Up to one-third of patients do not consume all the medicines dispensed by their pharmacy [1]. Patients either return unused medicines to pharmacies, where they are treated as special waste and discarded, or dispose of them at home as household waste [2]. This may result in medicinal waste, loss of healthcare resources, and environmental pollution in cases of incorrect medication disposal [3–5]. The annual economic impact of medication waste among Saudi families is estimated to be $150 million annually [6]. Medication waste in Saudi Arabia accounts for 25.8%, compared to 41.3% in other Gulf countries [6]. A substantial proportion of medicines [ranging from 20% to 90%] are returned to the pharmacy in their original, unopened packaging [7–11]. Thus, some healthcare systems have proposed the re-dispensing of returned and unused medication [7–14].

Re-dispensing medications involves reissuing medications that have been returned unused by patients or their families, typically within healthcare settings such as hospitals, pharmacies, or nursing homes [7–14]. However, the success of such initiatives depends on the following [12, 13]: 1) the willingness of patients to return unused medication to the pharmacy and accept re-dispensing of unused medicines for their treatment; 2) the availability of legal authorization and clear guidelines on which medicines can be re-dispensed, and the circumstances under which this can occur; 3) the adaptation of verification procedures, quality assurance processes, or advanced packaging technologies that could notify pharmacists if medicines have been improperly stored, handled, or tampered with, so the medication is in good condition and meets all safety criteria; and 4) the inclusion of visible expiry dates on the drug’s packaging to verify its validity and safety.

Although reusing unused returned medicines could lead to waste reduction and environmental protection, this concept remains widely debated [7–13]. Concerns about safety, product quality, effectiveness, and psychological discomfort associated with the use of medications previously owned by others are the reasons why re-dispensing is not widely adopted as a standard practice in most countries [13]. The Saudi Ministry of Health currently considers the reissue of medicines unethical and prohibits this practice. Similarly, the World Health Organization’s guidelines for drug donations also discourage sending unused medicines from one country to another unless medications meet specific criteria, such as being in their original container, unopened packaging, and having a long shelf life. These guidelines emphasize the importance of ensuring that donated medications are both effective and safe [14]. Despite this, the possibility of reusing medications has been discussed several times. A charity in the United Kingdom (UK) has also been re-dispensing patients’ unused medicines for humanitarian aid [15]. In the United States (USA), for instance, unused medications are collected and redistributed to patients who cannot afford the cost of medication [16]. In Italy, a return and reuse medication program was implemented for 3 years, demonstrating the benefits of reusing medication, primarily in reducing costs [17]. Studies in the UK and the Netherlands found that people would accept the re-dispensing of unused medicines if product quality and safety were guaranteed [13, 18–20]. In line with these international experiences, recent evidence from Jordan found that nearly three-quarters of the public expressed willingness to reuse unused medicines if safety and quality were guaranteed, with economic and environmental benefits cited as key motivators [21]. Beyond public perspectives, healthcare providers and stakeholders have highlighted the importance of tamper-evident packaging, digital monitoring of storage conditions, and clear legal frameworks to ensure feasibility [18, 22–24]. These insights suggest that while medication reuse has the potential to reduce waste and support sustainability, its success depends on robust safety verification, professional oversight, and alignment with international and national regulations. This could potentially address both preventable and non-preventable causes of medication waste. Preventable causes include patient stockpiling, while non-preventable causes include patient death, recovery, or a change in treatment [24].

Medication waste imposes considerable economic, environmental, and healthcare burdens [2–6]. While international initiatives in countries such as the UK, USA, Italy, and the Netherlands have explored medication reuse, and regional evidence from Jordan has demonstrated public willingness under strict safety conditions, no study has yet examined this issue in Saudi Arabia. Understanding public attitudes and the factors influencing acceptance of re-dispensed medications is essential for informing national policy, reducing waste, and ensuring patient safety. This study, therefore, fills a critical gap by providing evidence specific to the Saudi context, with implications for sustainable healthcare practices and regulatory development. The aim of this study is to assess the public’s willingness to use unused medicines returned to the pharmacy by other patients and the characteristics associated with this willingness. Thoroughly understanding patients’ willingness to use returned, unused medications is essential for assessing the feasibility of re-dispensing them.

This study examined public attitudes in Saudi Arabia toward the reuse of unused medications returned to pharmacies, revealing both cautious support and significant influencing factors. Approximately 60% of our participants expressed willingness to accept re-dispensed tablets and capsules, aligning with the international literature. Bekker et al. [13] in the Netherlands reported a similar acceptance rate (61.2%) when quality was guaranteed, while McRae et al. [26] found even higher willingness in Wales, with 78.7% and 75.1% acceptance of tablets and capsules, respectively. The preference in our study for non-invasive dosage forms such as tablets and capsules, and rejection of injections or pessaries mirrors these earlier findings [26]. Alhamad et al. [21] also observed higher public acceptance for reusing oral medications than other forms, emphasizing that dosage form greatly affects public trust in reused medications. Although the healthcare systems in the Netherlands and Wales differ from that of Saudi Arabia—particularly regarding medication dispensing and reuse regulations—the comparison was drawn to highlight international patterns of public acceptance rather than direct policy equivalence.

Our participants emphasized the importance of pharmacist verification, intact packaging, expiry date visibility, and informed consent, which were also highlighted in the McRae [26] and Bekker [13] studies as essential conditions for public approval. This reinforces the idea that the successful implementation of reuse programs depends on rigorous safety protocols and transparent communication.

The results also showed that although 59.5% of the participants had never returned unused medicines to the pharmacy, most indicated that they would do so if a reuse program existed. This matches the patterns reported in Wales [26] and the Netherlands [13], where participants expressed a greater willingness to return medications when they believed the system would use them effectively. These findings suggest that, while public support for medication reuse exists in Saudi Arabia, it highly depends on safety, transparency, and trust in the pharmacy system. With proper protocols, legal backing, and public education, there is strong potential to implement effective and widely accepted medicine reuse programs.

Interestingly, 50.6% of respondents in the current study believed that all medications, not just expensive ones, should be eligible for re-dispensing—a more progressive view than that reported in the UK [26] or Netherlands [13]. McRae et al. [26] found that some participants believed free medications were less valued, which may reduce public motivation for reuse in such systems. In contrast, our findings suggest that in Saudi Arabia, environmental and social responsibility may override cost considerations, reflecting a public concern about medication waste (66.4% expressed concern).

Another key finding was the influence of demographic factors. Younger participants were significantly more willing to use re-dispensed medications than older participants. This aligns with Alhamad et al. [21], who found that younger individuals in Jordan were more open to reuse initiatives, potentially because of more flexible attitudes and greater environmental awareness. Interestingly, Bekker et al. [13] did not find age to be a statistically significant predictor, suggesting possible cultural or system-based differences. Our study revealed that being employed or retired was associated with a lower willingness to use medications that had been previously dispensed. The lower willingness observed among retired participants may be attributed to greater safety concerns and perceived vulnerability among older adults, who typically use multiple medications and may prefer newly dispensed medicines to minimize perceived risks. Similarly, Alhamad et al. [21] found that employed individuals, particularly those with higher education or in the healthcare sector, showed more skepticism about safety issues.

In our analysis, regular users of prescription medications were more hesitant to accept re-dispensed drugs, which may reflect heightened safety concerns or higher expectations of medicine quality. This contrasts with Bekker et al. [13], who found that those regularly using medications were more willing to accept reused medications, possibly because of familiarity and experience. This discrepancy may also arise from cultural attitudes toward medication safety or differences in trust levels within the healthcare system. Alhamad et al. [21] similarly observed mixed reactions among chronic medication users; while some supported reuse due to cost and environmental concerns, others worried about effectiveness and storage integrity.

In our study, concern about medication waste was a significant predictor, but contrary to expectations, those who expressed greater concern were less likely to accept re-dispensed medications. This suggests that, while people may acknowledge the issue of medication waste, their concerns about safety, storage, or quality may outweigh their willingness to participate in reuse initiatives. This finding contrasts with those of previous studies. For instance, McRae et al. [26] reported that 89.1% of participants were concerned about medicinal waste, which was associated with a greater acceptance of reuse schemes. Similarly, Bekker et al. [13] found that participants who had experience with unused medications or had returned medicines were more open to re-dispensing. Alhamad et al. [21] also observed that environmental concerns and the desire to reduce waste are key motivators for supporting medication reuse. These conflicting results highlight the need for targeted public education that not only raises awareness about the scale of medication waste but also reassures the public about the safety and regulatory oversight of re-dispensing programs. Future policies should prioritize building public trust by involving pharmacists in quality verification, ensuring transparent communication, and utilizing tamper-evident packaging or smart storage monitoring technologies [21, 27]. Bridging this perception gap is critical for transforming environmental concerns into actionable public support for sustainable pharmaceutical practices [21, 27].

Globally, the legality and feasibility of medication re-dispensing vary considerably across healthcare systems. Several countries have piloted or implemented medication reuse initiatives under strict regulatory and professional oversight to ensure product integrity and patient safety. For instance, the United Kingdom and the Netherlands have explored pharmacist-led reuse programs supported by tamper-evident packaging and digital monitoring systems to verify storage conditions and safety [13, 17, 18, 20]. In the United States, several states have enacted laws permitting the return and reuse of medications, primarily through safety-net or charitable programs that serve underserved populations [16]. Similarly, in Italy, a government-regulated program was piloted for 3 years, demonstrating the operational feasibility of medicine return and redistribution. Regionally, evidence from Jordan highlights strong public support for medication reuse, provided that safety and quality are ensured [21].

At the international level, the World Health Organization discourages the cross-border donation of unused medicines unless stringent quality and safety requirements are met [14]. These international and regional experiences collectively highlight both the potential advantages of reuse—such as cost savings, waste reduction, and improved access—and the operational and ethical challenges, including maintaining storage integrity, labeling accuracy, and public trust. In contrast, the Saudi Ministry of Health currently prohibits medication reuse on ethical grounds, and Saudi Arabia lacks a formal legal or regulatory framework to govern such practices. While lessons from other countries can inform local policy development, successful implementation in Saudi Arabia will require context-specific legislation, clear professional accountability, and public education to ensure safety, ethical compliance, and sustainability.

This study offers valuable insights into the public perception and acceptance of medication re-dispensing in Saudi Arabia. While overall support was cautious yet notable, particularly for oral solid dosage forms, willingness was highly dependent on safety assurances such as pharmacist verification, intact packaging, and informed consent. Key demographic factors, including age, employment status, regular prescription use, and attitudes toward medication waste, significantly influenced participants’ willingness to accept re-dispensed medications.

Interestingly, although many participants expressed concern about medication waste, this did not always translate into a higher willingness to use returned medicines, indicating a complex relationship between environmental awareness and perceptions of personal safety. Compared to findings from Western countries, Saudi respondents appeared to be more supportive of re-dispensing all types of medications, not just expensive ones, highlighting a potentially broader sense of social responsibility.

These findings suggest that the successful implementation of a medication reuse program in Saudi Arabia will require more than regulatory change; it will demand sustained public education, pharmacist engagement, and investment in safety and quality control measures. Pilot initiatives supported by strong policy frameworks and community trust-building efforts could serve as a foundation for scalable national programs to reduce waste and promote sustainable medicine use. At the same time, it is essential to recognize that medicines are not ordinary consumer products. Unlike items that can be reused without consequence, medicines have pharmacokinetic and pharmacodynamic properties that directly influence their safety, stability, and therapeutic effectiveness. Therefore, any future redispensing initiatives must be guided by strict professional and regulatory standards to ensure patient safety. Only medicines in their original, unopened manufacturer packaging with intact seals and visible expiry dates should be considered, and their reuse should occur under pharmacist supervision, supported by robust verification processes. By embedding such safeguards, redispensing programs can achieve their intended goals of reducing waste and promoting sustainability without compromising the quality and safety of patient care.