Household medical waste disposal policy in Israel

Abstract

BackgroundLarge 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.MethodsIn this study, we investigated world-wide approaches and programs for household medical waste collection and disposal.ResultsIn 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.ConclusionsSeveral 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13584-016-0108-1) contains supplementary material, which is available to authorized users.

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“…Adding specific instructions regarding disposal of the drug, in the medication label and leaflet have been suggested in previous study conducted in Israel. [18] Public education regarding unused medication disposal is substantial and health-care professionals should provide information to patients on how to dispose unwanted medications and the environmental impact of improper disposal. Government and related stakeholders should establish take-back programs and examining incentives for returning unused medications to pharmacies.…”

“…Government and related stakeholders should establish take-back programs and examining incentives for returning unused medications to pharmacies. [18] National guidelines on the appropriate disposal of unused medications need to be developed and informed to the public.…”

Expired Medication: Societal, Regulatory and Ethical Aspects of a Wasted Opportunity

“…Furthermore, disposing expired medications in the garbage is the most commonly reported practice in various studies conducted in England [23], Lithuania [25], Serbia [26], Malta [27], Ireland [27,28], Romania [29], Cyprus [30], Poland [31], Pakistan [32,33], Bangladesh [34], India [35,36], Malaysia [37][38][39], Thailand [40], Hong Kong [41], China [42], Egypt [43], Ethiopia [44], Nigeria [45,46], Ghana [47], Kuwait [48,49], Qatar [50], Saudi Arabia [51], Israel [52], United States [53][54][55][56], Brazil [57,58], New Zealand [20], and Australia [19].…”

Mitigating pharmaceutical waste exposures: policy and program considerations

“…The authors note that lack of awareness among consumers and physicians “regarding the health and environmental implications of medication accumulation and disposal” is a significant barrier in the successful application of any program [1]. While this is likely true, awareness alone is not sufficient to motivate change in individual health behavior.…”

“…In a recent IJHPR article, Barnett-Itzhaki and colleagues discuss the unique challenges of inappropriate disposal of pharmaceuticals in Israel due to the lack of any national policy or program to address the issue. To this end, the authors review national programs and policies throughout the world (focusing on Europe and North America but also noting programs in selected Middle Eastern countries) and suggest possible policy directions for Israel [1]. …”