Introduction
Methods
World-wide approaches and programs for drug collection and disposal
Europe
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Several states in Europe have legislation obliging pharmacies to collect household medical waste: Iceland, Estonia, Belgium, UK, Denmark, Lithuania, Lichtenstein, Norway, France, Hungary, and Croatia [3, 15] (see Table 1). In the UK, the National Health Service (NHS) is in charge of collection of medical waste from pharmacies that were returned by households and residential homes [16]. In France, collected drugs that were still usable were used to be redistributed to humanitarian associations [17].Table 1Comparison between the policies, collection and funding systems, regarding household medical waste in six selected countriesCountryNational drug collection programLegislationCollection methodFundingMedical collected (weight)/collection rates (annual)USA0.01 kg/capita [44]CanadaMost of the provinces and territories run such programs (See Table 3)HungaryThe law obliges the pharmaceutical industry to establish and operate a disposal system or give this duty to another organization [15]Pharmacies and other selling points, containers in specific collection points [15]Pharmaceutical Industry Groups [15]0.02 kg/capita [15]UKNo programAccording to the UK environmental protection act and additional regulations, all Pharmacies are obliged to accept back unwanted medicines from patients [48].Local governments [15].Not availableAustraliaRUM (Return Unwanted Medicines) [31]Each state and territory have their own regulation regarding medicine disposal (embedded in the Drugs and Poisons Acts of each individual state)Special containers mounted in all pharmacies [31]Funded by the government until end of June 2018; then will be reconsidered. [31]0.03 kg/capita [31]IsraelNo programNo legislationHMO pharmacies are obliged to receive medicines from the public.The Israeli Ministry of Health13.9 % of the population [40]
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In several states, pharmacies collect household drugs on a voluntary base: Italy, Ireland, Albania, Austria, Germany, Netherland, Luxemburg, Latvia, Slovenia, Spain, Poland, Portugal, Finland, The Czech republic, Sweden, and Switzerland [3].
USA
How are unused drugs collected? | Examples |
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Drug collection events every several months in accordance with the DEA. The collection is free and anonymous [23]. | |
Drug collection on a monthly base | Pharmacies collect non-controlled prescription drugs and OTC medications on the last Saturday of every month in New-York state [24]. |
Secured drop boxes for drug collection that can be accessed in specific days and times. | Secure drop boxes in New-York state that can be accessed in specific days and times, several such drop boxes are available for the public 24 h a day, seven days a week [24]. |
Collection by the law enforcement agencies (Sheriff office, police) | In Manitowoc (Wisconsin) there are drug collection drop boxes in police stations [25]. |
Collection of unused or expired drugs by pharmacies. | Most of the states. |
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In 2016 in Massachusetts, “An Act relative to substance use, treatment, education and prevention” was passed. The law follows the “polluter pays” principle, in which pharmaceutical companies fund the collection, transfer and treatment of household unused and expired drugs [26].
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In New-York state the police and the Sheriff office usually fund the drug collection and transfer. In addition, in several counties in this state, it is funded by additional organizations or county departments [24]:
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BRiDGES Madison Co. Council on Alcoholism and Substance Abuse (Madison county) -
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Monroe County Department of Environmental Services -
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Tompkins County Department of Probation -
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Alliance for Safe Kids and Department of Environmental Facilities (Westchester county) -
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Guthrie Environmental Health (Jefferson county) -
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Department of Public Safety (Suffolk county)
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In Manitowoc county (Wisconsin), the drug collection programs are sponsored by a variety of agencies related to health and the environment.
Canada
Province/territory | Program and year of initiation | Voluntary of regulated framework | Return location | Funding sources |
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Alberta | ENVIRx (1988) | Voluntary | Pharmacies | Pharmaceutical companies, provincial government |
British Columbia | BC MRP (1999) | Regulated under environmental management act | Pharmacies | Pharmaceutical and consumer health product industries |
Manitoba | Manitoba MRP (2011) | Regulated under The Waste Reduction and Prevention Act) | Pharmacies | Pharmaceutical and consumer health product industries |
New Brunswick | None | Some of the pharmacies | ||
Newfound-land and Labrador | Household Hazardous Waste (1998) | Voluntary | Household hazardous waste depots | Provincial and municipal governments |
Nova Scotia | Medication Disposal Program (mid 1990s) | Voluntary | Pharmacies | Pharmaceutical companies |
Yukon/Quebec | None | Collection events, most of the pharmacies | ||
Nunavut | None | Pharmacies and health centers | ||
Ontario | Ontario MRP (2013) | Regulated under Environmental Protection Act | Collection events, pharmacies | Pharmaceutical and consumer health product industries, Provincial government |
Prince Edward Island | Take it back (2004) | Voluntary | Pharmacies and Waste Watch Drop-off centers | Island Waste Management Corporation |
Saskatchewan | Pharmaceutical Waste Disposal (1997) | Voluntary | Pharmacies | Pharmacies |
Selected central and south America countries
Australia
Selected Middle East Countries
Approaches for drug collection and disposal in Israel
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In 2001 the Ministry of Health published a circular that instructed the HMO pharmacies to receive unused medications, by any person (not necessarily HMO member), free of charge. This document requires the HMOs to transfer the collected medications to pharmaceutical waste centers [37]. Accordingly, the HMOs have mounted secured iron drop-boxes for medication collection [38].
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In 2006, one leading private pharmacy in Israel initiated, in coordination with the Israeli Ministry of Health, a campaign for collecting unused medications from the public. Those who returned unused medications to the pharmacy, got in return a new pack of vitamin C.
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In 2003 the Israeli organization “Friends for health” ( “Haverim Le’refua”) was established in order to help needy populations of sick and handicapped people. One of its major projects deals with medication recycling. The organization collects unused medications from patients and their families, and transfers them to sick people. This procedure was formally added to the pharmacist ordinance, as part of a legislative amendment of the Pharmacists Ordinance. Additionally, the organization runs a pharmacy (supervised by the Ministry of Health) which receives pharmaceuticals from the pharmaceutical companies and gives them to patients [39].
City | Medication return (%) |
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Jerusalem | 10.7 |
Haifa | 18.6 |
Petach-Tikva | 17.7 |
Ashdod | 15.3 |
Tel-Aviv Jaffa | 14.8 |
Rishon Letzion | 12.1 |
Total | 13.9 |