title: Household medical waste disposal policy in Israel.
abstract: 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.
  
  
  
  In this study, we investigated world-wide approaches and programs for household medical waste collection and disposal.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Public Health Services, Ministry of Health, 39 Yirmiyahu St, Jerusalem, Israel ; Mimshak, The Israel society of ecology and environmental sciences, 19 Kehilat New York St, Tel Aviv, Israel.
authors.forename: Zohar
authors.identifier: 0000-0001-9891-9397
authors.initials: Z
authors.lastname: Barnett-Itzhaki
authors.affiliation: Public Health Services, Ministry of Health, 39 Yirmiyahu St, Jerusalem, Israel.
authors.forename: Tamar
authors.initials: T
authors.lastname: Berman
authors.affiliation: Public Health Services, Ministry of Health, 39 Yirmiyahu St, Jerusalem, Israel ; Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, Israel.
authors.forename: Itamar
authors.initials: I
authors.lastname: Grotto
authors.affiliation: Pharmaceutical Division, Ministry of Health, 39 Yirmiyahu St, Jerusalem, Israel ; Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O.B. 653, Beer-Sheva, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Schwartzberg
mesh_terms: D004356:Drug Storage; D014943:Global Health; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007557:Israel; D008506:Medical Waste / Q000009:adverse effects; D017744:Medical Waste Disposal / Q000331:legislation & jurisprudence / Q000379:methods*; D004364:Pharmaceutical Preparations
chemical_list: D008506:Medical Waste; D017744:Medical Waste Disposal; D004364:Pharmaceutical Preparations
keywords: Environment; Medication; Pharmaceutical waste; Polluter pays; Pollution; Return Unwanted Medicines