International Journal of Clinical Pharmacy

, Volume 36, Issue 5, pp 873–881 | Cite as

A systematic review of the literature on ‘medication wastage’: an exploration of causative factors and effect of interventions

  • Lorna Marie West
  • Lesley Diack
  • Maria Cordina
  • Derek Stewart
Review Article


Introduction Reducing any wastage, including that of medications, is a paramount objective in promoting appropriate utilisation of finite resources. The objective was to systematically review the published literature, the possible causative factors associated with medication wastage and the effectiveness of any interventions to reduce wastage. Method A systematic review of studies published in English was identified from the following databases: Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PubMed, Science Citation Index and The Cochrane Library. Data extraction and critical appraisal was undertaken independently by two researchers. Results and discussion Title, abstract and full paper screening reduced the 14,157 studies to 42. A general definition of medication wastage was reported in one paper only. ‘Medication changed’, ‘patient death’, ‘resolution of patient’s condition’ and ‘expired medications’ were most commonly cited reasons for wastage. Only two studies were identified reporting wastage as a research outcome measure following intervention. Conclusion The systematic review has identified a limited literature on medication wastage with a lack of consistency of terms. There is a paucity of robust research focusing on the impact of healthcare interventions on outcomes around medication wastage.


Medication Medication wastage Systematic review Wastage 



Reporting of this systematic review is based, where appropriate and relevant, on the PRISMA statement 2009, which details the ‘Preferred Reporting Items for Systematic Reviews (and Meta-analysis)’.


This systematic review will form part of Lorna Marie West’s submission for PhD. The research work carried out, is partially funded by the Malta Government Scholarship Scheme.

Conflicts of interest

The authors declare no conflict of interest. The scholarship had no influence on study design, conduction, analysis, interpretation or writing of this article.


  1. 1.
    Commission of the European Communities. Taking sustainable use of resources forward: a thematic strategy on the prevention and recycling of waste. EUR-Lex., Year;; 5 Oct 2012.
  2. 2.
    Directive 2008/98/EC of the European parliament and of the Council of 19 November 2008. Official Journal of the European Union, 2008;; 20 July 2013.
  3. 3.
    Langley C, Marriott J, Mackridge A, Daniszewski R. An analysis of returned medicines in primary care. Pharm World Sci. 2005;27(4):296–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Castensson S, Ekedahl A. Pharmaceutical waste: the patient role. In: Kummerer K, Hempel M, editors. Green and sustainable pharmacy. 1st ed. Germany: Springer; 2010. p. 179–200.CrossRefGoogle Scholar
  5. 5.
    James TH, Helms ML, Braund R. Analysis of medications returned to community pharmacies. Ann Pharmacother. 2009;43:1631–5.PubMedCrossRefGoogle Scholar
  6. 6.
    York Health Economics Consortium, School of Pharmacy University of London. Evaluation of the scale, causes and costs of waste medicines, 2010.; 8 Feb 2011.
  7. 7.
    Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. Making it safe and sound. The King’s Fund, 2013;; 16 Mar 2014.
  8. 8.
    Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions, version 5.1.0. The cochrane collaboration, 2011;; 30 April 2011.
  9. 9.
    Lang TA. The value of systematic reviews as research activities in medical education. Acad Med. 2004;79(11):1067–72.PubMedCrossRefGoogle Scholar
  10. 10.
    Mickenautsch S. Systematic reviews, systematic error and the acquisition of clinical knowledge. BMC Med Res Methodol. 2010;10:53.; 13 Dec 2011.
  11. 11.
    Centre for Reviews and Dissemination. Systematic reviews. CRD’s guidance for undertaking reviews in healthcare, 2009.; 7 Jan 2011.
  12. 12.
    Public Health Resource Unit. Critical Appraisal Skills Program (CASP) 10 questions to help you make sense of randomised controlled trials, 2006.; 4 May 2011.
  13. 13.
    Koufogiannakis D, Booth A, Brettle A. ReLIANT: Reader’s guide to the literature on interventions addressing the need for education and training, 2006.; 4 May 2011.
  14. 14.
    Kmet LM, Lee RC, Cook LC. Standard quality assessment criteria for evaluating primary research papers from a variety of fields, 2004;; 4 May 2011.
  15. 15.
    Young JM, Solomon MJ. How to critically appraise an article. Nat Clin Pract Gastr. 2009;6(2):82–91.CrossRefGoogle Scholar
  16. 16.
    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):1–28.CrossRefGoogle Scholar
  17. 17.
    White KG. UK interventions to control medicines wastage: a critical review. IJPP. 2010;18(3):131–40.Google Scholar
  18. 18.
    Abahussain EA, Ball DE, Matowe WC. Practice and opinion towards disposal of unused medication in Kuwait. Med Princ Pract. 2006;15(5):352–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Abahussain EA, Ball DE. Disposal of unwanted medicines from households in Kuwait. Pharm World Sci. 2007;29(4):368–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Abou-Auda HS. An economic assessment of the extent of medication use and wastage among families in Saudi Arabia and Arabian Gulf countries. Clin Ther. 2003;25(4):1276–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Al Siyabi KH, Al Riyami K. Value and types of medicines returned by patients to Sultan Qaboos University Hospital pharmacy, Oman. Sultan Qaboos Univ Med J. 2007;7(2):109–15.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Boivin M. The cost of medication waste. Can Pharm J. 1997;130(4):33–9.Google Scholar
  23. 23.
    Bradley TJ, Williams WH. Evaluation of medicines returned in Manchester DUMP campaign. Pharm J. 1975;215(542):547.Google Scholar
  24. 24.
    Braund R, Yuen Y, Jung J. Identification and quantification of medication returned to Otago pharmacies. NZFP. 2007;34(4):258–62.Google Scholar
  25. 25.
    Braund R, Chuah F, Gilbert R, Gn G, Soh A, Yin Tan L, et al. Identification of the reasons for medication returns. NZFP. 2008;35:248–52.Google Scholar
  26. 26.
    Braund R, Gn G, Matthews R. Investigating unused medications in New Zealand. Pharm World Sci. 2009;3(6):664–9.CrossRefGoogle Scholar
  27. 27.
    Braund R, Peake BM, Shieffelbien L. Disposal practices for unused medications in New Zealand. Environ Int. 2009;35(6):952–5.PubMedCrossRefGoogle Scholar
  28. 28.
    Bronder E, Klimpel A. Unused drugs returned to the pharmacy—new data 2001. Int J Clin Pharmacol Ther. 2001;39(11):480–3.PubMedGoogle Scholar
  29. 29.
    Brown CH, Kirk KW. Cost of discarded medication in Indiana long-term care facilities. Am J Hosp Pharm. 1984;41(4):698–702.PubMedGoogle Scholar
  30. 30.
    Coma A, Modamio P, Lastra CF, Bouvy ML, Marino EL. Returned medicines in community pharmacies of Barcelona, Spain. Pharm World Sci. 2008;30(3):272–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Cook H. Why so many drugs go to waste. Pharm Pract. 1996;6(8):268–70.Google Scholar
  32. 32.
    David BM, Carwardine E, Longmore RB, McDonald C, Page MA. Some results of a campaign for the collection of unused medicines in Perth. AJP. 1979;60:350–3.Google Scholar
  33. 33.
    Ekedahl A. Unused drugs returned to pharmacies—a few patients return a large proportion of the unused drugs. JSAP. 2003;20(6):257–8.Google Scholar
  34. 34.
    Ekedahl A, Wergeman L, Rydberg T. Unused drugs in Sweden measured by returns to pharmacies. JSAP. 2003;20(1):26–31.Google Scholar
  35. 35.
    Ekedahl ABE. Reasons why medicines are returned to Swedish pharmacies unused. Pharm World Sci. 2006;28(6):352–8.PubMedCrossRefGoogle Scholar
  36. 36.
    Garey KW, Johle ML, Behrman K, Neuhauser MM. Economic consequences of unused medications in Houston, Texas. Ann Pharmacother. 2004;38(7–8):1165–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Grant P. Return of waste medicines to a community pharmacy. Prescriber. 2001;12(4):29–38.Google Scholar
  38. 38.
    Guirguis K. Medications collected for disposal by outreach pharmacists in Australia. Pharm World Sci. 2010;32(1):52–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Halloran TN, Frewen DB, Frost BR. An evaluation of the cost of drug wastage in a South Australian community—a pilot study. Aust J Hosp Pharm. 1978;8(3):84–6.Google Scholar
  40. 40.
    Harris DW, Karandikar DS, Spencer MG, Leach RH, Bower AC, Mander GA. Returned-medicines campaign in Birmingham, 1977. Lancet. 1979;1(8116):599–601.PubMedCrossRefGoogle Scholar
  41. 41.
    Hawksworth GM, Wright DJ, Chrystyn H. A detailed analysis of the day to day unwanted medicinal products returned to community pharmacies for disposal. JSAP. 1996;13(4):215–22.Google Scholar
  42. 42.
    Henderson S. Hospital pharmacy: survey of unwanted medicines. Pharm J. 1984;232:603–5.Google Scholar
  43. 43.
    Isacson D, Olofsson C. Drugs up in smoke: a study of caseated drugs in Sweden. Pharm World Sci. 1999;21(2):96–9.PubMedCrossRefGoogle Scholar
  44. 44.
    Kiyingi KS, Lauwo JAK. Drugs in the home: danger and waste. World Health Forum. 1993;14(4):381–4.PubMedGoogle Scholar
  45. 45.
    Longmore R, McDonald C, Sunderland B, Kailis S, Marshall C. Examination of a sample from a Medidump campaign in Perth, Western Australia. AJP. 1990;9(5):145–9.Google Scholar
  46. 46.
    Longmore RB, Sunderland VB, Sansom LN. Analysis of a “Medidump” campaign in Australia. IJPP. 1995;3(3):186–91.Google Scholar
  47. 47.
    Mackridge AJ, Marriott JF. Returned medicines: waste or a wasted opportunity? J Pub Health. 2007;29(3):258–62.CrossRefGoogle Scholar
  48. 48.
    Mackridge AJ, Marriott JF, Langley CA. Unused medicines with potential for misuse or abuse in primary care. IJPP. 2007;15(3):229–33.Google Scholar
  49. 49.
    Millar J, MacKinnon W, Struthers MV, Vass C. A pilot study to investigate the use of installment dispensing as a method of reducing drug wastage owing to adverse drug reactions. Br J Gen Pract. 2003;53(492):550–2.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Millar J, McNamee P, Heaney D, Selvaraj S, Bond C, Lindsay S, et al. Does a system of instalment dispensing for newly prescribed medicines save NHS costs? Results from a feasibility study. Fam Pract. 2009;26(2):163–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Morgan TM. The economic impact of wasted prescription medication in an outpatient population of older adults. J Fam Pract. 2001;50:779–81.PubMedGoogle Scholar
  52. 52.
    Pervanas HC, Cooper MR, Robert L. Description of a medication disposal event in a managed care setting. J Pharm Technol. 2010;26:264–70.CrossRefGoogle Scholar
  53. 53.
    Subratty AH, Hassed Nathire ME. A survey on home generated medical waste in Mauritius. Int J Environ Health Res. 2005;15(1):45–52.PubMedCrossRefGoogle Scholar
  54. 54.
    Sweileh WM, Ansam F, Sawalha AF, Zyoud SH, Al-Jabi SW, Bani Shamseh FF, et al. Storage, utilization and cost of drug products in Palestinian households. Int J Clin Pharmacol Ther. 2010;48(1):59–67.PubMedCrossRefGoogle Scholar
  55. 55.
    Wasserfallen JB, Bourgeois R, Bula C, Yersin B, Buclin T. Composition and cost of drugs stored at home by elderly patients. Ann Pharmacother. 2003;37(5):731–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Wongpoowarak P, Wanakamanee U, Panpongtham K, Trisdikoon P, Wongpoowarak W, Ngorsuraches S. Unused medications at home—reasons and costs. IJPP. 2004;12:141–8.Google Scholar
  57. 57.
    Zargarzadeh AH, Tavakoli N, Hassanzadeh A. A survey on the extent of medication storage and wastage in urban Iranian households. Clin Ther. 2005;27(6):970–8.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Lorna Marie West
    • 1
  • Lesley Diack
    • 1
  • Maria Cordina
    • 2
  • Derek Stewart
    • 1
  1. 1.Faculty of Health and Social Care, School of Pharmacy and Life SciencesRobert Gordon UniversityAberdeenUK
  2. 2.Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and SurgeryUniversity of MaltaMsidaMalta

Personalised recommendations