1. Introduction
The improper disposal of unused medicines poses a significant risk to public health [
1]. Accumulating these medicines in homes increases the risk of accidental poisoning or deliberate misuse, potentially leading to suicide [
1]. Therefore, it is essential to both reduce the generation of unused medicines and ensure their safe and appropriate disposal. This public health issue demands serious attention and responsible action [
2]. Drug donation represents a viable method for the disposal of medications, effectively redirecting unused drugs to where they are needed most [
3]. Drug donation practices are used for a variety of reasons, ranging from providing emergency relief to sustaining long-term medicinal supplies or even for recycling drugs. A common scenario is the donation of leftover medications nearing their expiry date, which often occurs when clinics purchase more than they need. Although the origins and intentions behind drug donations may differ, they are all guided by a set of universal basic guidelines, ensuring that these donations are handled responsibly and effectively. This approach helps to maximize the benefits of drug donations while minimizing potential risks [
4]. The accumulation of unused medicines in patients’ homes has prompted charitable organizations to step in, collecting and redistributing these medications before they expire as a way to reduce waste and ensure their proper use [
5,
6]. Drug donations, often provided free of charge, are supplied to various countries by individuals, organizations, and non-governmental organizations (NGOs) [
2]. In any medical practice, improperly managed donations can create more burdens than benefits for the intended recipient governments. The World Health Organization (WHO) published its first guidelines for drug donations in 1996, with contributions from various parties, including United Nations agencies, international humanitarian relief organizations, and others [
7]. In 2010, the third and final edition of the Medical Donations Guidelines was issued, featuring twelve best-practice recommendations for both donor and recipient countries. These recommendations specify that donations should meet the recipient country’s specific needs, align with its disease patterns, and be in agreed quantities. Donated medicines should be approved for use in the recipient country, listed on its national list of essential medicines or standard treatment guidelines, and similar to those commonly used there. They must originate from a quality-assured source and meet quality standards [
8]. In Saudi Arabia, the situation of drug donations is unique and warrants specific attention since the awareness and perception of community practices regarding drug donations represent an area lacking regulation and specific policy guidance. This study aims to thoroughly survey and assess the current practices and community perceptions of drug donations within Saudi Arabia, evaluating their alignment with international norms and identifying unique local challenges. By highlighting these insights, this research intends to illuminate the path toward establishing effective management and regulatory frameworks for drug donations, thereby enhancing public health outcomes and ensuring environmental safety in Saudi Arabia.
3. Result
The study included 430 participants whose demographic information is presented in
Table 1. The majority were female (73.0%), and the age distribution was diverse, with a mean age of 32.5 (±11.2) years. The age breakdown indicated a significant proportion of individuals aged 20 to less than 30 years (41.6%). The study predominantly included Saudi participants (95.1%), reflecting the regional demographic composition. Marital status was evenly distributed, with 47.2% married and 46.5% single participants. In terms of education, 73.0% held a university degree. Employment status varied, with 42.3% employed and 29.3% being students. The monthly household income distribution was diverse, with 41.9% falling in the 6000 to 15,000 SAR range. Geographically, participants were distributed across provinces, with Mecca (41.4%), Madinah (27.7%), and Riyadh (12.8%) being the most represented.
Table 2 presents an overview of the respondents’ awareness of drug donation programs and the necessity of such initiatives in Saudi Arabia. A significant proportion of participants (66.3%) reported not having heard about drug donation programs, whereas 23.0% affirmed awareness. Among those aware, social media emerged as the primary source of information (12.1%), followed by family or friends (5.6%) and healthcare professionals (4.7%). Awareness of drug donation centers or collection points was low, with only 12.1% acknowledging their existence. Regarding knowledge levels, the majority indicated limited familiarity with program details (84.2%).
The responses to questions about the awareness and perceived necessity of different types of medication donations reveal valuable insights and are presented in
Table 3. A substantial proportion of participants were aware that various medication forms could be donated, with a majority recognizing the suitability of oral medications (67.2%), topical medications (46.3%), and inhalers or respiratory medications (42.3%) for donation. However, there was a notable lack of awareness regarding donation possibilities, as indicated by the 9.5% who responded as “Not aware”. When expressing preferences on the types of medications needed in Saudi Arabia, respondents predominantly favor oral medications (64.0%), inhalers or respiratory medications (55.1%), and injectable medications such as insulin (44.9%).
The perceptions of drug donation programs among the respondents provide valuable insights into the potential impact and challenges associated with such initiatives in Saudi Arabia, as shown in
Table 4. A significant majority (83.7%) acknowledged the importance of drug donation programs, underscoring their perceived value in contributing to healthcare. Participants foresaw various benefits from these programs, with the most emphasized being the facilitation of the donation process (69.8%), increased awareness of the culture of drug donation (76.0%), and the reduction in medication waste (69.1%). Concerns about the safe use and potential misuse of donated medication emerged as a prominent barrier, highlighted by 69.1% of respondents. Despite some concerns, a majority (71.4%) believe that drug donation programs positively impact healthcare in Saudi Arabia. Notably, when asked about improvements that can be made to enhance the impact and effectiveness of drug donation programs in Saudi Arabia, responses centered on the importance of information, awareness, and marketing (67.0%).
The factors influencing participation in drug donation programs among the respondents revealed key considerations that could impact their willingness to engage in such initiatives (
Table 5). A substantial majority (87.4%) expressed the motivation to participate when they knew it would benefit those in need. Additionally, participants emphasized the importance of a simplified donation process (45.6%), trust in the program’s organization (46.5%), community support and awareness (57.2%), and clear information about donation locations and procedures (43.0%). Notably, a significant portion believed that drug donation can reduce drug waste (87.9%) and environmental pollution (75.6%). Respondents also expressed concern about the lack of drug donation programs in Saudi Arabia (26.7%) and the need for regulations governing pharmaceutical donations in Arab countries (86.3%). The large number of “neutral” responses (59.1%) about the existence of drug donation programs in Saudi Arabia indicates that many participants were uncertain or lacked enough knowledge to give a clear answer. This highlights the general uncertainty, even among those who had not heard of the programs.
The responses to questions about the ethical contributions of drug donation programs revealed a positive perception of their societal impact among the participants (
Table 6). An overwhelming majority (92.3%) agreed that drug donation programs contribute to community service. Furthermore, a significant proportion (69.3%) believed that these programs could play a role in reducing unethical trade in medicines. Regarding knowledge of legislation and regulations related to drug donation, a substantial number of participants expressed varying levels of awareness, with a notable percentage acknowledging limited knowledge (77%). Interestingly, a substantial portion (48.1%) expressed concerns about the potential misuse of donated medicines for fraudulent purposes.
The findings from the responses to questions about the willingness to participate in drug donation programs provided valuable insights into the factors influencing individuals’ decisions. Most respondents (89.3%) reported no previous experience in drug donation, whereas 10.7% indicated having participated before. Of those with experience, 31 respondents chose to describe their experience. Among them, only four respondents reported that they donated through a drug donation program, while the others described personal donations. Notably, most participants (83.7%) expressed a willingness to participate if they knew that the donated medication would directly benefit individuals in their community. When asked about factors influencing their decision to participate, participants highlighted the significance of clear guidelines on acceptable donations (76.7%), the assurance of proper disposal of expired medications (66.0%), and the convenience of donation drop-off locations (67.0%). Interestingly, a sizeable proportion (29.5%) noted the importance of incentives for donors, such as tax benefits or acknowledgments.
Effects of Demographic Characteristics on the Awareness, Perceptions, and Willingness to Participate in Drug Donation Programs
The results of the modified Poisson regression analyses reveal significant associations between demographic factors and the awareness of drug donation programs in terms of existence, program details, and familiarity with regulations. Participants aged 30 to less than 40, 40 to less than 50, and those aged 50 and above demonstrated significantly higher awareness about the existence of drug donation programs compared with the reference group (20 to less than 30), with PRs of 3.03 (95% CI: 1.31, 7.04, p = 0.010), 3.32 (95% CI: 1.41, 7.82, p = 0.006), and 3.52 (95% CI: 1.12, 11.06, p = 0.032), respectively. Participants aged 40 to less than 50 exhibited increased knowledge about program details, showing a PR of 2.93 (95% CI: 1.06, 8.12, p = 0.039). Moreover, individuals with a monthly household income of more than SAR 50,000 were significantly more aware of the existence of drug donation programs (PR = 5.12, 95% CI: 1.05, 24.89, p = 0.043). Notably, other demographic factors, including gender, nationality, marital status, educational level, employment status, and province, were not significantly associated with awareness, knowledge, or familiarity with drug donation programs.
The modified Poisson regression analyses investigated the impact of respondents’ demographic characteristics on their perception of the importance of drug donation programs, their positive impact, and willingness to participate in such programs. Noteworthy associations include the influence of age, employment status, and monthly household income. Participants aged 40 to 50 years were more likely to perceive the importance of drug donation programs (PR = 1.19, 95% CI: 1.00, 1.42, p = 0.050) but less likely to perceive their current positive impact (PR = 0.77, 95% CI: 0.59, 0.99, p = 0.044) compared with the reference group (20 to less than 30). Single individuals were more likely to perceive the importance of drug donation programs (PR = 1.13, 95% CI: 1.01, 1.26, p = 0.032) than their married counterparts. Students were less likely to perceive the current positive impact of drug donation programs (PR = 0.78, 95% CI: 0.65, 0.94, p = 0.007), and unemployed individuals were less willing to participate (PR = 0.85, 95% CI: 0.73, 0.99, p = 0.036) compared with employed individuals. Moreover, participants with a monthly household income of more than SAR 15,000 to 30,000 were more likely to perceive the current positive impact of drug donation programs (PR = 1.18, 95% CI: 1.03, 1.35, p = 0.020) than those with a monthly household income of more than SAR 6000 to 15,000. No significant associations were found for the other demographic factors.
4. Discussion
In this study, we explored the awareness and perceptions surrounding drug donation programs among participants. A significant 66.3% of respondents were not aware of such programs, with social media emerging as a key information source for those who were informed. This study underscores the pervasive issue of inadequate knowledge regarding proper medication disposal and donation practices, as highlighted by Althagafi et al. (2022), who noted that 12.9% of individuals donate their unused medications, thereby contributing to a culture of medication redistribution within communities [
11].
Only 12.1% of participants knew about drug donation centers, despite a substantial majority (90.2%) recognizing the urgent need for increased public awareness. The types of medications deemed suitable for donation were predominantly oral, reflecting concerns about medication integrity, potential abuse, and regulatory challenges, similar to other studies [
12,
13].
This study also revealed strong support (83.7%) for drug donation programs as a means to alleviate health disparities and provide emergency assistance. Yet, 69.1% of participants believed these programs could minimize medication waste. Notwithstanding the evident support for drug donation initiatives, apprehensions regarding privacy, legal issues, and safety were prominent, paralleling a Dutch study where 61.2% of patients expressed willingness to use returned medication, contingent on quality assurance [
14]. Another study uncovered disposal practices among respondents, with a significant 73% admitting to discarding medications in the trash. Conversely, 14% reported returning unused medications to pharmacies, while only 3% of participants engaged in the practice of donating their medications to friends or charity centers [
15]. Also, another study highlights the effectiveness of permanent drug donation boxes in safely removing controlled substances from communities, reducing potential misuse. Ensuring convenient access to these disposal options for both rural and urban populations is crucial for improving public safety and health [
16].
Most people viewed the ethics of drug donation programs positively, though some were concerned about the potential for misuse or fraud. The study also examined drug donation policies, finding that while they generally follow WHO guidelines, there is still a lack of clear policies for both donors and recipients [
8]. Demographic variables such as age and income level markedly influenced awareness and perceptions, with middle-aged and higher-income groups showing greater program awareness. This aligns with another study that emphasized the necessity for improved public education on drug donation and disposal, advocating for the use of social networks to expand awareness [
11].
To enhance the safety and utilization of unused medicines, it is imperative to advocate for the establishment of approved policies and regulations governing drug donations in Saudi Arabia. Such measures will ensure the safe and effective redistribution of medications, thereby regulating the practice and maximizing its benefits to society. This study is not without its limitations. A limitation of this study is the use of convenience sampling, which may restrict the generalizability of the findings due to potential selection bias, despite efforts to achieve broad geographic distribution across different regions of Saudi Arabia. Also, another limitation of this study is that online data collection may have led to a lower number of older adult participants, who are regular medication users. The reliance on self-reported data may introduce bias. Additionally, the cross-sectional design limits the ability to ascertain causality or track changes over time. Future research should aim to diversify the participant pool and employ longitudinal designs to observe trends. There is also a need for intervention studies to test the effectiveness of different educational strategies on enhancing awareness and perceptions regarding drug donation programs.