EVALUATION OF PUBLIC PERCEPTION AND PRACTICE ABOUT DISPOSAL OF UNUSED ANDEXPIRED MEDICINES IN SELECTED REGION OF KHYBER PAKHTUNKHWA

Background: The unsafe disposal of unused and expired medications is an emerging global concern, contributing to environmental contamination and public health risks. Pharmaceuticals discarded in household garbage, sewers, or water systems release harmful chemicals that threaten human health, wildlife, and ecological stability. In developing regions, limited awareness and inadequate disposal infrastructure worsen the problem. Pakistan lacks comprehensive guidelines on safe disposal, and the extent of public awareness in cities such as Peshawar and Mardan remains largely undocumented. This study was therefore designed to evaluate community perceptions and practices regarding the disposal of unused and expired medicines. Objective: To investigate the prevailing perceptions and disposal practices of the general public regarding unused and expired medications and assess their implications for the environment. Methods: A cross-sectional descriptive-exploratory study was conducted in Peshawar and Mardan, enrolling 400 participants through convenient sampling. Both self-administered and interviewer-guided questionnaires, consisting of open- and close-ended items, were used for data collection. Questionnaires were translated into local language and supplemented with audio recordings for illiterate participants. Data were analyzed using SPSS version 22, employing descriptive statistics, confirmatory factor analysis, correlation, and regression models to explore associations between perceptions, practices, and environmental outcomes. Ethical approval was obtained, and informed consent was secured from all participants. Results: The study population comprised 76.5% males and 23.5% females, with the majority aged 18–40 years. Most respondents resided in rural areas (72.5%). Awareness was high, with 93% acknowledging that unsafe disposal harms the environment. Despite this, unsafe practices dominated: 50% reported keeping medicines until expiry, 30% disposed into household garbage, 10% shared with others, while only 7% returned drugs to pharmacies or hospitals. Regression analysis showed perceptions (β = 0.453) and practices (β = 0.389) significantly predicted environmental outcomes, with an adjusted R² of 0.921. Cronbach’s alpha values confirmed strong internal reliability for perceptions (0.91), practices (0.90), and environmental effects (0.93). Conclusion: Unsafe disposal of unused and expired medicines remains widespread despite high awareness of its environmental risks. Perceptions and practices were strongly correlated with environmental impacts, emphasizing the urgent need for structured awareness campaigns, pharmacy-based return programs, and legislative frameworks to ensure safe disposal. The findings provide critical evidence for policymakers to design effective interventions and highlight areas for future research in other regions of Pakistan.