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

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.