Community-based assessment of medication disposal practices and associated health and environmental risks in Santa Cruz District, Guanacaste, Costa Rica

Abstract: Improper disposal of unused and expired medications is a growing public health and environmental concern in Costa Rica. However, community-level evidence on medication management and household medication disposal practices remains limited. This study aimed to assess medication management and disposal practices and their associated health and environmental risks among adults in Santa Cruz District, Guanacaste, Costa Rica.

This community-based cross-sectional study was conducted between March and April 2025 among adults aged ≥18 years residing in Santa Cruz District. Participants were recruited through household visits using convenience sampling. Eligibility criteria included age ≥18 years, permanent residency in the district, ability to complete the questionnaire, and written informed consent. A structured questionnaire developed for this study included four sections addressing sociodemographic and clinical characteristics, medication consumption, knowledge of medication storage and disposal, and household medication management practices. The main outcomes were medication knowledge, medication consumption intensity, the Medication Management Practice Score, and health and environmental risk scores. Descriptive statistics and non-parametric analyses were used to evaluate the data, with statistical significance defined as p<0.05.

A total of 557 adults were included. Household waste was the most common disposal method (47.2%), followed by prolonged storage (22.4%), while only 9.9% reported returning medications to healthcare facilities. Overall, only 20.65% of participants demonstrated adequate medication management practices. Significant associations were observed among participants without reported chronic conditions for medication management practices (r=−0.760, p<0.001) and health risk scores (r=−0.339, p=0.007). Participants with metabolic/endocrine conditions also showed a significant association with medication management practices (r=−0.0758, p=0.027).

Inappropriate medication disposal remains prevalent and potentially preventable. Strengthening community education, expanding accessible medication take-back programs, and implementing national pharmaceutical waste-management policies are needed to improve medication disposal practices and reduce associated public health and environmental risks in Costa Rica.