Policies to address pharmaceutical waste should take a lifecycle approach, including source-directed, user-orientated and waste management focused measures, targeting the full range of stakeholders and using a combination of voluntary, economic and regulatory instruments.
Recommendation 1: The first priority is to prevent unused or expired medicine. A number of approaches can help avoid the generation of pharmaceutical waste, such as improved disease prevention, precision medicine and improved dimensioning of packaging sizes.1
Recommendation 2: Marketplaces and redistribution platforms for unused close-to-expiry-date medicines provide better matching of supply and demand and contribute to waste prevention and economic savings. Countries should assess possibilities for redistribution. Initiatives in the Netherlands and the United States have highlighted the potential of these measures.
Recommendation 3: The collection of unused medication has to be customised to the national context and local challenges. Separate collection of UEM is useful to control the impacts on the environment and public health by:
Lowering the risk of abuse or accidents by third parties accessing household bins to recover UEM.
Reducing the risk of UEM, in particular liquids, creams and ointments, being flushed down the drain and contaminating waterways.
Avoiding entry of active pharmaceutical ingredients (API) into the environment, via other pathways, such as solid waste, particularly in countries, regions or municipalities where state-of-the-art household waste incineration is not widespread.
Recommendation 4: If a separate collection system is deemed relevant, EPR schemes have shown to be an effective approach to organise environmentally sound collection and treatment.2 Alternative approaches such as publicly financed take-back schemes can also be effective but do not implement the polluter pays principle.
Recommendation 5: If an EPR scheme is implemented, monitoring and prosecution of freeriding by ePharmacies, online sales and postal deliveries should be set up in order to maintain a level playing field for industry and to ensure long-term financing of the scheme.3
Recommendation 6: The following considerations can further support the design of separate collection systems:
Drug take-back should be available to consumers all year-round at convenient collection points and free of charge to minimise transaction costs compared to other disposal routes. Pharmacies have shown to be suitable collection points.
Targets and regular review periods can ensure an economically efficient functioning of producer responsibility organisations (PROs) in EPRs. For instance, the French EPR law accredits PRO mandates in a five-year cycle.
Recommendation 7: The limited awareness of consumers about proper disposal routes and/or the existence of drug take-back schemes induces improper household disposal. In order to increase the awareness, governments and PROs should foresee well-focused communication campaigns. Key elements for impactful communication are:
Identify the target group and the optimal communication channel. Set up indicators and benchmark to monitor the effectiveness of the campaign.
Focus on liquid pharmaceuticals, since studies indicate that this product group is still often discarded via the sink or toilet.
Visible sorting instructions on the packaging contributes to the awareness about take-back facilities.4
Nudging is a strong tool for behavioural change. Programs such as ‘bonus points’ given by pharmacies in Sweden motivate citizens to return UEM to pharmacies.
