Pharmaceutical Waste Disposal: A Cross‐Sectional Survey of Disposal Practices and Awareness in Sefwi Wiawso Municipality, Ghana

ABSTRACT

Background and Aims

The rising global demand for medication has intensified concerns about improper pharmaceutical waste disposal in Ghana. Although disposal laws exist, enforcement is weak. While some Ghanaian regions report poor disposal practices, the Western North remains unstudied. Sefwi Wiawso Municipal (SWM), a rapidly growing area with numerous health facilities, pharmacies, and OTCMs, lacks data on how pharmaceutical waste is handled. This study assessed disposal practices and environmental awareness among households and pharmacies/OTCMs in SWM.

Methods

A survey was conducted among 230 households and 31 pharmacies/OCTMs. Using the Kobo toolbox and Kobo Collect application, pre‐validated structured questionnaires were administered randomly in major towns within the SWM.

Results

Of the household respondents, 77.39% reported the disposal of unused or expired drugs by placing them in the garbage before disposal at a dumpsite. Similarly, pharmacies reported that 45.16%, 41.94%, and 51.61% of solid, liquid, and semi‐solid pharmaceutical wastes, respectively, were disposed of in the same manner. The majority of household respondents (86.09%) were unaware that they could return unused or expired medications to pharmacies for proper disposal. The survey revealed unhealthy disposal practices in both homes and pharmacies in the SWM, with analgesics, antimalarials, and antibiotics being the most frequently disposed of drugs. A higher percentage of respondents lacked knowledge about the potential effects of these residues on nontargeted organisms in the environment.

Conclusion

This study underscores the pressing need for public education on the proper disposal of unused and expired medications to mitigate the potential adverse effects of pharmaceutical residues on the environment and non‐targeted organisms.

1. Introduction

Pharmaceuticals are biologically active substances with documented therapeutic benefits for animals and humans [1]. Factors such as demography, lifestyle changes, population growth, increase in chronic diseases, the availability of low‐cost generic treatments, and the ease of access to a large number of over‐the‐counter medications have all played a role in increased pharmaceutical consumption [2]. Though pharmaceuticals are essential for human health, they have become compounds of emerging concern globally [3]. The most common sources of environmental pharmaceutical residues are excreted matter and improperly discarded or expired pharmaceuticals [2]. Because they interact with living systems and produce a pharmacological response in non‐target organisms, their presence in the environment is challenging to manage [4].

Pharmaceutical products may be left unused due to a variety of factors, such as side effects, dosage adjustments, improved medical conditions, promotional practices employed by manufacturers, physician prescribing protocols, or dispensing practices, and as a result, would have to be disposed of [5, 6]. According to a study conducted in Ghana, more than half of the respondents (59%) completed their medication, and the remaining respondents stopped taking medications when they thought they felt better [5]. A study in New Zealand sought to understand why people have leftover medicines and to explore their views about possible disposal options. Results showed that 62% of homes had leftover medications, most commonly due to “medical condition improved,” “change in treatment,” “excess supplied,” “passed expiry date,” or “side effects of medication” [7]. Also, respondents from Malaysia admitted that they had unused medicines because they stopped taking medicines when they felt better (76.9%), their doctor changed their treatment (50.3%), they experienced unwanted side effects (49%), they did not take the medicines as instructed/prescribed (47.2%), or they did not feel better after taking the medicines (46%) [5]. Thus, unused medications may include those that have deteriorated, have been discontinued for use, have expired, or are not intended for future use [8]. According to available data, more than half of all medications are inappropriately prescribed and sold, resulting in unnecessary storage and disposal, and hence endangering the environment [9].

A recent study has shown that the general public needs to gain more knowledge regarding the proper disposal of unwanted and expired pharmaceuticals [6] and the threats they pose to water supply and the general environment [8]. The presence of discarded medicines in waterways, mainly drinking water, is a serious and complex issue that has attracted the interest of the public, lawmakers, and regulators [10]. Pharmaceuticals could enter the soil and aquatic environments through wastewater effluents, landfill leachates, industrial effluents, aquaculture, and animal feedlots [2]. Antibiotics in water may cause antibiotic resistance and, in the long run, possible genetic effects on humans and marine life [11]. Ethinyl estradiol, the active component of a common oral contraceptive, interferes with the development of sexuality and feminization in fish [12]. Furthermore, diclofenac, a non‐steroidal anti‐inflammatory drug, has been shown to cause kidney damage in birds such as vultures [13]. The environmental consequences of improper medication disposal are expected to be more significant in low‐ and middle‐income countries [5]. The need for well‐defined protocols for properly disposing of pharmaceuticals is prevalent in such contexts. This is especially true in countries like Ghana, where deficiencies in waste management infrastructure exacerbate the problems associated with this issue.

The improper disposal of unused and expired medications poses significant environmental and public health challenges worldwide. In the United States, for instance, pharmaceuticals such as acetaminophen, verapamil, and estradiol have been detected in waterways, highlighting the consequences of inadequate disposal practices. Similarly, in New Zealand, a study revealed that over 35% of respondents considered it acceptable to flush unused medicines down the toilet, while more than 21% believed rinsing them down the kitchen sink was appropriate [14]. These practices are not isolated; in Lagos, Nigeria, a study found that 62.4% of respondents disposed of pharmaceutical waste without any modification, while only 17.0% crushed it, 8.6% diluted it with water, and 22.1% were unsure of how to proceed [15]. Further compounding the issue, research in Sunyani, Ghana, revealed that most hospitals, pharmacies, over‐the‐counter medication shops (OTCMs), and households lacked formal regulations for disposing of unused and expired medicines [16].

Globally, the absence of standardized disposal systems exacerbates the problem. However, some regions have implemented effective strategies to address pharmaceutical waste. For example, countries in the European Union have established take‐back programs and implemented strict regulations for drug disposal, which have significantly reduced environmental contamination. Similarly, Australia's National Return and Disposal of Unwanted Medicines (RUM) program has successfully collected and incinerated thousands of tons of pharmaceutical waste, setting a benchmark for other nations. These examples underscore the importance of well‐run disposal systems and collection programs, which not only ensure public safety but also safeguard the natural environment [14]. By examining these global practices, this study aims to identify best practices and inform the development of more effective pharmaceutical waste management strategies.

Despite the significant environmental risks posed by improper pharmaceutical waste disposal, research on this issue has primarily focused on major cities in Ghana, such as Accra, Sunyani, and Kumasi [16]. This urban‐centric focus has left a critical gap in understanding pharmaceutical waste management practices in smaller municipalities and rural areas. To address this gap, this study investigates the pharmaceutical waste disposal practices of households, pharmacies, and OTCMs, as well as their awareness of the environmental impacts of improper disposal. The study is conducted in the Sefwi Wiawso Municipality (SWM), located in the Western North region of Ghana, to expand the evidence base and inform more inclusive and effective waste management strategies across diverse geographic and demographic settings.

2. Materials and Methods

2.1. Study Setting

The survey was conducted in the SWM (Figure 1). The Municipality is one of the fastest‐growing assemblies in the Western North Region of Ghana. The Municipality has a population of 151,220 people, of which 63,539 and 87,681 live in urban and rural areas, respectively. The western north region, the SWM, has 470,614 people 6 years and older who are literate [17]. The most common method of solid waste disposal in the Municipality is a public dump in open space, which accounts for 71.0% of waste disposal [18]. Moreover, the Municipality has several health facilities, pharmacies, and over‐the‐counter medication stores that dispense medication daily. This makes the area a potential spot for improper pharmaceutical waste disposal and its attendant implications.

Figure 1.

Map of Sefwi Wiawso Municipality showing the distribution of areas where the survey was conducted.

2.2. Research Methods

This study adopted a descriptive research methodology to analyze the disposal practices of expired or unused drugs in the SWM. Data were collected through face‐to‐face interviews using structured questionnaires (Supporting Information S1: Tables S1 and S2), which were pre‐validated through expert review and a pilot study. The expert review ensured content validity, while the pilot study, conducted with a small sample of respondents, assessed clarity, reliability, and consistency. The questionnaires focused on respondents' demographic information, availability of unused medications, disposal patterns, and awareness of pharmaceutical residues as environmental pollutants. For participants not proficient in English, questions were verbally translated into the local dialect (Sefwi or Twi) to ensure comprehension.

A random sampling technique was employed, and data collection was facilitated using the Kobo Collect software (https://kf.kobotoolbox.org/). The study was conducted in April 2023 across five communities within the municipality: Asafo, Asawinso, Boako, Dwinase, and Wiawso.

2.3. Sample Size Estimation

A sample size of 230 households was estimated using Andrew Fisher's formula, based on a population of 151,220 [17]. The calculation assumed a 95% confidence level, a margin of error of ±2.81%, a standard deviation of 0.5, and a z‐score of 1.96. The study was conducted at Asafo, Asawinso, Boako, Dwinase, and Wiawso within the SWM in April 2023. A sample size of 230 was estimated from a population of 151,220 in the municipality based on the 2021 population and census data using Andrew Fisher's formula [19]. The formula is outlined as follows in (1);

$$\text{Sample size}=\frac{{(\mathrm{z}-\text{score})}^2\times \text{standard deviation}\times (1-\text{standard deviation})}{\left(\text{confidence level}\right)\mathrm{²}}$$ (1)

The population of the municipality was obtained from the Ghana Statistical Service data on the Population and Housing Census 2021 [17]. With a confidence level of 95%, the margin of error was determined as ±2.81% and a standard deviation of 0.5 was chosen with a z‐score of 1.96.

Additionally, 31 pharmacies and OTCMs were randomly selected to provide insights into their disposal practices.

2.4. Study Design and Data Collection

Household respondents were randomly selected, with one participant per household representing the unit. Pharmacies and OTCMs were visited randomly, and all approached establishments agreed to participate. Data collection involved face‐to‐face interviews, the Kobo Collect app, and, where preferred, printed questionnaires. The survey was divided into four sections: (1) background information, (2) disposal patterns, (3) types and frequency of medicine intake (e.g., painkillers, antibiotics, antihistamines), and (4) awareness of pharmaceutical residues as environmental pollutants. The questionnaire included both closed‐ and open‐ended questions to ensure comprehensive data collection.

2.5. Eligibility Criteria

Participation was voluntary, with eligibility limited to individuals aged 15 years or older who had unused or expired medicines within the past year and were residents of the municipality. For participants aged 15–18, parental or guardian consent was obtained. The questionnaire was administered in English or the local dialect, depending on the respondent's preference.

2.6. Data Processing and Analysis

Survey responses were exported from the Kobo Collect toolbox to Microsoft Excel and analyzed using SPSS version 27. Unanswered questions were treated as null and excluded from the analysis. Descriptive statistics, including frequencies and percentages, summarized demographic variables (age, gender, educational level, years of practice), and disposal patterns. Associations between categorical variables were assessed using chi‐square tests [9], and Spearman's rank‐order correlation coefficient was used to examine relationships between demographic characteristics and disposal practices or environmental awareness.

2.7. Ethical Considerations

The study received ethical approval from the Kwame Nkrumah University of Science and Technology's Ethics Committee for Research. Participants provided informed consent, with parental or guardian consent required for minors (aged 15–18). Confidentiality was ensured, with all data anonymized and used exclusively for research purposes. Results were presented in aggregate form to protect respondents' privacy.

3. Results

3.1. Socio‐Demographic Characteristics of Household and Pharmacy Respondents

There was a higher proportion of males, 57.83% and 58.06% for household and pharmacy/over–the–counter medication respondents, respectively. Most of the household respondents were between 18 and 30 years old (49.57%). Also, 45.16% of respondents from the pharmacy were between the ages of 18 and 30 years. Most of the household respondents had either completed the JSS/JHS or beyond. More OTCMs (21) than pharmacies (10) were visited in the SWM. In the pharmacies, 7 out of 10 pharmacy respondents, representing 70%, were Pharmacy Assistants. The socio‐demographic data for households and pharmacies in the SWM are presented in Table 1.

Table 1.

Sociodemographic data of household and pharmacy respondents in the Sefwi Wiawso Municipality.

	Number of mentions	Percentage (%)	Pearson chi‐square (p‐square)
Household category (N = 230)
Gender
Male	133	57.83	0.177
Female	97	42.17
Age (years)
18–30	114	49.57	0.441
31–45	92	40.00
Above 45	24	10.43
Educational level
No formal education	13	5.65	0.004
Primary	21	9.13
JSS/JHS	80	34.78
SSS/SHS	86	37.39
Tertiary	30	13.04
Pharmacy category (N = 31)
Gender
Male	18	58.06
Female	13	41.94
Age (years)
18–30	14	45.16
31–45	13	41.94
Above 45	4	12.90
Educational level
Primary	0	0
JSS/JHS	1	3.23
SSS/SHS	17	54.84
Tertiary	13	41.94
Position
Pharmacist	0	0
Pharmacy assistant	7	22.58
Technician	1	3.23
Pharmacy store manager	2	6.45
Over‐the‐counter drug seller	21	67.74

3.2. In‐Home Drug Use, Frequency, and Disposal of Unused and Expired Medications

A higher percentage of 76.96% of household individuals affirmed having medicines at home. Of the 230 respondents, 72.17% had analgesics, while 55.65% had antibiotics at home. About 50.87% of the respondents had leftover or unused prescription drugs at home. The prescription drugs most present at home were antimalarials (43.04%) and analgesics (34.78%), whereas the most non‐prescription drugs present at home were analgesics (41.74%) and antimalarials (36.52%). About 58.26% of the respondents disposed of prescription and non‐prescription drugs when they had no use, while 52.61% also disposed of herbal medicines. Drugs were also disposed of weekly (prescription and non‐prescription drugs, 5.22% and herbal medicines, 4.35%) and yearly (prescription and non‐prescription drugs, 8.26% and herbal medicines, 5.22%). About 77.39% of the household sample population disposed of their unused and expired medication in garbage cans and onward disposal at the dumpsites. Figure 2 shows households' disposal patterns for unused and expired medications within the SWM.

Figure 2.

Disposal patterns of unused and expired drugs by households in the Sefwi Wiawso Municipality.

3.3. Sales, Frequency, and Disposal of Unused and Expired Drugs in Pharmacies

The types of medicines sold to consumers in the SWM were ascertained. Of the 31 pharmacies and OTCMs, the most frequently sold drugs in the SWM were antimalarials (87.10%), analgesics (74.19%), and antibiotics (67.74%). The pharmacies and over‐the‐counter medicine shops reported that 45.16%, 41.94%, and 51.61% of solid, liquid, and semi‐solid pharmaceutical wastes were disposed of in garbage cans before disposal at the dumpsites. Figure 3 shows the disposal patterns for solid, liquid, and semi‐solid medications in a clustered chart within the SWM.

Figure 3.

Disposal patterns of the solid, liquid, and semi‐solid medications by pharmacies within the Sefwi Wiawso Municipality.

3.4. Environmental Awareness of Households on Pharmaceuticals Is an Environmental Concern

3.4.1. Relationship Between Demographic Characteristics of Households and Awareness of Environmental Concerns Associated With Pharmaceuticals

3.4.1.1. Relationship Between Gender and Environmental Awareness of Pharmaceuticals

A chi‐square test was conducted to establish the relationship between gender and awareness of environmental concerns, both categorical variables. The results of the chi‐square test, as shown in Table 1, revealed a p‐value of 0.177 (i.e., p < 0.05). Since the test statistic gives a p‐value greater than the α level (i.e., 0.05), the results suggest that the relationship between gender and awareness of environmental concern is statistically significant at the 0.05 α level.

3.4.1.2. Relationship Between Age and Environmental Awareness of Pharmaceuticals

A chi‐square was conducted on two categorical variables: Age (in categories, i.e., 18−30, 31−45, and above 45 years) and awareness of environmental concerns. The test, as indicated in Table 1, shows a p‐value of 0.441 (i.e., p < 0.001). Since the estimated p‐value is greater than the α level (i.e., 0.05), these results suggest a statistically significant relationship between the age of household and their awareness of environmental concerns with the disposal of pharmaceuticals.

3.4.1.3. Relationship Between Educational Level and Environmental Awareness of Pharmaceuticals

A chi‐square test was conducted to establish the relationship between the educational levels of households in the municipality and their awareness of the dangers associated with the disposal of unused and expired pharmaceutical products. The test result from Table 1 revealed a p‐value of 0.004 (i.e., p < 0.05). The test statistics show a p‐value less than the α level of 0.05, which indicates that there is a very weak association between educational levels and environmental awareness of pharmaceuticals.

3.4.2. Subjective Awareness of Environmental Concerns Associated With Pharmaceuticals

The literacy of households and pharmacies on issues of pharmaceutical disposal as an environmental concern was assessed. The results from the survey showed that about 52.61% and 77.42% of households and pharmacies, respectively, are aware that pollution of rivers and streams by unused and expired pharmaceutical products is an environmental concern. Also, about 68.70% and 93.55% of households and pharmacies are willing to pay to improve sewage treatment to prevent pollution of rivers and streams by pharmaceutical products. Additionally, the findings revealed that about 93.55% of the pharmacy respondents in the study area think Ghana needs a national medicines disposal scheme accessible to all pharmacies across the country.

The results further show that a large portion of households agree that taking leftover and expired medication back to drug dispensary shops or pharmacies for proper disposal at the present state is a burden (see Table 2). The narrative suggests that most households in the study area perceive sending unused and expired pharmaceutical products to pharmaceutical shops for proper disposal as inconvenient for their living arrangements. Additionally, the results indicate that about 21.7% of households agree that investments should be on environmental issues that concern only humans and not on ecological issues that negatively affect other species.

Table 2.

Descriptive statistics of households' awareness of the disposal of pharmaceuticals.

	N (%)	SA (%)	A (%)	NA/D (%)	D (%)	SD (%)	Median
Taking my leftover and expired medication back to drug dispensary shops or pharmacies for proper disposal would be a burden.	230	79 (34.3)	100 (43.5)	5 (2.2)	10 (4.3)	36 (15.7)	4.00
We should disburse money only on environmental challenges that impact human health, not on challenges that impact other species or the natural environment.	230	50 (21.7)	20 (8.7)	8 (3.5)	52 (22.6)	100 (43.5)	2.00
We should try to avoid all water contamination, even if we have no proof that a contaminant will distress humans or ecosystems.	230	164 (71.3)	41 (17.8)	5 (2.2)	6 (2.6)	14 (6.1)	5.00
If an environmental challenge does not impact my health or my property, I am not bothered.	230	32 (13.9)	13 (5.7)	10 (4.3)	24 (11.7)	148 (64.3)	1.00
Valid N (listwise)	230

Note: N = 230.

Abbreviations: A = agree, D = disagree, NA/D = neither agree or disagree, SA = strongly agree, SD = strongly disagree.

Conversely, many households in the study area agree that environmental investments should not only focus on issues that impact humans but should also include other species. The findings suggest that about one‐third of households are only concerned with environmental issues that only impact humans. Moreover, most pharmacy and over‐the‐counter workers disagree that investment should be made in environmental issues that affect human health, not on concerns that only affect other species or ecosystems (see Table 3). However, about 22.6% of the workers mentioned above strongly agree that investment should only be limited to issues that impact humans.

Table 3.

Descriptive statistics of pharmacies' awareness of the disposal of pharmaceuticals.

	N	SA (%)	A (%)	NA/D (%)	D (%)	SD (%)	Median
We should spend money only on environmental problems that affect human health, not on problems that only affect other species or ecosystems.	31	7 (22.6)	0 (0)	0 (0)	2 (6.5)	22 (71.0)	1.00
We should try to prevent all water pollution, even if we have no evidence that a pollutant will harm human or ecosystem health.	31	29 (93.5)	1 (3.2)	0 (0)	0 (0)	1 (3.2)	5.00
If an environmental problem does not affect my health or my property, I do not care about it.	31	2 (6.5)	1 (3.2)	2 (6.5)	2 (6.5)	24 (77.4)	1.00
Valid N (listwise)	31

Note: N = 31.

Abbreviations: A = agree, D = disagree, NA/D = neither agree or disagree, SA = strongly agree, SD = strongly disagree.

Moreover, the findings from the survey, as shown in Table 2, indicate that most households believe that Ghana's government, through its institutions, should try to avoid all water contamination, even if we have no proof that a contaminant will distress humans or ecosystems. The results from the survey of pharmacies also show that almost all the workers agree that efforts should be made to prevent all water pollution, even if we have no evidence that a pollutant will harm human or ecosystem health. The results indicate the priority both household and pharmacy workers place on water resources compared with other resources and species, as presented earlier. However, about 45 out of 230 households in the study area believe environmental issues are a concern only when they affect their lives and properties (see Table 2). The results from the pharmacies showed that a smaller portion of workers agree that environmental concerns are only when they impact individual health or property. Although a large portion of households and pharmacy workers are concerned with environmental issues even when they do not impact their health and property, the results are an indication that a portion of households and workers are self‐centered on environmental issues and are likely to manifest in the disposal of unused or expired drugs if they perceived it not to pose any threat to their health and properties.

4. Discussion

Because of the global increase in pharmaceutical use, there is a greater international awareness of the problem of unused pharmaceuticals in households and the harmful environmental and health effects of improper disposal [2]. Pharmaceutical waste management and disposal are currently receiving attention because improper disposal can contaminate the environment, pose a risk to water, air, agricultural products, and the food chain, and harm animals or livestock. As a result, studies on this topic have been conducted worldwide to find policy solutions [9].

The analysis reveals a moderate relationship between gender and awareness of environmental concerns related to the disposal of expired or unused drugs in the SWM, with a p‐value of 0.177 (see Table 1). While one gender appears more aware of the issue than the other, this finding requires careful interpretation. The observed differences may be attributed to variations in education, exposure to information about pharmaceuticals in the environment, or personal experiences and concerns related to environmental health. However, it is important to note that the relationship between gender and environmental awareness lacks clear justification and may be influenced by external factors such as societal roles or cultural norms. For instance, a study in Sunyani, Ghana, found no correlation between gender and improper disposal practices, suggesting that gender alone may not be a reliable predictor of environmental awareness [16].

In contrast, a stronger association was observed between age and awareness of environmental concerns, with a p‐value of 0.441 (see Table 1). This suggests significant differences in awareness across age groups, with older individuals potentially being more aware of the issue than younger individuals, or vice versa. This finding aligns with the notion that life experiences and accumulated knowledge may play a role in shaping environmental awareness. However, further research is needed to explore the underlying reasons for this association, as Amoabeng also reported no correlation between age and improper disposal practices in their study [16].

The study also examined the relationship between education and awareness of proper disposal practices. While it is often assumed that individuals with no formal education are more likely to have poor knowledge about unused and expired medication disposal, the findings in the SWM revealed no significant difference across educational levels (p‐value of 0.004, see Table 1). This result is consistent with studies such as Kahsay in Adigrat city, Ethiopia [14], and Rogowska and Zimmermann in Bandung city, Indonesia [5], which found that high education levels do not necessarily translate to greater awareness of the environmental impacts of improper medication disposal. These findings suggest that factors such as personal experiences, social influences, or access to targeted information campaigns may play a more critical role in shaping environmental awareness than formal education alone. Overall, the results highlight the complexity of factors influencing awareness of pharmaceutical waste disposal practices. While gender, age, and education provide some insights, they do not fully explain the variations observed.

Pharmacists are important in reducing medicine waste and educating the public about proper disposal. Community pharmacies and over‐the‐counter medication stores are the most accessible primary healthcare facilities to the general public. Community pharmacists' traditional roles are mostly business‐oriented, focusing on prescription, dispensing, selling over‐the‐counter medications, and running the pharmacy [20]. According to a study conducted in Ghana, a quasi‐governmental hospital has implemented a drug disposal program known as the Disposal of Unused Medicines program, while the other hospitals do not provide separate drug disposal programs. The general public admitted to keeping unwanted or expired drugs in their homes, and more than 75% admitted to disposing of medical waste in regular trash cans, which ended up in landfills or dumpsites [6]. According to the findings of a California unused medication collection program, more than half of over‐the‐counter medications were discarded unused, compared to 45% of prescription medications [9].

The majority of household respondents (76.96%) confirmed the presence of medicines at home, with analgesics (72.17%) and antibiotics (55.65%) dominating, which contradicts studies conducted in Harar, USA, and Nigeria for analgesics (62.7%, 15%, 18.6%), respectively [14]. The leftover medications at home may result from a patient getting well, not following prescription procedures, and having easy access to over‐the‐counter medicine. Other reasons included a doctor's change in medication, no therapeutic effects, changes in the prescription, experiencing side effects, and switching to herbal remedies. According to a study conducted in Ghana, more than half of the respondents (59%) finished their medication, and the remaining respondents stopped taking medications when they thought they felt better [5]. The prospective effect of increased use of these medications within the SWM is the likely improper disposal of their unused portions.

In this study, the most commonly used disposal practice in households and pharmacies in the SWM is throwing unused and expired medications in garbage cans and further depositing them at dumpsites and landfills (see Figures 2 and 3). Similarly, in Adigrat city of Northern Ethiopia, the most preferred disposal practice for unused medicines was throwing them in garbage bins [14]. A study in India also reported that the most common method of disposing of the unused or expired medicines was throwing the medicines in dustbins (household garbage), where no system exists for unused medication collection. In a study in Kabul, the majority of survey respondents (n = 234; 77.7%) asserted throwing the expired medicine in household trash [9].

Although 52.61% and 77.42% of household and pharmacy respondents, respectively, were aware that pharmaceutical pollution of rivers and streams was a concern, no attention has been paid to the improper disposal of these pollutants into the environment. Respondents from households and pharmacies also argued that there are no formal guidelines or requirements for community pharmacies to accept medicine returned by the public. About 74.19% of the pharmacies and over‐the‐counter medicine shop respondents argued that the Food and Drugs Authority (FDA) should fund a state‐run medicine disposal and destruction system because it is the government agency responsible for and with in‐depth knowledge about drug disposal and management. In Ghana, the National Drug Policy states that the FDA is responsible for implementing appropriate measures for the regular identification, collection, and safe disposal of expired drugs and drug wastes in collaboration with other agencies where appropriate. Under Section 148 of the Public Health Act, 2012 (Act 851), the FDA of Ghana is required to supervise the safe disposal of regulated products that are unfit for human or animal consumption. However, the FDA lacks policies addressing the safe disposal of unused and expired drugs [16]. In Ethiopia, there is no national policy that aims to control the safe disposal of unused/expired medicines or raise public awareness of this issue [5]. Similarly, in Tanzania, the only existing guideline established by the Tanzania Medicines and Medical Devices Authority (TMDA) is for the disposal of expired or unused medications in drug dispensing units, health centers, and hospitals [5]. It is the same case in Malaysia, where there are laws only regarding hazardous waste from healthcare facilities and pharmaceutical companies [5].

Most of the household respondents also complained about the inconvenience of returning unused or expired drugs to the SWM pharmacies. Their reason was their location, time, and even unawareness of the pharmacies of such policy. Time, place, and space are all factors that influence perceived convenience. Proper disposal becomes inconvenient when people are busy, live far from medicine waste collection points, and need more storage space [7]. Education on proper medication disposal is a critical intervention for all pharmacy settings [20]. The release of pharmaceutical residues (unaltered or as metabolites) that pass through the body into sewage systems may be reduced by limiting excessive drug consumption, particularly over‐the‐counter medicine, or by emphasizing the development of more effective wastewater treatment methods [5].

Some measures to mitigate the environmental impact of pharmaceutical waste from households and pharmacies, and over‐the‐counter medicine shops, are employing collection schemes and take‐back systems for household pharmaceutical waste, eco‐prescription or green prescription methods in dispensaries, development, or redesigning of new pharmaceuticals, using education and information campaigns, and recycling of the unused and expired medications [16]. Healthcare organizations such as the Connecticut Department of Environmental Protection suggest four easy steps for medication disposal. First, keep medication in its original container and cross out the patient's name or remove the label. Second, modify the medications to discourage consumption, for example for pills or capsules: add a small amount of water to partially dissolve them; for liquid medications: add salt, flour, charcoal, kitty litter, or powdered spice to make a pungent, unsightly mixture that discourages anyone from eating it; for blister packs: wrap pack containing pills in multiple layers of duct tape. Third, seal, conceal, and tape the medicine container cover closed with packing or plastic tape, and then put it inside an opaque plastic bag or container. Precautionary, the medicines should not be concealed with food items because animals could accidentally eat or drink them. Finally, discard the container in the trash [9]. Nevertheless, the recommended method for disposal of most pharmaceuticals is high‐temperature incineration (as it oxidizes all organic material into carbon dioxide and renders them inert to any toxicological effect in the environment), which requires some initial organized method of collecting and sorting [14]. Nowadays, in many developed countries, drug‐take‐back systems are established for the collection of unused and expired medicines [14]. Similar to the work by Amoabeng et al., the survey respondents agreed on the need for a national medicine disposal scheme available to all pharmacies across the country to help them dispose of unused and expired drugs [16]. The FDA and pharmaceutical companies, because of their broad knowledge and expertise in the area, should run this scheme.

Improper disposal of pharmaceuticals poses significant risks to both the environment and human health. When medications are flushed down toilets, rinsed down sinks, or discarded in household waste, they can enter water systems and soil, leading to the contamination of aquatic ecosystems and drinking water sources. Studies have detected pharmaceutical residues, such as antibiotics, analgesics, and hormones, in surface water, groundwater, and even drinking water, which can disrupt aquatic life and contribute to antibiotic resistance [5, 21]. For instance, the presence of antibiotics in water bodies has been linked to the development of resistant bacterial strains, posing a serious threat to public health [22]. Additionally, the accumulation of pharmaceuticals in soil can affect plant growth and enter the food chain, potentially exposing humans to low levels of drugs over time [23]. These environmental impacts underscore the need for proper disposal systems and public awareness campaigns to mitigate the risks associated with pharmaceutical waste.

The study encountered several limitations that should be acknowledged. First, some respondents were reluctant to participate without financial incentives, as they perceived the survey to be a government‐initiated project. Additionally, there was a possibility of social desirability bias, where respondents provided answers they deemed socially acceptable rather than reflecting their true practices. Despite these challenges, the majority of participants willingly took part in the survey. Language barriers also posed a difficulty, as not all respondents were fluent in the dominant languages used (English, Sefwi, and Twi), potentially affecting the clarity and accuracy of responses. Furthermore, the study did not include populations in remote or hard‐to‐reach areas, which may have unique disposal practices and challenges. Future research should address these limitations by incorporating remote communities and exploring additional variables, such as community engagement, access to disposal facilities, and the effectiveness of public awareness campaigns. These steps would provide a more comprehensive understanding of pharmaceutical waste disposal practices and help bridge existing knowledge gaps.

5. Conclusion

This study investigated the disposal patterns of pharmaceutical waste in the SWM through face‐to‐face surveys with households, pharmacies, and over‐the‐counter medicine sellers. The findings reveal that the most common improper disposal methods include throwing medications in trash cans or garbage and flushing them down toilets, practices widely adopted due to a lack of policies for managing unused and expired medications and limited awareness of their environmental and public health consequences. To address these issues, it is recommended that the government establish regulatory agencies to oversee pharmaceutical use and disposal, implement take‐back programs, improve dumpsite and landfill management, and launch media campaigns to raise public awareness. Additionally, healthcare practitioners, community pharmacists, and OTCM attendants should educate customers on proper disposal practices. Rural and hard‐to‐reach areas must also be included in these efforts to ensure equitable and effective solutions. By adopting these measures, the municipality can mitigate the risks of improper pharmaceutical waste disposal and promote sustainable waste management practices.

Author Contributions

Lawrence Sheringham Borquaye, Godfred Darko, and Michael Konney Laryea conceived the study. Lawrence Sheringham Borquaye, Godfred Darko, Michael Konney Laryea, Emmanuel Amponsah, Rita Opoku, and Seidu Atta Ishmael designed all experiments. Seidu Atta Ishmael, Emmanuel Amponsah, and Rita Opoku collected survey data. Data analysis was done by Lawrence Sheringham Borquaye, Godfred Darko, Michael Konney Laryea, Emmanuel Amponsah, Rita Opoku, and Seidu Atta Ishmael. Lawrence Sheringham Borquaye, Godfred Darko, Michael Konney Laryea, Emmanuel Amponsah, Rita Opoku, and Seidu Atta Ishmael prepared the manuscript. All authors have read and approved the final version of the manuscript. Lawrence Sheringham Borquaye had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

Ethics Statement

The research study received ethical approval from the Kwame Nkrumah University of Science and Technology's Ethics Committee for Research, ensuring it followed ethical principles and guidelines.

Consent

All participants gave their consent to participate in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author, Lawrence Sheringham Borquaye, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Supporting information

Ishmael et al (2024) ‐ Supporting Information.

Data Availability Statement

The data that support the findings of this study are available in the article.