Section 4).

In Section 3, household medicines were placed into three different categories: medicines in use, unnecessary medicines and expired medicines. The categories were defined in the questionnaire as follows: Medicines in use refers to any medicine that is taken either regularly or as needed. Unnecessary medicines refer to any medicine that has been left unused or is unlikely to be used again but has not passed its expiry date. A medicine that has expired is one whose shelf life has been exceeded. For each defined category, respondents were asked for the number of packs of prescription medicines and the number of packs of over‐the‐counter medicines separately using a dropdown menu (1–100) (Appendix 1). Respondents were also asked to identify unnecessary or expired medicines in household using structured questions, with 34 response options and space for an open answer under “other medicines”. Reasons for unnecessary or expired medicines were explored using the question, “Why are some of your household medicines unnecessary or have expired?”, with a list of 12 structured response options and space for an open answer for the option “other”. If the respondent selected at least one of the following options in the previous question — “the condition/symptom improved”, “switched to another medicine”, “the medicine caused side‐effects”, “the medicine was not sufficiently effective” or “taking the medicine was uncomfortable” — they were then asked an additional question for each option: “Who made the decision to discontinue the medicine?”, with five structured response options and open space for an answer “someone else”. Except for questions about the number of medicines, it was possible to select multiple options in the section's questions.

In Section 4, the storage of medicines in the household was investigated with the questions, “In which room in your household are medicines stored?” and “In what place in your household are medicines stored?”, with several structured response options and open space for “other” responses, from which multiple options could be selected (Appendix 1). Section 4 also included a structured question on the safe storage of medicines, asking, “Is the place where the medicines are stored locked or otherwise secured so that children or/and pets cannot have access to the medicines?”, with three response options. If respondents stored expired medicines separate from other medicines, the same questions were asked regarding the storage of expired medicines.

In this study, background information was initially requested in Section 1 of the questionnaire (Appendix 1). Structured questions were used to ask the respondent's year of birth, gender, region and area of residence, highest level of education, education in the health sector, health sector education of other household members, household's disposable income and the respondent's state of health and long‐term illnesses. Open‐ended questions were used for household size. In addition, the frequency of returning household medicines to a pharmacy and the respondent's pharmaco‐environmental attitude were asked for background information in sections 5 and 6 (Appendix 1). The frequency of returns was investigated with the question, “How often do you return unnecessary or expired medicines to the pharmacy in your household?” with six structured response options. The respondent's environmental attitude towards medicines was examined using five Likert scale questions with response options: 1 = completely agree, 2 = somewhat agree, 3 = somewhat disagree, 4 = completely disagree, and 5 = I do not know.

The survey was conducted using the Webropol online survey tool. The questionnaire was designed for this study based on the objectives of the study and previous studies. ¹⁵ , ²⁸ , ³³ , ³⁴ , ³⁵ , ³⁶ The questionnaire was piloted by research colleagues (n = 9) and lay people (n = 9) in May 2023. Based on the pilot, the structure of the questionnaire was slightly modified, some questions were combined, and definitions of medicines in use, unnecessary medicines and expired medicines were clarified. The questionnaire was then re‐piloted (n = 10) in June 2023.

2.3. Data analysis

The data were examined through descriptive analysis to estimate frequencies and percentages as well as means and standard deviations. Binary logistic regression was used to examine the association between the presence of expired medicines in households and background factors. For analysis purposes, the continuous variables year of birth and size of household were transformed into the categorical variables age in years and type of household. In addition, the variables healthcare education and healthcare education of household members were combined into the variable healthcare education in the household. Classes with too few respondents were combined with the class responded to most frequently. The presence of expired medicines in the household (yes = 1, no = 0) was a dependent variable in the model, with independent variables being: gender (woman, man, other), age in years (18–34 years, 35–59 years, 60–74 years, 75–79 years, 80 years or more), region of residence (Southern Finland, Western and Inland Finland, Eastern Finland, Northern Finland, Lapland), area of residence (city centre or suburb of Helsinki metropolitan area, other city centre or suburb, town centre or village or urban area, sparsely populated area or countryside), state of health (good, quite good, mediocre, quite poor, poor), long‐term illness (yes/no), pharmaco‐environmental attitude (positive, active, moderate, sceptical, undecided), education (elementary school, upper secondary school, tertiary education), healthcare education in household (yes/no), type of household (single household, other adult household, household with children), household income (≤ €2000, €2001–3000, €3001–4000, €4001–5000, ≥€5000, other), number of medicines in use in the household (1–10, 11–20, over 20, none) and return frequency of medicines to the pharmacy (every 1–3 months, every 6 months, once a year, every 2 years, less frequently, never). Correlations between the independent variables were examined using Spearman's rank correlation coefficient. Univariate logistic regressions were performed for each independent variable separately to examine the unadjusted association of the independent variables with the dependent variable. Statistically significant independent variables were included in the final model (p < 0.05) by systematically removing the independent variable with the highest, non‐significant p‐value one by one from the model. Results were reported as odds ratios (ORs) and 95% confidence intervals (CIs).

The variable describing pharmaco‐environmental attitude was created using latent class analysis (LCA), where responses to five questions relating to medicines and the environmental (Question 38; Appendix 1) were summarized into a single categorical variable with aiming of capturing latent subgroups of respondents exhibiting a specific response pattern on Likert scale questions. Models with one to five classes were fitted to the data (Appendix 2). Alternative models were compared using Akaike's information criterion (AIC) and Bayesian Information Criteria (BIC), with smaller values indicating a better fit to the data. In addition, the interpretability of the model was used as one of the selection criteria. All data analyses were conducted using IBM SPSS Statistics for Windows, version 29.0.0 (SPSS, Inc, Chicago, IL, USA).

2.4. Ethical statement

The study was conducted in accordance with the Basic & Clinical Pharmacology & Toxicology policy for experimental and clinical studies. ³⁷ The study design and the research process were in line with Finland's national ethical guidelines for research in non‐medical human sciences. ³⁸ The type of human sciences research conducted in this study does not necessitate an ethical review in Finland. Participation in the study was voluntary, and respondents were asked to give their informed consent to participate at the beginning of the questionnaire (Appendix 1).

3. RESULTS

In total, 5030 respondents started to fill in the questionnaire, 26 of whom did not give their consent to use their answers for research purposes, bringing the final total to 5004 respondents. Most of the respondents were female (87.1%; Table 1) and had long‐term illnesses (85.3%). The mean age of the study participants was 61 (SD 13.9; range 18–95) years. Approximately two‐thirds lived in households with other individuals (65.2%).

TABLE 1.

Characteristics of the study respondents (n = 5004).

	Respondent % (n)
Gender
Female	87.1 (4358)
Male	11.6 (578)
Other	0.4 (22)
Prefer not to answer	0.9 (46)
Age in years
18–34	6.1 (305)
35–59	33.1 (1658)
60–74	45.4 (2270)
75–79	10.8 (540)
≥ 80	4.6 (231)
State of health
Good	24.8 (1241)
Quite good	43.6 (2182)
Mediocre	26.4 (1320)
Quite poor	4.5 (223)
Poor	0.8 (38)
Long‐term illness
Yes	85.3 (4269)
No	14.7 (735)
Education
Elementary school	8.5 (424)
Upper secondary education	48.0 (2402)
Tertiary education	42.8 (2141)
Other	0.7 (37)
Healthcare education
Yes	23.5 (1176)
No	76.5 (3828)
Healthcare education of household members
Yes	26.2 (1312)
No	73.8 (3692)
Type of household
Single household	34.7 (1737)
Other adult household	38.3 (1919)
Household with children	26.9 (1348)
Region of residence
Southern Finland	53.5 (2676)
Southwestern Finland	13.2 (661)
Western and Inland Finland	16.2 (811)
Eastern Finland	7.8 (389)
Northern Finland	6.8 (338)
Lapland	2.6 (129)
Area of residence
Helsinki metropolitan area (Helsinki, Espoo, Vantaa, Kauniainen) city centre or suburb	38.1 (1907)
Other city centre or suburb	46.9 (2348)
Town centre, village, or urban area	7.7 (383)
Sparsely populated area or countryside	7.3 (366)
Household income (euros)
≤2000	21.4 (1071)
2001–3000	20.1 (1007)
3001–4000	16.7 (836)
4001–5000	12.4 (619)
>5000	12.9 (647)
Do not know how to answer	3.0 (151)
Prefer not to answer	13.4 (673)

3.1. Medicines in households

On average, each household had 13.9 medicine packs in use (8.2 prescription medicines (Rx) and 5.7 over‐the‐counter medicines (OTC)), 2.8 unnecessary medicine packs (1.6 Rx and 1.2 OTC) and 2.2 expired medicine packs (1.2 Rx and 1.0 OTC). Nearly all the households had at least one prescription medicine pack in use (97.1%; Table 2), and similarly, 94.4% of the households had at least one over‐the‐counter medicine in use.

TABLE 2.

Household medicines (n = 5004).

	Prescription % (n)	Over the counter % (n)	Total % (n)
Medicine packs in use
None	2.9 (147)	5.6 (280)	0.3 (13)
1–5	40.4 (2002)	61.5 (3076)	15.8 (792)
6–10	34.5 (1724)	21.4 (1069)	32.0 (1600)
> 10	22.2 (1111)	11.6 (579)	51.9 (2599)
Unnecessary medicine packs
None	53.8 (2690)	64.2 (3214)	42.7 (2138)
1–5	39.8 (1993)	31.8 (1590)	42.1 (2107)
6–10	5.0 (248)	2.9 (147)	10.2 (510)
> 10	1.4 (73)	1.1 (53)	5.0 (249)
Expired medicine packs
None	66.0 (3304)	69.6 (3482)	55.6 (2781)
1–5	29.5 (1478)	27.2 (1362)	33.0 (1651)
6–10	3.0 (150)	2.4 (119)	7.6 (382)
> 10	1.5 (72)	0.8 (41)	3.8 (190)

Almost half of the households (46.2%; Table 2) had at least one unnecessary prescription medicine packs and 34.0% had at least one expired prescription medicine packs. In the case of OTC medicines, 35.8% of households had at least one unnecessary medicine pack, and 30.4% of households had at least one expired medicine pack. If expired or unnecessary medicines were found in the household, they typical amounted 1 to 5 packages (Table 2). The most common unnecessary medicines were analgesics (41.4%; Appendix 3), medicines for skin diseases (18.1%), allergy medicines (18.0%) and heartburn medicines (16.6%). Analgesics were also the most common type of expired medicines found in households (42.7%; Appendix 3), followed by allergy medicines (20.6%), medicines for skin diseases (18.2%) and antibiotics (14.0%).

3.2. Storage of medicines in households

Medicines were typically stored in the kitchen (67.0%) or bedroom (24.7%; Table 3). The storage place was typically a cupboard (58.7%), drawer (32.4%) or medicine cabinet (27.9%). Forty percent of households kept medicines under lock or otherwise ensured that children or pets could not access them. Over half of the households (51.8%) stored expired medicines separate from other medicines, and about a tenth (9.6%) kept at least some expired medicines separate from other medicines. If household had expired medicines and stored them apart from another medicine (n = 1430), they were usually kept in the kitchen (43.4%) or hallway (17.4%). Cupboards were the most common storage place (50.3%) for expired medicines.

TABLE 3.

Storage of medicines in the household.

	All medicines % (n) a n = 5004	Expired medicines % (n) a n = 1430 b
Medicine storage room
Kitchen	67.0 (3354)	43.3 (621)
Bedroom	24.7 (1234)	12.6 (180)
Toilet	17.1 (857)	7.7 (110)
Bathroom	14.4 (721)	6.5 (93)
Hallway	9.5 (473)	17.4 (249)
Living room	6.1 (305)	3.4 (49)
Utility room	5.6 (282)	8.3 (119)
Wardrobe	5.0 (248)	5.2 (75)
Other	3.6 (182)	7.5 (107)
Medicine storage place
Cupboard	35.7 (2939)	50.3 (719)
Drawer	19.7 (1622)	27.6 (395)
Medicine cabinet	17.0 (1397)	8.7 (125)
Refrigerator	10.5 (861)	2.9 (41)
Shelf	10.0 (819)	12.3 (176)
Table	5.6 (465)	3.2 (46)
Other	1.6 (128)	10.3 (148)
Secure storage place c
Yes	40.0 (2000)	45.9 (657)
No	50.2 (2511)	48.5 (693)
Some stored in secured location	9.9 (493)	5.6 (80)

^a In questions about medicine storage room and medicine storage place, the respondents could choose more than one options.

^b Those who had expired medicines and stored them separate from other medicines answered the question.

^c Locked or otherwise ensured that children and/or pets could not have access to the medicine.

3.3. Reasons for unnecessary or expired medicines

The most common reason for having unnecessary or expired medicines in the household was improvement of the condition or symptom (39.2%; Table 4). Other common reasons included switching to another medicine (31.9%), having a medicine pack that was unnecessarily large (28.0%) and the limited shelf life of medicines once opened (27.4%). The decision to stop using the medicine was usually made by either the physician (47.9%) or the user of the medicine herself/himself (47.5%; Table 4).

TABLE 4.

Reasons why some household medicines have become unnecessary or have expired.

Reasons for unnecessary or expired medicines a	% (n) b n = 3083
Condition/symptom improved	39.2 (1210)
Switched to another medicine	31.9 (985)
Medicine pack unnecessarily large	28.0 (862)
Limited shelf life of medicine after opening	27.4 (846)
Medicine was bought as a precaution	24.3 (748)
Medicine caused side‐effects	22.7 (700)
Medicine sufficiently effective	10.8 (332)
User felt no need for the medicine	10.7 (330)
User of the medicine has moved away or died	4.8 (147)
Taking the medicine was uncomfortable	2.6 (79)
Other	3.4 (104)

Who decided to discontinue the medicine? c	(n = 4096)
Physician	47.9 (1964)
User of the medicine	47.5 (1946)
Nurse	2.2 (92)
Pharmacist	1.2 (48)
Someone else, who?	1.1 (46)

^a Question answered by those who had unnecessary or expired medicine packs.

^b The respondents could choose more than one option.

^c Those who selected any of the following options: “condition/symptom improved,” “switched to another medicine,” “medicine caused side‐effects,” “medicine not sufficiently effective,” or “taking the medicine was uncomfortable” from the question, “Reasons for unnecessary or expired medicines” answered this question.

3.4. Background factors associated with the presence of expired medicines

Returning medicines to a pharmacy every 2 years increased the odds of expired medicines being kept in households by 185% (OR: 2.85; 95% CI: 2.13–3.82; Table 5) when compared with a more frequent return rate of every 1–3 months. Having over 20 medicines in use was associated with a 114% increase in the odds of expired medicines being kept in households (OR: 2.14; 95% CI: 1.79–2.54) when compared with having 1–10 medicines in use. Furthermore, the odds of expired medicines being kept in households increased by 15% (95% CI: 1%–31%) if nobody in the household had any healthcare education. The odds were also greater in the case of a deterioration in the respondent's health, when compared with respondents whose health was reported as good. Correspondingly, older age resulted in a decrease in the odds. The level of the respondent's education also affected the presence of expired medicines: compared with elementary school education, upper secondary education increased the odds by 30% (95% CI: 4%–62%) and tertiary education increased them by 68% (95% CI: 35%–210%).

TABLE 5.

Logistic regression analysis of background factors associated with the presence of expired medicines in households (n = 5004). Results are reported as odds ratios (ORs) and 95% confidence intervals (CIs).

	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
Gender
Female	1.00
Male	1.02 (0.86–1.21)
Other or prefer not to answer	1.34 (0.83–2.16)
Age in years
18–34	1.00	1.00
35–59	0.93 (0.73–1.18)	0.83 (0.65–1.07)
60–74	0.54 (0.43–0.69)	0.53 (0.41–0.68)
75–79	0.50 (0.37–0.66)	0.50 (0.37–0.67)
≥ 80	0.59 (0.41–0.83)	0.58 (0.41–0.83)
Region of residence
Southern Finland	1.00
Southwestern Finland	1.07 (0.91–1.27)
Western and Inland Finland	1.03 (0.88–1.21)
Eastern Finland	0.89 (0.72–1.11)
Northern Finland	0.98 (0.78–1.23)
Lapland	0.90 (0.63–1.29)
Area of residence
Helsinki metropolitan area (Helsinki, Espoo, Vantaa, Kauniainen) city centre or suburb	1.00
Other city centre or suburb	1.02 (0.90–1.15)
Town centre, village, or urban area	1.01 (0.81–1.35)
Sparsely populated area or countryside	1.08 (0.86–1.35)
State of health
Good	1.00	1.00
Quite good	1.11 (0.99–1.28)	1.16 (0.10–1.34)
Mediocre	1.16 (0.99–1.36)	1.22 (1.03–1.44)
Quite poor	1.73 (1.30–2.30)	1.58 (1.16–2.14)
Poor	1.93 (1.01–3.72)	1.93 (0.97–3.85)
Long‐term illness
Yes	1.00
No	1.04 (0.89–1.22)
Pharmaco‐environmental attitude
Positive	1.00
Active	1.09 (0.93–1.26)
Moderate	0.89 (0.78–1.01)
Sceptical	1.51 (1.04–2.19)
Undecided	1.02 (0.73–1.41)
Education
Elementary school	1.00	1.00
Upper secondary education	1.44 (1.17–1.78)	1.30 (1.04–1.62)
Tertiary education	2.00 (1.62–2.47)	1.68 (1.35–2.10)
Healthcare education in household
Yes	1.00	1.00
No	1.12 (0.99–1.27)	1.15 (1.01–1.31)
Type of household
Single household	1.00
Other adult household	1.10 (0.96–1.25)
Household with children	1.27 (1.01–1.46)
Household income (euros)
≤2000	1.00
2001–3000	1.06 (0.89–1.27)
3001–4000	0.99 (0.83–1.19)
4001–5000	1.16 (0.95–1.42)
>5000	1.46 (1.20–1.78)
Do not know or prefer not to answer	1.00 (0.83–1.20)
Number of medicines in use in the household
1–10	1.00	1.00
11–20	1.40 (1.23–1.58)	1.39 (1.22–1.59)
>20	2.27 (1.93–2.67)	2.14 (1.79–2.54)
none	0.72 (0.22–2.33)	0.93 (0.27–3.14)
Frequency of returning medicines to a pharmacy
Every 1–3 months	1.00	1.00
Every 6 months	1.76 (1.39–2.23)	1.77 (1.39–2.26)
Once a year	2.26 (1.79–2.85)	2.50 (1.97–3.18)
Every 2 years	2.62 (1.97–3.47)	2.85 (2.13–3.82)
Less frequently	1.22 (0.94–1.57)	1.47 (1.13–1.92)
Never	1.28 (0.79–2.06)	1.38 (0.84–2.27)

4. DISCUSSION

4.1. Amount and type of medicines in the household

In this study, households had an average of 14 medicine packs in use, significantly more than the number of unused medicine packs, which averaged three for unnecessary and two for expired. This differs from estimates presented elsewhere, where the ratio of unused medicines to medicines in use has been 2:3. ⁹ , ²² This discrepancy is probably explained by the fact that this study was specifically targeted at people taking medicines, which resulted in a significant number of medicine packs being used. This was also found in another study where people with chronic heart failure had significantly more medicines in use compared to unused medicines. ⁴ Moreover, it is known that 90% of Finns report returning unnecessary or expired medicines to pharmacies, ³⁹ which aligns with the finding that households have more medicines in use than they have unnecessary or expired medicines.

According to this study, both unnecessary and expired medicines in households were often those intended for pain and allergies, which is consistent with previous findings. ⁶ , ⁴⁰ For these symptoms, medicines are usually used when needed, which have previously been identified as one of the factors that may increase medicine waste. ¹⁵ Analgesics such as paracetamol and ibuprofen are widely used in Finland, which explains their high prevalence in households. ⁴¹ In addition, Finnish citizens are advised to keep some analgesics and allergy medicines at home as a home emergency supply kit. ⁴² Keeping the number of medicines at home closer to the optimum could reduce the amount of wastage, which would also improve medication safety.

Compared to the results of a study on medicines returned from households to Finnish community pharmacies, ¹⁵ households in the current study had relatively more unnecessary and expired medicines for skin diseases and antibiotics. These include topical ointments and gels that have limited shelf life, and determining the optimal dose can be challenging, ⁴³ which may partly explain their higher proportion among unnecessary and expired medicines. Antibiotics should be prescribed and used with great caution, as antimicrobial resistance is a global public health threat to humanity. ⁴⁴ The prevalence of unused and expired antibiotics in households is a cause for concern, especially in view of the previous study, which showed that relatively few antibiotics are returned to community pharmacies for proper disposal, ¹⁵ suggesting irrational use of antibiotics. More attention should be given to the prescription and proper guidance of antibiotics use by both by physicians and pharmacists.

4.2. Storage of medicines

The typical storage places for medicines found in this study — kitchen, bedroom and toilet/bathroom — are in line with the literature. ⁹ , ²¹ , ²² , ²³ Faisal et al. found that the choice of medicine storage place was based on how well it helps the user to remember to take the medicine. In this case, particularly for regularly used medicines, it is natural to store medicines in places where other routine daily activities occur, such as eating and morning or evening routines. Another perspective on the choice of storage place was the preservation of the medicine user's privacy, ⁴⁵ which could partly explain why medicines are kept in the bedroom, a space that is normally private for its users. Privacy is also enhanced by keeping medicines out of sight, for example in a cupboard or drawer, as both this study and the literature show people do. ⁴⁶

However, as previously found, ⁵ , ⁶ , ¹⁸ , ⁴⁶ a significant number of respondents (around half of them) store their medicines carelessly, without ensuring that they are stored in a locked place or somehow ensure that children or pets are unable access them. Under half do not kept expired medicines separate from other medicines, which increases the risk that expired medicines may be used, although studies have reported that the majority of users check the expiry date on their medicine before using it. ³⁴ , ⁴⁷ Rational pharmacotherapy requires medicines to be used as directed. ¹¹ Therefore, it is advisable to store them in a way that helps users to remember to take them, which often means keeping them visible. On the other hand, it is crucial for safety to ensure that children, pets or other persons cannot access medicines. Storing them in a locked place is the safest option but may make using the medicines more cumbersome. Each household should consider its resident structure when deciding how to store medicines. In addition to written instructions on the packaging, which urge keeping medicines out of the reach of children, ⁴⁸ , ⁴⁹ pharmaceutical counselling should include verbal guidance from healthcare professionals on the proper and safe storage of medicines to ensure rational medicine management.

4.3. Reasons for unnecessary or expired medicines

The results of this study on the reasons for unnecessary or expired medicines are similar to the findings of the previous study on medicines returned to Finnish community pharmacies ¹⁵ and elsewhere in the literature. ⁹ , ³⁴ , ⁴⁰ , ⁴⁶ , ⁵⁰ The present results further confirm that large pack sizes contribute significantly to medicine waste. As discussed elsewhere, ¹⁵ rationalizing of the price and reimbursement system to encourage the purchase of a quantity of medicine that is commensurate with need would promote rational pharmacotherapy, improve medicine safety and ease the burden on the environment.

Rational pharmacotherapy requires that the decision to discontinue using a medicine should be made together with a physician. ¹¹ However, the results of this study show that this is not the case, with around half of respondents making the decision to stop independently. Although Finns consider health professionals to be trustworthy, ⁵¹ continuity of care in non‐urgent physician visits is low. ⁵² In practice, this means that patients rarely meet the same physician again, which makes it difficult to monitor medicine treatment and to make the decision to discontinue medication together with a physician, for example when the medicine causes side effects, it is not sufficiently effective, or taking the medicine is uncomfortable. Improved continuity of care, for instance, through a Personal Doctor 2.0 model, ⁵³ would promote rational pharmacotherapy by enhancing the quality and continuity of care and medicine user's adherence to their treatment, which would contribute to reducing the amount of pharmaceutical waste generated and the risks associated with unnecessary medicines.

4.4. Presence of expired medicines

This study found that the quantity of medicines in use and the frequency of returning unnecessary or expired medicines to the community pharmacy were associated with the presence of expired medicines in the household. The results are consistent: The less frequently medicines are returned to the pharmacy, the more likely it is that the household will accumulate at least some medicines, especially if there are many medicines in use. However, these factors alone do not fully explain the presence of expired medicines in households. Factors such as the respondent's age, level of education and health status also influence this, as noted in the literature. ⁶ , ²⁴ , ²⁵ The higher likelihood of expired medicines being present in young and middle‐aged people's households may be partly explained by their less frequent use of medicines, ⁵⁴ which in turn leads to less frequent pharmacy visits, making the return of expired medicines less routine. It is somewhat surprising that a higher level of education was associated with greater presence of expired medicines in the household. However, even though the more educated are generally healthier than the less well educated, many have access to occupational health services or private health insurance, which allows them to obtain prescriptions easily and quickly, for example instantly via online chat services with a physician. ⁵¹ , ⁵⁵ This system has been identified as leading to the overtreatment of healthy individuals, which in turn can result in unnecessary medicines that are more likely to go unused. ⁵⁵ On the other hand, medicines may go unused due to non‐adherence to treatment instructions, which is more common among individuals with poor health literacy, a factor linked to poor health outcomes. ⁵⁶ , ⁵⁷

Previous findings have indicated that environmental attitudes impact medicine disposal practices. ³⁹ However, unlike previous reports, ⁶ , ²⁵ the current study did not find any statistically significant association between the presence in the household of expired medicines and environmental attitudes and the respondent's long‐term illness or household size.

4.5. Utilization of the results

This study presented comprehensive information on the amount, type and storage of medicines in Finnish households, as well as the reasons for unused medicines and factors associated with presence of expired medicines in households. The results of this study provide additional information for authorities and community pharmacies' communications related to medicines and the environment, which have so far focused more on the proper disposal of medicines. By expanding public information to also cover the correct and safe storage of medicines, the risks associated with storing unnecessary and expired medicines in households would be illustrated. At the same time, encouraging the public to return unused household medicines to pharmacies regularly would promote safe and rational medicine management for the public.

To gain a deeper understanding in the future, it would be beneficial to further investigate the factors that influence the expired medicine management and proper disposal practices at home.

Training based on the research findings should also be provided to physicians and pharmacy professionals. By understanding why pharmaceutical waste is generated and how people store medicines at home, the healthcare professionals can focus on the right aspects to promote rational medicine management in prescribing, dispensing and medication counselling, which would reduce the amount of pharmaceutical waste produced. Sustainable pharmacotherapy and its principles should be integrated into the basic education of all medical professionals and pharmacists.

4.6. Strengths and limitations

The questions used in the study were not validated; instead, they were developed based on the prior literature ¹⁵ , ²⁸ , ³³ , ³⁴ , ³⁵ , ³⁶ and the expertise of the researchers. However, the comprehensibility and clarity of the questionnaire were tested during pilot test with both researchers experienced in conducting surveys and laypersons. Additionally, after making revisions, the survey was piloted again. These measures enhance the reliability of the questionnaire. This survey was based on self‐reporting by respondents, which may affect reliability of the results. It is also possible that some respondents may have completed the survey entirely from memory, even though they were instructed to complete it at home, where medicine packs would be close at hand, and information about medicines could be checked.

Despite the relatively long questionnaire, the total number of respondents was over 5000, which is the strength of the study. The study was thus effectively in reaching medicine users. However, the sample is nonetheless selective, as it is likely that those who responded to the survey invitation were medicine users with a strong interest in environmental issues related to pharmaceuticals and appropriate medicine use in general. Conducting the survey electronically may have affected the selection of respondents. It excludes those who do not use the internet or electronic devices, but their share of the Finnish population is not very high. ⁵⁸ Typically, in Finnish online studies, highly educated people are more to respond actively. ³³ , ⁵⁹

There is no register of Finnish pharmacy customers or medicine users against which the study data could be compared. However, compared to citizens over 18 years of age who have the right to medicine cost reimbursement, women were significantly overrepresented in the respondent population. ⁵⁴ On the other hand, there is evidence that women usually take on a greater role than men in managing their household's healthcare. ⁶⁰ , ⁶¹ Women have also generally been more active than men in responding to Finnish surveys on medicines. ⁶² However, caution should be exercised when generalizing the study's results to all households that have medicines.

5. CONCLUSIONS

This study indicated that a considerable number of medicine packs are stored in Finnish households, predominantly consisting of medicines currently in use. Medicines are usually stored in kitchen cupboards, where about half of households store expired medicines alongside other medicines. Households that return medicines to the pharmacy every 2 years, as well as those with a high usage of medicines, are more likely to have expired medicines at home. Households have room for improvement, especially in the safe storage of medicines. Large pack sizes contribute to medicine wastage. Optimizing the pack sizes of medicines that are used as needed would reduce the number of unnecessary medicines and, consequently, the generation of pharmaceutical waste. Implementing rational pharmacotherapy, with particular attention to the safety of medical treatment, would enhance household medicine management practices and reduce the volume of medicine waste produced.

AUTHOR CONTRIBUTIONS

Mella Louhisalmi: Conceptualization; methodology; investigation; data curation; formal analysis; writing—original draft; writing—review and editing; visualization. Piia Lavikainen: Formal analysis; writing—review and editing. Kari Linden: Conceptualization; methodology; investigation; resources; writing—review and editing. Janne Martikainen: Conceptualization; methodology; investigation; writing—review and editing; supervision; resources; funding acquisition; project administration. Johanna Timonen: Conceptualization; methodology; investigation; writing—review and editing; supervision; resources; funding acquisition; project administration.

Supporting information

Data S1. Supplementary Information.

Louhisalmi M, Lavikainen P, Linden K, Martikainen J, Timonen J. Amount, type and storage of medicines in households – A survey for medicine users. Basic Clin Pharmacol Toxicol. 2025;136(1):e14104. doi: 10.1111/bcpt.14104

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.