Unused medications could cause harm to children

The Health Ministry told health fund pharmacies to accept unused drugs free of charge even from people who were not members in that health fund, and some have installed drop boxes.

January 10, 2017 01:14
3 minute read.

Pills. (photo credit: INGIMAGE / ASAP)


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Only 13.9% of Israelis dispose properly of outof- date or unused medications by returning them to their pharmacy.

The result can be potential seepage of prescription and over-the-counter drugs into the groundwater and accumulation in the environment and unintentional poisoning of children who come across them. About a third of unintentional poisoning cases in the US resulted from uncontrolled use of medications.

This was reported in the article “Household medical waste disposal policy in Israel” published in Israel Journal of Health Policy Research.

Zohar Barnett-Itzhaki, Dr. Tamar Berman, Prof.

Itamar Grotto and Dr. Eyal Schwartzberg of the Health Ministry wrote that the vast majority of unused drugs are thrown in the garbage or flushed down the toilet, potentially contaminating waste water and even drinking water. There is evidence that pharmaceutical active ingredients reach the environment, including food.

While many countries around the world have programs for household medical waste collection – and even laws to deal with medical waste disposal in homes as well as hospitals, clinics, there is no legislation for medication disposal here.

The authors recommend legislation and regulation to enable a variety of institutes to collect household medical waste, implementing the “polluter pays” principle and enforcing medical products manufactures to pay for the collection and destruction of household medical waste.

They also call for raising awareness of patients, pharmacists and other medical health providers on the health and environmental risks in accumulation of drugs and throwing them to the garbage, sink or toilet; and adding specific instructions regarding disposal of the drug, on the medication label.

They also suggested examining the issues of incentives for returning medications to pharmacies and drug collection from deceased in retirement homes and hospitals.

Some of the medications, they wrote, consist of stable ingredients that may accumulate in the environment and are barely removed in wastewater treatment plants. Therefore, residues of medications may contaminate purified wastewater that are used for agricultural irrigation. More than 90% of the wastewater in Israel is treated in treatment plants, most of which is used for agriculture.

In recent years, researchers have found that agricultural products irrigated with treated wastewater contain pharmaceutical compounds.

However, some of the medications found in wastewater are excreted from humans and animals and not from medications thrown into the garbage or down the toilet.

Today, most European countries supply detailed information regarding the collection of unused or expired medications. Information channels range from oral information to the patient by the physician or the pharmacist on the best way of disposal, brochures, comprehensive information via websites, information on collection containers and information on the package of the pharmaceutical product.

Several European countries have legislation requiring pharmacies to collect household medical waste including Iceland, Estonia, Belgium, UK, Denmark, Lithuania, Lichtenstein, Norway, France, Hungary, and Croatia. In the UK, the National Health Service is in charge of collection of medical waste from pharmacies that were returned by households and residential homes.

In France, collected drugs that were still usable were redistributed to humanitarian associations, a project that exists in Israel as well.

To prevent children from ingesting thrown away pills, the authors noted that foreign authorities initially recommended mixing medications (without crushing tablets or capsules) with an unpalatable substance such as dirt, kitty litter or used coffee grounds and then placing the mixture in a container such as a sealed plastic bag and throwing it to the garbage. But then they changed their policy and urged that they be collected at pharmacies, special drop boxes and even in police stations.

The Health Ministry told health fund pharmacies to accept unused drugs free of charge even from people who were not members in that health fund, and some have installed drop boxes. In 2006, one pharmaceutical company initiated, in coordination with the ministry, a campaign for collecting unused medications from the public. People who returned drugs received in exchange, a pack of vitamin C. But only a small minority of Israelis actually return drugs they don’t need, and the country is way behind others.

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