1. Santé Canada Health Canada 1 Edith Gagnon Environmental Impact Initiative Health Canada Pharmaceutical Disposal Programs: A Canadian Perspective Maine, November 10-11, 2008 International Symposium on Pharmaceuticals in the Home and Environment: Catalysts for Change

2. Santé Canada Health Canada 2 Outline Context Disposal programs –Canada –Other countries Other programs Next steps

3. Santé Canada Health Canada 3 Context The Environmental Impact Initiative (EII) Division of Health Canada, is researching Best Management Practices (BMPs) for commodity groups regulated under the Canadian Food and Drugs Act (F&DA), including pharmaceuticals BMPs aim at reducing the exposure of the environment to F&DA substances and products, to prevent direct environmental impacts and indirect human health impacts If necessary, existing Canadian BMPs will be improved or more appropriate BMPs will be developed

4. Santé Canada Health Canada 4 Context (2) Pharmaceuticals are being found in the environment Consumption versus disposal practices –Canadian consumers dispose of a large part of their unused and expired pharmaceuticals in garbage, toilets, and sinks By changing the behaviour of consumers, environmental contamination can be reduced –Disposal programs may reduce the levels of pharmaceuticals entering the environment

5. Santé Canada Health Canada 5 Disposal programs Program : Province : Region/municipality/community Source: Wikipedia, 2007 Canada

6. Santé Canada Health Canada 6 Alberta ENVIRx Program (since 1988) –Alberta Pharmacists’ Association –Voluntary –Funded by producers with grants from provincial government –Collection by pharmacies (up 7% from 2006-07) Antibiotics, painkillers, and medications for heart conditions Encouraged to remove packaging Sharps was accepted prior to 2000 (27 tonnes per year) –Incineration at Wainwright Regional Waste to Energy Facility in Wainwright, Alberta –Brochures

7. Santé Canada Health Canada 7 Canada (2) British Columbia Medications Return Program (since 1996) –Post-Consumer Pharmaceutical Stewardship Association –Recycling Regulation requires brand-owners to provide free consumer access to return/collection facilities –Funded by brand-owners –Enforcement and monitoring responsibility of the provincial government Regulated programs in development in Ontario and Manitoba –Collection by community and hospital (out-patients) pharmacies Up 17% from 2006-07 Participation of consumers ~20% and awareness ~31% in 2007 –Incineration at Beiseker Envirotech Inc. in Beiseker, Alberta –Posters and brochures, websites, newspapers

8. Santé Canada Health Canada 8 Canada (3) Nova Scotia Medication Disposal Program (since 90's) –Pharmacy Association of Nova Scotia –Voluntary –Destruction and transport are paid by manufacturers –Collection by pharmacies (up 18% from 2005- 06) Also the Safe Sharps Bring-Back Program –Incineration

9. Santé Canada Health Canada 9 Canada (4) Prince Edward Island Take It Back Program (since 2004) –Island Waste Management Corporation (provincial crown corporation) –Voluntary –Disposal is paid by the provincial government –Collection by pharmacies Also the Don’t Get Stuck Program for sharps –Licensed hazardous waste disposal facilities off-Island

10. Santé Canada Health Canada 10 Canada (5) Saskatchewan Pharmaceutical Waste Disposal Program (since 1997) –Pharmacists' Association of Saskatchewan –Voluntary –Pharmacies have to pay for the pick-up of pharmaceutical wastes –Collection by pharmacies Sharps are also accepted –Incineration by BioMed –Posters reminding consumers to return all expired or unwanted pharmaceuticals, brochures and other consumer information

11. Santé Canada Health Canada 11 Comparison of Canadian programs Note: Weight may include packaging, sharps, etc.

12. Santé Canada Health Canada 12 Other countries Australia Return Unwanted Medicines (RUM) Program (since 1999) –National Return & Disposal of Unwanted Medicines Limited, national non-profit company –Voluntary –Funded by the government with limited support from industry Restricted to collection and disposal costs Government initial funds: $3 million for 3 years Federal budget for July 2005: >$6 million for 4 years Funding review: June 2009 –Collection by pharmacies (up 2.3% from 2005 to 2006) –Incineration –Brochures and consumer awareness campaign for health professionals and consumers

13. Santé Canada Health Canada 13 Other countries (2) France Cyclamed Program (since 1993) –Being restructured to stop the redistribution to destitute people of France and emerging countries < 5 % (planned for 2009) –Medicines distribution chain (pharmacies, wholesalers, industry) –Pharmacies are required by legislation to collect and dispose of pharmaceutical wastes (since 2006) –Industry finances external costs and wholesalers provide transportation from pharmacies to their facilities free of charge Collection, transportation, incineration (63%) Communication, personnel expenses, humanitarian donation (37%) –Collection by pharmacies (down 6.2% from 2005-06) –Incineration with energy recovery (7,000 houses x year) –TV, radio, poster and comics

14. Santé Canada Health Canada 14 Other countries (3) Spain Integrated Waste Management System (SIGRE) (since 2002) –Initiative of the Spanish pharmaceutical industry with the collaboration of pharmacies and distributors European Directive 94/62/CEE on the management of packages –Voluntary –Funded by industry, based on volume of sales (non-profit) –Collection by pharmacies (up 16.5% from 2006-07) Separation into toxic, non toxic, and recyclable materials –Recycling or destruction Disposal into trash dropped from 42% in 2003 to 8% in 2007 –Logos and website

15. Santé Canada Health Canada 15 Other countries (4) Portugal Valormed Program (since 2001) –Initiative of the Portuguese Associations of the Pharmaceutical Industry, pharmacists and distributors (European Directives) –Voluntary –Funded by members of the pharmaceutical associations, including community pharmacies, pharmaceutical manufacturers, pharmaceutical distributors, and chemical and pharmaceutical importers Eco-fee of €0.00504 euro for each package placed on the market –Collection by pharmacies (up 11% from 2006-07) –Incineration Criticized for incinerating packaging rather than recycling them

16. Santé Canada Health Canada 16 Other countries (4) Sweden Apoteket AB Environmental Program (since 2002) –Government (the national pharmacy) –Incorporated European Directive on waste into national legislation –Funded by the government (Apoteket AB, non-profit) –Collection by pharmacies (up 12% from 2006-07) Prescription, over the counter, recreational drugs, needles Consumers, care centers, dentists, hospitals, farmers (vet products) 65% to 75% of all unused pharmaceuticals Participation of consumers ~73% (target ~80% for 2010) –Incineration (gas is cleaned before being released) –Campaigns in media, at pharmacies and clinics in order to raise awareness, transparent plastic bags provided to consumers to dispose of their products

17. Santé Canada Health Canada 17 Note: Weight may include packaging, sharps, etc. *Exclude packages Comparison of programs of other countries

18. Santé Canada Health Canada 18 Other programs Aimed at reducing pharmaceutical wastes –By decreasing consumption and increasing compliance, e.g. Reducing the size of prescriptions Selecting the most appropriate therapies Respecting quality of life and treatment costs Promoting full use of prescriptions Promoting the use and development of environmentally-friendly pharmaceuticals

19. Santé Canada Health Canada 19 Next steps How do pharmacies, health care facilities (hospitals, long-term care facilities, nursing homes, etc.), manufacturers, etc., dispose of expired, unwanted, unsold pharmaceuticals (as well as veterinary drugs), and packaging (direct and external packaging)? –Survey Canadian health care sector and manufacturers

20. Santé Canada Health Canada 20 Next steps (2) What are the best environmentally friendly disposal methods for pharmaceutical wastes (including any products that may contain residues of pharmaceuticals, i.e. packaging, sharps, human fluids, etc.)? –A comparative analysis of final disposal practices for drug wastes Does Canada need a national program and what should be its scope (regulatory or non-regulatory, targeting consumers, pharmacies, health care facilities, etc.)? –Multi-stakeholder consultations with provincial, territorial and municipal governments; industries; environmental non- governmental organizations; and consumer associations

21. Santé Canada Health Canada 21 Questions & Comments

22. Santé Canada Health Canada 22 Pharmaceutical Disposal Programs: A Canadian Perspective For further information about this presentation or to have a copy of the paper please contact: Edith Gagnon (613) 948-7925 E-mail: edith_gagnon@hc-sc.gc.ca