Top

Israel Journal of Health Policy Research

Published in:

Open Access 01-12-2016 | Integrative article

Household medical waste disposal policy in Israel

Authors: Zohar Barnett-Itzhaki, Tamar Berman, Itamar Grotto, Eyal Schwartzberg

Published in: Israel Journal of Health Policy Research | Issue 1/2016

Abstract

Background

Large amounts of expired and unused medications accumulate in households. This potentially exposes the public to hazards due to uncontrolled use of medications. Most of the expired or unused medications that accumulate in households (household medical waste) is thrown to the garbage or flushed down to the sewage, potentially contaminating waste-water, water resources and even drinking water. There is evidence that pharmaceutical active ingredients reach the environment, including food, however the risk to public health from low level exposure to pharmaceuticals in the environment is currently unknown. In Israel, there is no legislation regarding household medical waste collection and disposal. Furthermore, only less than 14 % of Israelis return unused medications to Health Maintenance Organization (HMO) pharmacies.

Methods

In this study, we investigated world-wide approaches and programs for household medical waste collection and disposal.

Results

In many countries around the world there are programs for household medical waste collection. In many countries there is legislation to address the issue of household medical waste, and this waste is collected in hospitals, clinics, law enforcement agencies and pharmacies. Furthermore, in many countries, medication producers and pharmacies pay for the collection and destruction of household medical waste, following the “polluter pays” principle.

Conclusions

Several approaches and methods should be considered in Israel: (a) legislation and regulation to enable a variety of institutes to collect household medical waste (b) implementing the “polluter pays” principle and enforcing medical products manufactures to pay for the collection and destruction of household medical waste. (c) Raising awareness of patients, pharmacists, and other medical health providers regarding the health and environmental risks in accumulation of drugs and throwing them to the garbage, sink or toilet. (d) Adding specific instructions regarding disposal of the drug, in the medication label and leaflet. (e) Examining incentives for returning medications to pharmacies. (f) Examining drug collection from deceased in retirement homes and hospitals.

Available only for authorised users

Naidu RP. Causality assessment: A brief insight into practices in pharmaceutical industry. Perspect Clin Res. 2013;4(4):233–6.CrossRefPubMedPubMedCentral

Gu Q, Dillon CF, Burt VL. Prescription drug use continues to increase: U.S. prescription drug data for 2007–2008. NCHS Data Brief. 2010; (42):1–8. http://www.cdc.gov/nchs/products/databriefs/db42.htm. Accessed Oct 2016.

Vollmer G. Disposal of Pharmaceutical Waste in Households – A European Survey. In: Kummerer K, Hemple M, editors. Green and Sustainable Pharmacy. Freiburg: Springer-Verlag Berlin Heidelberg; 2010. p. 165–78.

Maccabi’s Corporate Responsibility Report 2009–2010. http://www.maccabi4u.co.il/SIP_STORAGE/files/2/9392.pdf. Accessed 9 Mar 2016.

Alvin B, et al. 2009 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 27th Annual Report. Clin Toxicol. 2010;48(10):979–1178.CrossRef

Israel poison information center. https://www.rambam.org.il/departmentsandclinics/laboratoriesdiv/clinicalpharmacologyandtoxicology/poisonings/Pages/Default.aspx. Accessed 14 Feb 2016.

Lester Y, Avisar D, Mamane H. Removal of pharmaceuticals using combination of UV/H₂O₂/O₃ advanced oxidation process. Water Sci Technol. 2011;64(11):2230–8.CrossRefPubMed

Gilbert N. Drug-pollution law all washed up. Nature. 2012;491(7425):503–4.CrossRefPubMed

World Health Organization. Pharmaceuticals in drinking-water. (2012). http://apps.who.int/iris/bitstream/10665/44630/1/9789241502085_eng.pdf?ua=1. Accessed 14 Feb 2016.

10.

Schlüter A, Szczepanowski R, Pühler A, Top EM. Genomics of IncP-1 antibiotic resistance plasmids isolated from wastewater treatment plants provides evidence for a widely accessible drug resistance gene pool. FEMS Microbiol Rev. 2007;31(4):449–77.CrossRefPubMed

11.

Chen J, et al. A survey of drug resistance bla genes originating from synthetic plasmid vectors in six Chinese rivers. Environ Sci Technol. 2012;46(24):13448–54.CrossRefPubMed

12.

Cosgrove SE, Carmeli Y. The impact of antimicrobial resistance on health and economic outcomes. Clin Infect Dis. 2003;36(11):1433–7.CrossRefPubMed

13.

DIRECTIVE 2001/83/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, 2001. http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2001:311:0067:0128:en:PDF. Accessed 12 Feb 2016.

14.

DIRECTIVE 2004/27/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL, 2004. http://www.biosafety.be/PDF/2004_27.pdf. Accessed 12 Feb 2016.

15.

Health care without harm Europe website. https://noharm-europe.org/sites/default/files/documents-files/2616/Pharm%20Report_WEB.pdf. Accessed 30 Jun 16.

16.

Pharmaceutical Services Negotiating Committee. http://psnc.org.uk/services-commissioning/essential-services/disposal-of-unwanted-medicines/. Accessed 14 Feb 2016.

17.

Kingsmore L. The management of post-consumer pharmaceutical waste: a comparison between British Columbia and Ontario programs. Winthrop University. 2009 http://digital.library.ryerson.ca/islandora/object/RULA%3A3020/datastream/OBJ/view. Accessed 14 Feb 2016

18.

Health Canada. Pharmaceutical disposal programs for the public: A Canadian perspective. Health Canada environmental impact initiative. 2009. http://c.ymcdn.com/sites/www.productstewardship.us/resource/resmgr/imported/Takeback%20(2).pdf. Accessed Oct 2016.

19.

California Product Stewardship Council. International Programs for Pharmaceuticals. http://calpsc.org/products/pharmaceuticals/international-epr-programs-for-pharmaceuticals/. Accessed 10 March 2016.

20.

U.S food and drug administration. Disposal of Unused Medicines: What You Should Know. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm. Accessed 14 Feb 2016.

21.

California Product Stewardship Council. A call on the FDA to end its recommendation that certain medications be disposed by flushing. http://calpsc.org/mobius/cpsc-content/uploads/2016/01/FINAL-FDA-Sign-on-Letter-Sent-1-22-16.pdf. Accessed 14 Feb 2016.

22.

DEA’s Diversion Control Program - US Department of Justice. http://www.dea.gov/divisions/hq/2014/hq090814.shtml. Accessed 10 Mar 2016.

23.

Take Back Your Meds. http://www.takebackyourmeds.org/dea-events. Accessed 14 Feb 2016.

24.

New-York state department of environmental conservation http://www.dec.ny.gov/chemical/63826.html. Accessed 14 Feb 2016.

25.

Manitowoc county recycling center. http://www.manitowocrecycles.org/. Accessed Oct 2016.

26.

Massachusetts law: An Act relative to substance use, treatment, education and prevention. https://malegislature.gov/Bills/189/House/H4056. Accessed 6 Jul 16.

27.

California Product Stewardship Council. Pharmaceuticals. http://calpsc.org/products/pharmaceuticals/. Accessed 14 Feb 2016.

28.

Santa Cruz county safe drug and sharps disposal http://c.ymcdn.com/sites/www.productstewardship.us/resource/resmgr/2016_Legislation_PDFs/2015_CA_Santa_Cruz_Pharms.pdf. Accessed 6 Jul 16.

29.

Gracia-Vásquez SL, et al. An analysis of unused and expired medications in Mexican households. Int J Clin Pharm. 2015;37(1):121–6.CrossRefPubMed

30.

SINGREM. http://www.singrem.org.mx/laboratoriosParticipantes.html. Accessed 14 Feb 2016.

31.

Return unwanted medicine (the RUM project). http://www.returnmed.com.au/. Accessed 14 Feb 2016.

32.

El-Hamamsy M. Unused Medications: how cost and how disposal of in Cairo, Egypt. Int J Pharm studies and res Clin. 2011;2(1):21–7.

33.

Ibrahim SZ, Mamdouh HM, El-Haddad IZ. Analysis of medications returned to community pharmacies in Alexandria, Egypt. Life Science J. 2012;9(2):746–51.

34.

Ashoka website. https://www.ashoka.org/fellow/waleed-shawky. Accessed 30 Jun 2016.

35.

Massoud MA, Chami G, Al-Hindi M, Alameddine I. Assessment of Household Disposal of Pharmaceuticals in Lebanon: Management Options to Protect WaterQuality and Public Health. Environ Manage. 2016;57(5):1125–37.CrossRefPubMed

36.

Al-Shareef F, et al. Investigating the disposal of expired and unused medication in Riyadh, Saudi Arabia: a cross-sectional study. Int J Clin Pharm. 2016. doi:10.1007/s11096-016-0287-4.PubMed

37.

The Ministry of Health, Israel. http://www.health.gov.il/hozer/sbn16_2011.pdf. Accessed 14 Feb 2016.

38.

Maccabi HMO. http://www.maccabi4u.co.il/8223-HE/Maccabi.aspx. Accessed 14 Feb 2016.

39.

Friends for Health. http://www.haverim.org.il/. Accessed 14 Feb 2016.

40.

Central Bureau of Statistics. http://www.cbs.gov.il/reader/newhodaot/hodaa_template.html?hodaa=201519229. Accessed 14 Feb 2016.

41.

Mir D. Hazardous Household Chemicals and Hazardous Waste: Policy and Procedures Recommendations for Implementation in Israel. Samuel Neaman institute for national policy research. 2012. http://www.neaman.org.il/Neaman2011/userdata/SendFile.asp?DBID=1&LNGID=1&GID=2685. Accessed 14 Feb 2016.

42.

Dispose my meds website. http://www.disposemymeds.org/. Accessed 30 June 2016.

43.

Illinois Environmental Protection Agency. Disposal of Unwanted / Unused Pharmaceuticals http://www.epa.illinois.gov/topics/waste-management/waste-disposal/household-hazardous-waste/pharmaceuticals/index. Accessed 14 Feb 2016.

44.

The White House website (USA). https://www.whitehouse.gov/the-press-office/2016/07/05/obama-administration-takes-more-actions-address-prescription-opioid-and. Accessed 14 Jul 16.

45.

Alberta Pharmacists association. http://www.rxa.ca/for-the-public/medication-disposal.aspx. Accessed 30 Jun 16.

46.

Health Product Stewardship association. http://www.healthsteward.ca/sites/default/files/2014%20BCMRP%20Annual%20Report.pdf. Accessed 30 June 16.

47.

California Product Stewardship Council. International Pharmaceutical EPR Program Fact Sheet. http://calpsc.org/mobius/cpsc-content/uploads/2015/05/Hungary_Fact_Sheet_2_24_2015.pdf. Accessed 14 Feb 2016.

48.

UK department of health. Environment and sustainability Health Technical Memorandum 07–01: Safe management of healthcare waste. 2013. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/167976/HTM_07-01_Final.pdf. Accessed 30 Jun 16.

49.

Calderdale council website. http://www.calderdale.gov.uk/environment/waste/household-collections/clinical-collections.html. Accessed 30 Jun 16.

Title: Household medical waste disposal policy in Israel
Authors: Zohar Barnett-Itzhaki
Tamar Berman
Itamar Grotto
Eyal Schwartzberg
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Israel Journal of Health Policy Research / Issue 1/2016
Electronic ISSN: 2045-4015
DOI: https://doi.org/10.1186/s13584-016-0108-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Household medical waste disposal policy in Israel

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2016

A feasibility study to assess the validity of administrative data sources and self-reported information of breast cancer survivors

The impact of facility characteristics on the use of antipsychotic medications in nursing homes: a cross-sectional study

Dealing with ambiguity: Israeli physician’s attitudes and practices regarding pre-exercise certificates: a questionnaire study

Energy drink consumption in Israeli youth: Public health & the perils of energetic marketing

Social media as a platform for science and health engagement: challenges and opportunities

Do women prefer a female breast surgeon?