[Pharmwaste] RE: Cost free disposal program

Thu Aug 22 17:00:54 EDT 2013

Meika,

If you are looking at funding, ditto going with Product Stewardship!

For large programs that could be possible models, check out what is
being done in other countries.
Jennifer V. provided you with great links which include descriptions of
some of these programs.
Many are referenced in a 2008 paper from the PSI.  I don't think that
paper was among the links Jennifer sent.

Doing a quick search of the PSI website, I couldn't find this 2008
paper.  Can someone provide Meika with a link?
I'm pasting an excerpt from it below.

Ed Gottlieb
Chair, Coalition for Safe Medication Disposal
Industrial Pretreatment Coordinator
Ithaca Area Wastewater Treatment Facility
525 3rd Street
Ithaca, NY 14850
(607) 273-8381
fax: (607) 273-8433

Canada[1] ( #_ftn1 )
The Canadian pharmaceutical return programs are established on the
principles of convenience for customers, public awareness through
advertising, and funding for waste disposal. The program accepts
controlled, OTC and prescription medications. The program is supported
by professional associations and their partners/sponsors, and thus
enjoys wide participation throughout the provinces.

Post Consumer Pharmaceutical Stewardship Association (PCPSA) was
created as a response to regulations requiring industry stewardship
programs in certain provinces of Canada. PCPSA represents various
pharmaceutical and natural health product industries, who fund 80
percent of the program, where the self-care health sector provides the
remaining 20 percent of funding. The program is free to those returning
their medications to participating pharmacies. When a container is full,
the pharmacy contacts the program administrator so it can be picked up,
and the quantity of pharmaceuticals collected is recorded. Final steps
in the program include storage and incineration of the pharmaceuticals.
In 2007, 23,284 kg of medications, or 2,129 containers were collected
from pharmacies in British Columbia through this program.[2] ( #_ftn2 )
More information is available at:
http://www.medicationsreturn.ca/index.html

British Columbia has a Medications Return Program which allows
residents to return expired or unused medications at no charge to
participating community pharmacies throughout the province.  The program
was established voluntarily by the pharmaceutical industry in 1996 and
subsequently regulated by the Post-Consumer Residual Stewardship Program
Regulation in 1997.  The program is financed and managed by the Post
Consumer Pharmaceuticals Stewardship Association, a consortium of
branded, generic and OTC drug makers.  Pharmaceuticals collected through
this program are incinerated.  In 2006, the most recent year for which
data is available, there was a 92% participation rate by licensed
community pharmacies; this translates into over 800 takeback pharmacy
locations in the province. A total of 19,995 kg of medicines in 1,709
containers was returned. This represented an 11% increase in volume over
the previous calendar year 2005. Total cost for managing the program
during the calendar year 2005, including pharmaceutical incineration,
was $257,000 CN. Annual reports for the program through 2006 are
available at:
http://www.env.gov.bc.ca/epd/epdpa/ips/meds/reports/index.html

Alberta Pharmaceutical Association & British Columbia Pharmacy
Association
The ENVIRx program encourages consumers to take unused medications back
to Alberta pharmacies for environmentally safe disposal. Ultimately the
unused drugs are transported to incinerators. The program provides
posters, brochures, a pharmacist information guide and warning labels
for waste containers.

Prince Edward Island
The province has a voluntary program where residents drop off unwanted
medicines at pharmacies. Pharmacies transport the drugs to the solid
waste management company, which pays for proper disposal.

Saskatchewan Pharmaceutical Association
SPhA works with Biomed Recovery and Disposal, a company that collects
and disposes pharmaceutical waste directly from community pharmacies.
The program includes posters reminding consumers to return all outdated,
expired and unwanted drugs and sharps.

Ontario, Manitoba and British Columbia
Browning Ferris Industries (BFI) offers a contract waste disposal
system in Ontario, Manitoba and BC. The company takes returned
medications and/or sterile preparation waste collected in pharmacies and
incinerates them. For information on packaging instructions, see:
http://www.napra.ca/practice/toolkits/toolkit9/package.pdf

Sudbury and District Pharmacists' Association
The region offers a cleanup campaign, and has published data collected
as part of the campaign. Extrapolated, the total cost of waste across
Canada is estimated to be as high as $113,381,687. The data collected
supports the effectiveness of these campaigns.

Ottawa Carleton Pharmacists' Association
This region offers a Medicine Clean Up Campaign that includes letters
to patients, data collection sheet for medicine cabinet cleanup month
and commitment to participate form.[3] ( #_ftn3 )

Other Canadian Resources and Programs
Apotex's "Time to talk"
This program includes a "brown bag medication review form" to assist in
identifying medications for return and disposal.
Canadian Feed the Children and Canadian Medicine Aid Program
Unused drugs can be made available to third world countries through
various programs including CANMAP. The World Health Organization has
published guidelines for drug donations, which outline acceptable
contributions in terms of shipping medications to third world countries.
The guidelines are supported by four core principles:
1.      A drug donation should benefit the recipient to the maximum
extent possible.
2.      A donation should be given with full respect for the wishes and
authority of the recipient, and be supportive of existing government
policies and administrative arrangements.
3.      There should be no double standards in quality: if the quality
of an item is unacceptable to the donor country, it is also unacceptable
as a donation.
4.      There should be effective communication between the donor and
the recipient; donations should be sent on expressed need and should not
be sent unannounced.
The World Health Organization guidelines also state that only drugs
that have not been previously dispensed and with at least a year
remaining before the expiration date is considered acceptable.

Australia
Australia’s Department of Health and Family Services funded a program
for the collection and destruction of unwanted and out-of-date
medicines, known as the Return Unwanted Medicines (RUM) Project in 1998.
In 2005, 501,000 pounds of unwanted pharmaceuticals were collected. For
more information, see: http://www.returnmed.com.au/

Citizens bring their unwanted pharmaceuticals to participating
community pharmacies and convey them to pharmacists.  RUM
Project-approved containers with Rum Project- approved liner and seal
are located in sight, but out of reach to the public locations within
the pharmacy. Pharmacists are required to record the substances as they
are returned and are not reimbursed for their collection services. Five
thousand pharmacies participate in the RUM Project.
When full, containers are collected by the wholesalers and taken to the
wholesaler depot where they must be stored in a quarantined area. The
containers are then palletized for collection by an appointed waste
disposal company. That company delivers the containers to an approved
high temperature incinerator.
The Australian government funds the RUM Project at the cost of
approximately $737,000 annually. The concept of Extended Producer
Responsibility (EPR) has been discussed with drug manufacturers, but no
understanding has been reached with the manufacturers to date. RUM will
continue to pursue this issue. European Union
Eleven of the twenty-seven European Union countries have pharmaceutical
return programs in place serving 90% of European citizens. These
programs allow citizens to return their unwanted pharmaceuticals at
local pharmacies.

The EU national systems are operated and funded in various ways. More
than half of the programs are funded by the pharmaceuticals industry or
by retail pharmacies only. The balance is funded by municipal or
national taxpayers. The operation of the pharmaceutical takeback systems
may be the responsibility of the retail pharmacies or that of public or
private waste contractors. Three examples:

·        Spain. The Spanish program collects waste packaging as well as
the leftover medicines and is operated by SIGRE (Spain Integrated Waste
Management System) as a free service.  Logos appear on medications
indicating that they can be returned to pharmacies for collection.
Citizens may return their medications to over 260 pharmacies across the
country which serve a population of 40 million.  The pharmaceutical
industry originated the program in 2002, and funds the system through
fees based on volumes of sales.  Collected materials are shipped to a
central facility for destruction.  In 2006 the diversion rate was
estimated at .057 kg/ capita, and collected volumes have increased every
year since inception.

·        France. The French program, Cyclamed, was fully established in
1995, is authorized by a federal decree, and is run in a collaborative
manner between manufacturers (265), wholesalers (6), and community
pharmacies (22,590).  Manufacturers fund the program through fees based
on prior year’s sales. Households may return all unused medicines and
packaging. Promotional efforts include bags and leaflets handed out at
the time of dispensing, as well as window stickers, posters and TV
advertising.  The program also includes an element to separate and
redistribute medications to charity.  All residual materials are sent to
waste-to-energy facilities across the country.

·        In Sweden, retail pharmacies must take back unwanted
pharmaceuticals. The pharmacies are owned by the government, which fully
funds the return program. Sweden estimates that 65% of consumers'
unwanted medications are ultimately captured through the return system.
Most pharmaceuticals are incinerated. [4] ( #_ftn4 )
Sweden is also making an effort to address pharmaceutical contamination
in the environment at the source. Medicines are assessed and classified
according to their impact on the environment through their document
“Environmentally Classified Pharmaceuticals.” The goal is to
encourage manufacturers to move toward producing pharmaceuticals that
have reduced toxicity, persistence and bioaccumulation in the
environment. [5] ( #_ftn5 )

[1] ( #_ftnref1 ) More information is available at:
http://www.napra.org/docs/0/97/194/184.asp

[2] ( #_ftnref2 ) Vanasse, Ginette. Post Consumer Pharmaceutical
Stewardship Association. Presentation from PSI’s 1st Pharmaceutical
Dialogue Meeting, Sacramento, CA. June 19, 2008,

[3] ( #_ftnref3 ) For more information, see:
http://www.napra.ca/practice/toolkits/toolkit9/takeback.pdf

[4] ( #_ftnref4 ) Environment and Pharmaceuticals  Apoteket AB (The
National Corporation of Swedish Pharmacies) Stockholm County Council and
Stockholm University, pub. 04-03-07. p. 14 accessed March 20, 2007
http://www.janusinfo.se/imcms/servlet/GetDoc?meta_id=9564

[5] ( #_ftnref5 ) More information is available at:
http://www.janusinfo.se/imcms/servlet/GetDoc?meta_id=10205
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