A review of medicines reuse: Thematic analysis and metaphors of return economies

This paper provides a literature review on medicines reuse explaining how this phenomenon has evolved and has being re-interpreted in academic research. Literature review in combination with a descriptive and a qualitative thematic analysis was employed to answer two questions: (i) How the medicines returns phenomenon has been documented and discussed? (ii) To what extent the critical literature on circular and sharing/collaborative economies can be taken as metaphors for the advancement of knowledge to better understand the complexities of medicines returns? After the selection of 125 papers, 10 hubs of collaboration were identified in this research field with early work on reuse stemming from the UK. From the thematic analysis, three outcomes emerged. The first relates to the problem of wastage versus costs and affordability, and the role of stockpiles and misplacement of leftover medicines. The second arises from a chronological description of the selected studies. Using a timeline, recurring debates were identified: prescription costs/sharing; reuse in evolutionary perspective of rational use; affordability and avoidance of wastes; and the role of pharmacists and care in the community/solidary pharmacies. The third outcome delivers metaphors linking critical aspects of circular and sharing/collaborative economies with concepts and situations of medicines reuse. It was found that the circular economy, which is still far from consumer reality, offers a limited contribution as a metaphor for medicines reuse, while sharing/collaborative economy reflects current practices that can be understood as access giving, thus interpreted as a form of affordability.