Most people in Ghana rarely dispose of things which are of no use or have expired. They prefer to keep them and use them sometimes as decorators in their rooms. Re-use and recycling are key components of the drive towards safe environment, but the nature of drugs makes it very, very difficult to apply the principles of re-use. Reuse of old/unwanted medicines could be very dangerous and fatal. What is so astonishing is the culture of keeping unused or expired pharmaceuticals (waste medicines) for use in the future. Unfortunately this culture is gradually promoting the attitude of self medication in our homes which poses a great danger to our health. The issue of keeping unused/unwanted medicines at homes could be attributed to a combination of factors. Increased access to health care (in this respect the noble NHIS could fuel stockpile of medicines at home). Another cause of the problem is increasing volumes of prescriptions. In the United States two thirds of the population receive at least one prescription per year and close to 40% receive prescriptions for four or more medications. Half of the prescriptions taken each year are used improperly, and 96% of patients nationwide fail to ask questions about how to use their medications (ISMP report 2009). Furthermore the increasing trend of direct-to-consumer advertising needs to be addressed dispassionately by all stake-holders to avoid stockpile of medicines at homes. The unbridled direct-to-consumer advertising is a major cause of inappropriate self medication by the public. Perhaps one need not lose sight of the literacy rates as a contributing factor to the problem of unused/unwanted medicines at homes. The need for health education and health literacy is critical to prempting the problem of unused/unwanted medicines at homes. People with chronic disease conditions such as hypertension, diabetes need to take medicines everyday unless advised otherwise by the prescriber. There are occasions when changes are made on the prescription. However inability to arrange for the return of previous medicines could only lead to presence of unused/unwanted medicines at homes. Patient non-compliance is a major cause for the presence of unused/unwanted medicines at homes. Patients with chronic diseases need to be properly counselled about reasons for the use of medications everyday else they could easily become tired of daily use of medicines. There are situations where the side effects of the medicines fuel non-compliance by the patient. Again counselling is critical to prompting the client about the potential side effects and measures required to minimize these side effects. Polypharmacy (where a patient is required to take many medicines everyday) could really pose challenges to the person particularly for the aged and result in non-compliance. Generally there is the tendency to stop taking medicines when you think you feel better. After all there is the possibility of experiencing the same situation again. The left-over medicine then becomes useful without giving any thought to the implications of the state of the product (storage conditions, stability, degradation, expiry date). In Ghana many medicines are dispensed in loose form in dispensing envelopes without any written information about the expiry date. In recent times the need for all to safeguard the environment is on the agenda of many international forums. Pharmaceutical wastes have been identified as environmental pollutants. In this regard the various vehicles used by the World Health Organization (WHO) to promote rational use of drugs (medicines) must be promoted at all levels. The tenets to be adhered to are right drug, right dose, right client, right time, and right route. This dovetails into one of the vehicles of the WHO Essential Drugs(medicines) Concept which is people everywhere should have access to the essential medicines they need; that the medicines are safe, effective and of assured quality; and that they are prescribed and used rationally. Implications What are the key issues associated with unused/unwanted medicines at home? Do you know that medicines stored at home deteriorate even if their expiry dates are not due? Do you know that the left over drugs on your shelves can be dangerous to your children, pets, or even old aged people or mentally retarded people at your home? Do you also know that there is some minute concentration of drugs in our ground water, surface water and even drinking water? Hoarding of waste medicines has been the normal practice in most homes in Ghana. It is a cancer that should be tackled by the country as a matter of urgency. Interestingly, this problem is not peculiar to only pharmaceutical products but also other household products like detergents, creams, perfumes, packaging foods and etc. Another key issue is how do you handle and dispose unused or expired medicines? Until recently there was no facility to address the problem of unused/unwanted medicines in Ghana. Cocoa Clinic, the medical wing of the Ghana Cocoa Board blazed the trail through its Disposal of Unused/Unwanted Medicines Program (‘DUMP’). This was occasioned by some observations made at the clinic. Approximately 113 different medicines were returned by clients of the hospital. About 20% of these were anti-hypertensives and 17% of returned medicines were antibiotics. The programme is currently running at the Trust hospital of Accra with very interesting results. There have been calls to extend this novel idea to all healthcare facilities in Ghana. It is important to spend adequate resources to educate the general public so as to dispel notions of the inappropriate reuse/resale of the returned medicines at medicines outlets in the country. With a good legal framework backed by requisite logistical support it should be possible to place branded ‘DUMP’ boxes at all health care facilities (with active participation of all health care providers) within the country. Aside governmental support, pharmaceutical manufacturers and agencies are critical to the success and sustainability of the programme in Ghana. I am certain that with the right approach they would be willing to continuously support this noble program of the country. This raises the issue of Product Stewardship, an issue gaining currency internationally. This is a product centered approach to environmental protection. Product stewardship calls on those in the product lifecycle i.e. manufacturers, retailers, consumers and disposers to share the responsibility of reducing the environmental impact of products. Take back program is one of the best and recommended ways of disposing waste medicines in line with product stewardship. This program requires the patient to return unused or expired medicines back to the pharmacy shops, drug stores, chemical sellers or hospitals. Finally, manufactures are encouraged to include disposal methods on labelling of their products and be prepared to take back their product for proper disposal. Humans are an integral part of the environment. It has been proven that there are inseparable connections between human health and the quality of environment. Don’t hesitate to take action on your unused or expired medicines because they can be a recipe for disaster in the future. Consume responsibly and dispose responsibly. Credit: Samuel Sasu and Edward Amporful E-mail: [samuel.sasu@uniklinik-freiburg.de and amporful221065@yahoo.com]