{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T16:32:14Z","timestamp":1776357134400,"version":"3.51.2"},"reference-count":53,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>Background: Improper disposal of unused and expired medicines represents an environmental and public health concern. In Romania, Law No. 269\/2023 assigned the responsibility for collecting household pharmaceutical waste to public and private hospitals, while operational procedures were further detailed in the Ministry of Health (MoH) Instruction No. 6226\/2024. Objectives: This study aimed to assess knowledge, attitudes, and practices (KAP) related to the disposal of unused and expired medicines among the general public and community pharmacy staff during the early phase of implementation of the hospital-based medicine take-back system in Romania. Methods: A cross-sectional survey using convenience sampling was conducted between 1 and 31 August 2023. Two structured questionnaires were administered: one targeting the general public\/patients and another addressing community pharmacy staff. Data were analyzed descriptively using frequencies and percentages. Several items allowed multiple responses. Results: Among public respondents (n = 108; predominantly male, 90.7%; urban, 75.0%), household waste disposal was the most frequently reported method (58.3%), followed by pharmacy return (43.5%). Willingness to use a dedicated collection system was very high (96.3%). Among pharmacy staff (n = 71; predominantly female, 78.9%; urban, 74.6%), 40.8% reported no collection activity; where collection occurred, it was typically on demand. Disposal routes included transfer to specialized waste companies (56.3%) and regulated destruction (43.7%). Only 1.4% of pharmacies offered incentives, while 45.4% of the public indicated discounts could motivate returns. Conclusions: Findings indicate an implementation and communication gap during the transition to a hospital-based pharmaceutical waste collection system. Strengthening public communication on official collection points and providing clearer operational guidance may support safer disposal practices.<\/jats:p>","DOI":"10.3390\/pharmacy14020061","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:14:12Z","timestamp":1776352452000},"page":"61","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, Attitudes, and Practices Regarding the Disposal of Unused and Expired Medicines in Romania During the Early Implementation of the 2023 Hospital-Based Collection Framework"],"prefix":"10.3390","volume":"14","author":[{"given":"Anca","family":"Lupu","sequence":"first","affiliation":[{"name":"Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 35 Al. I. Cuza Street, 800010 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u0218tefan","family":"Ro\u0219ca","sequence":"additional","affiliation":[{"name":"Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 35 Al. I. Cuza Street, 800010 Gala\u021bi, Romania"},{"name":"Medical Assistance Service of Gala\u021bi Municipality, Traian Street 97, 800112 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6291-1008","authenticated-orcid":false,"given":"Ancu\u021ba","family":"Iacob","sequence":"additional","affiliation":[{"name":"Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 35 Al. I. Cuza Street, 800010 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marius","family":"Moroianu","sequence":"additional","affiliation":[{"name":"Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 35 Al. I. Cuza Street, 800010 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0732-3497","authenticated-orcid":false,"given":"Ramona-Oana","family":"Ro\u0219ca","sequence":"additional","affiliation":[{"name":"Research Centre in the Medical-Pharmaceutical Field, Faculty of Medicine and Pharmacy, \u201cDun\u0103rea de Jos\u201d University of Gala\u021bi, 35 Al. I. Cuza Street, 800010 Gala\u021bi, Romania"},{"name":"Emergency Ambulance Service Gala\u021bi, 1 Foc\u0219ani Street, 800509 Gala\u021bi, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","unstructured":"OECD (2022). Management of Pharmaceutical Household Waste: Limiting Environmental Impacts of Unused or Expired Medicine, OECD Publishing."},{"key":"ref_2","unstructured":"OECD (2019). Pharmaceutical Residues in Freshwater: Hazards and Policy Responses, OECD Publishing."},{"key":"ref_3","unstructured":"European Commission (2019). Communication from the Commission to the European Parliament, the Council and the European Economic and Social Committee European Union Strategic Approach to Pharmaceuticals in the Environment, European Commission."},{"key":"ref_4","unstructured":"European Commission (2025). Health and Food Safety Directorate-General Pharmaceuticals in the Environment\u2014Implement the EU Strategic Approach, European Commission. Compilation of Recommendations and Best Practices."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1093\/ijpp\/riae001","article-title":"The Knowledge, Attitude, and Practice of the Public Regarding Household Pharmaceutical Waste Disposal: A Systematic Review (2013\u20132023)","volume":"32","author":"Hiew","year":"2024","journal-title":"Int. J. Pharm. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e085124","DOI":"10.1136\/bmjopen-2024-085124","article-title":"Disposal Practices, Knowledge and Attitude of Adult Patients Visiting Outpatient Pharmacy Services towards Unused Medicines in Debre Tabor, Northwest Ethiopia: A Descriptive Cross-Sectional Study","volume":"14","author":"Yazie","year":"2024","journal-title":"BMJ Open"},{"key":"ref_7","first-page":"100556","article-title":"A Systematic Review of the Knowledge, Attitude and Practice of Healthcare Professionals and Healthcare Professional Students towards Household Pharmaceutical Waste Disposal","volume":"17","author":"Hiew","year":"2025","journal-title":"Explor. Res. Clin. Soc. Pharm."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"101404","DOI":"10.1016\/j.lanplh.2025.101404","article-title":"Pharmaceutical Pollution from Health Care: A Systems-Based Strategy for Mitigating Risks to Public and Environmental Health","volume":"10","author":"Thornber","year":"2026","journal-title":"Lancet Planet. Health"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Paut Kusturica, M., Jevtic, M., and Ristovski, J.T. (2022). Minimizing the Environmental Impact of Unused Pharmaceuticals: Review Focused on Prevention. Front. Environ. Sci., 10.","DOI":"10.3389\/fenvs.2022.1077974"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"7215","DOI":"10.1021\/acs.est.9b00570","article-title":"Systematic Review of Toxicity Removal by Advanced Wastewater Treatment Technologies via Ozonation and Activated Carbon","volume":"53","author":"Stapf","year":"2019","journal-title":"Environ. Sci. Technol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3433","DOI":"10.1039\/D4MA01122H","article-title":"Pharmaceutical Pollution in the Aquatic Environment: Advanced Oxidation Processes as Efficient Treatment Approaches: A Review","volume":"6","author":"Aziz","year":"2025","journal-title":"Mater. Adv."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2986","DOI":"10.1039\/D5EW00600G","article-title":"Wastewater Remediation of Pharmaceuticals with Ozone and Granular Active Carbon: A Risk-Driven Approach","volume":"11","author":"Davey","year":"2025","journal-title":"Environ. Sci. Water Res. Technol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.watres.2017.10.036","article-title":"Evaluation of a Full-Scale Wastewater Treatment Plant Upgraded with Ozonation and Biological Post-Treatments: Abatement of Micropollutants, Formation of Transformation Products and Oxidation by-Products","volume":"129","author":"Bourgin","year":"2018","journal-title":"Water Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e2113947119","DOI":"10.1073\/pnas.2113947119","article-title":"Pharmaceutical Pollution of the World\u2019s Rivers","volume":"119","author":"Wilkinson","year":"2022","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.emcon.2016.12.004","article-title":"Pharmaceuticals and Personal Care Products (PPCPs) in the Freshwater Aquatic Environment","volume":"3","author":"Ebele","year":"2017","journal-title":"Emerg. Contam."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1039\/D1EW00132A","article-title":"Occurrence of Pharmaceutical Active Compounds in Sewage Sludge from Two Urban Wastewater Treatment Plants and Their Potential Behaviour in Agricultural Soils","volume":"7","author":"Silva","year":"2021","journal-title":"Environ. Sci. Water Res. Technol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8897","DOI":"10.1073\/pnas.0609568104","article-title":"Collapse of a Fish Population after Exposure to a Synthetic Estrogen","volume":"104","author":"Kidd","year":"2007","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_18","first-page":"20202294","article-title":"Psychoactive Pollution Suppresses Individual Differences in Fish Behaviour","volume":"288","author":"Polverino","year":"2021","journal-title":"Proc. Biol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1289\/ehp.7209","article-title":"Long-Term Exposure to Environmental Concentrations of the Pharmaceutical Ethynylestradiol Causes Reproductive Failure in Fish","volume":"112","author":"Nash","year":"2004","journal-title":"Environ. Health Perspect."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"20689","DOI":"10.1038\/s41598-024-71747-y","article-title":"Environmental Risk of Diclofenac in European Groundwaters and Implications for Environmental Quality Standards","volume":"14","author":"Duarte","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zinsstag, J., Schelling, E., Crump, L., Whittaker, M., Tanner, M., and Stephen, C. (2020). One Health: The Theory and Practice of Integrated Health Approaches, CABI. [2nd ed.].","DOI":"10.1079\/9781789242577.0000"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wu, S., Zhou, X., Hu, X., and Wang, J. (2025). Bibliometric Analysis and Review of Global Academic Research on Drug Take-Back Programs. Healthcare, 13.","DOI":"10.3390\/healthcare13212711"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/s40545-022-00502-3","article-title":"Patient Medication Counselling in Community Pharmacy: Evaluation of the Quality and Content","volume":"15","author":"Showande","year":"2022","journal-title":"J. Pharm. Policy Pract."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Rogowska, J., and Zimmermann, A. (2022). Household Pharmaceutical Waste Disposal as a Global Problem-A Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192315798"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Mansouri, F., Chouchene, K., Roche, N., and Ksibi, M. (2021). Removal of Pharmaceuticals from Water by Adsorption and Advanced Oxidation Processes: State of the Art and Trends. Appl. Sci., 11.","DOI":"10.3390\/app11146659"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Al-Ajmi, F., Al-Marri, M., Almomani, F., and AlNouss, A. (2024). A Comprehensive Review of Advanced Treatment Technologies for the Enhanced Reuse of Produced Water. Water, 16.","DOI":"10.3390\/w16223306"},{"key":"ref_27","unstructured":"(2026, February 19). Environmental Risk Assessment of Medicinal Products for Human Use\u2014Scientific Guideline|European Medicines Agency (EMA). Available online: https:\/\/www.ema.europa.eu\/en\/environmental-risk-assessment-medicinal-products-human-use-scientific-guideline."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"101020","DOI":"10.1016\/j.envc.2024.101020","article-title":"Exploring Awareness of Planetary Health and Antibiotic Disposal Advice across Australian Pharmacies: A Mystery Shopping Expedition","volume":"17","author":"Lim","year":"2024","journal-title":"Environ. Chall."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2395535","DOI":"10.1080\/20523211.2024.2395535","article-title":"Unused Medicine Take-Back Programmes: A Systematic Review","volume":"17","author":"Wang","year":"2024","journal-title":"J. Pharm. Policy Pract."},{"key":"ref_30","unstructured":"(2026, February 19). LEGE 269 10\/10\/2023\u2014Portal Legislativ. Available online: https:\/\/legislatie.just.ro\/public\/DetaliiDocument\/275200."},{"key":"ref_31","unstructured":"(2026, February 20). INSTRUCTIUNI 6226 04\/04\/2024\u2014Portal Legislativ. Available online: https:\/\/legislatie.just.ro\/public\/DetaliiDocument\/281609."},{"key":"ref_32","unstructured":"(2026, April 06). Activitatea Re\u021belei Sanitare \u0218i de Ocrotire a S\u0103n\u0103t\u0103\u021bii \u00cen Anul 2024|Institutul Na\u021bional de Statistic\u0103. Available online: https:\/\/insse.ro\/cms\/ro\/content\/activitatea-re%C8%9Belei-sanitare-%C8%99i-de-ocrotire-s%C4%83n%C4%83t%C4%83%C8%9Bii-%C3%AEn-anul-2024-0."},{"key":"ref_33","unstructured":"United States Environmental Protection Agency (2026, February 21). Basics About Household Medication Disposal, Available online: https:\/\/www.epa.gov\/household-medication-disposal\/basics-about-household-medication-disposal."},{"key":"ref_34","unstructured":"(2026, February 21). Important Notification\u2014NAMMDR. Available online: https:\/\/www.anm.ro\/en\/important-notification-20-05-2024\/?utm_source=chatgpt.com."},{"key":"ref_35","unstructured":"(2026, February 21). Important Notifications\u2014Medicines for Human Use\u2014NAMMDR. Available online: https:\/\/www.anm.ro\/en\/medicamente-de-uz-uman\/anunturi-importante-medicamente-de-uz-uman\/?utm_source=chatgpt.com."},{"key":"ref_36","unstructured":"(2026, February 21). Measures for Minimising Impacts of Unused Pharmaceuticals: Management of Pharmaceutical Household Waste. Available online: https:\/\/www.oecd.org\/en\/publications\/management-of-pharmaceutical-household-waste_3854026c-en\/full-report\/component-8.html."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e093636","DOI":"10.1136\/bmjopen-2024-093636","article-title":"Assessing the Knowledge, Attitudes and Practices of Healthcare Staff and Students Regarding Disposal of Unwanted Medications: A Systematic Review","volume":"14","author":"Lam","year":"2024","journal-title":"BMJ Open"},{"key":"ref_38","unstructured":"(2026, February 21). Parlementaire Monitor\u2014Parlementaire Monitor. Available online: https:\/\/www.parlementairemonitor.nl\/9353000\/1\/j9vvij5epmj1ey0\/vk0gkfd9vbfw."},{"key":"ref_39","unstructured":"European Commission (2007). Directive 2001\/83\/EC of the European Parliament and of the Council of 6 November 2001 on the Community Code Relating to Medicinal Products for Human Use, European Commission."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"(2026, February 21). Anun\u021b Important\u2014ANMDMR. Available online: https:\/\/www.anm.ro\/anunt-important-20-05-2024\/?utm_source=chatgpt.com.","DOI":"10.12927\/hcpol.2025.27666"},{"key":"ref_41","unstructured":"(2026, February 21). Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and After Emergencies. Available online: https:\/\/iris.who.int\/items\/59725b98-8de3-4dd2-be9f-ab604fbe4524."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"rmae028","DOI":"10.1093\/jphsr\/rmae028","article-title":"Prevalence and Disposal of Unused Medicines: A Systematic Review of Cross-Sectional Studies","volume":"16","author":"Wang","year":"2025","journal-title":"J. Pharm. Health Serv. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s00267-019-01174-7","article-title":"Pharmaceutical Household Waste Practices: Preliminary Findings from a Case Study in Poland","volume":"64","author":"Rogowska","year":"2019","journal-title":"Environ. Manag."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1007\/s10163-022-01494-7","article-title":"Household Disposal of Pharmaceuticals: Attitudes and Risk Perception in a UK Sample","volume":"24","author":"Watkins","year":"2022","journal-title":"J. Mater. Cycles Waste Manag."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.envint.2008.10.002","article-title":"Handling of Unused Prescription Drugs\u2014Knowledge, Behaviour and Attitude among Swedish People","volume":"35","author":"Persson","year":"2009","journal-title":"Environ. Int."},{"key":"ref_46","unstructured":"(2026, February 21). English\u2014Cyclamed. Available online: https:\/\/www.cyclamed.org\/english\/."},{"key":"ref_47","unstructured":"(2026, February 21). L\u2019engagement du Leem en Faveur du Pacte Mondial des Nations-Unies. Available online: https:\/\/www.leem.org\/publication\/l-engagement-du-leem-en-faveur-du-pacte-mondial-des-nations-unies."},{"key":"ref_48","unstructured":"(2026, February 21). El Reciclaje de Medicamentos Crece Casi un 4% en Espa\u00f1a. Available online: https:\/\/sigre.es\/post\/el-reciclaje-de-medicamentos-crece-casi-un-4-en-espana?utm_source=chatgpt.com&lang=en."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/j.envint.2010.10.002","article-title":"Disposal Practices for Unused Medications around the World","volume":"37","author":"Tong","year":"2011","journal-title":"Environ. Int."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/2052-3211-7-6","article-title":"Medicines Discarded in Household Garbage: Analysis of a Pharmaceutical Waste Sample in Vienna","volume":"7","author":"Vogler","year":"2014","journal-title":"J. Pharm. Policy Pract."},{"key":"ref_51","first-page":"100133","article-title":"Analysis of Medicines Returned to Pharmacies for Disposal and Estimation of the Cost Due to Medicine Wasting","volume":"5","author":"Romanelli","year":"2022","journal-title":"Explor. Res. Clin. Soc. Pharm."},{"key":"ref_52","unstructured":"(2026, February 21). Consolidated TEXT: 32001L0083\u2014EN\u201426.07.2019. Available online: https:\/\/eur-lex.europa.eu\/eli\/dir\/2001\/83\/2019-07-26\/eng."},{"key":"ref_53","unstructured":"(2026, February 21). The Over-55s, the Most Proud of Recycling Medicines in Spain. Available online: https:\/\/sigre.es\/post\/los-mayores-de-55-anos-los-mas-orgullosos-del-reciclaje-de-medicamentos-en-espana?lang=en."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/2\/61\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T15:25:09Z","timestamp":1776353109000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/14\/2\/61"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":53,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["pharmacy14020061"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy14020061","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}