Although, since the beginning of the year, the law obliges hospitals to collect expired drugs from the population, the reality on the ground reveals a suffocating bureaucracy and alarming indifference. Five months after the new regulation came into force, most hospitals have failed to implement the collection system and medicines continue to be thrown away, endangering public health and the environment.
Too few hospitals collect expired drugs as required by law
All state and private medical facilities are obliged, from the beginning of 2024, to collect expired or unused medicines from the population. In practice, only a few hospitals do this. We remind you that special tanks for collecting expired medicines must be placed in the courtyards of health facilities. They must be accessible to citizens and properly signposted. Collection areas must be monitored either by video cameras or security personnel, the law says. In areas without hospitals, containers can be placed near dispensaries.
However, the implementation of the law encounters difficulties. Many hospitals are not prepared to take on this responsibility, and collection of expired drugs is considered an additional burdensome task. This is also seen in the way collection is carried out, where it happens: most health facilities, including private ones, collect medicines on a certain day and in a certain time interval, and to find out the schedule, which would must be clearly displayed and communicated, Romanians are forced to do real detective work. “Obviously, no one in the chain of responsibility follows the Official Gazette on a daily basis. I popularized and pushed where I could that the law appeared and that there is this responsibility of public and private hospitals to organize collection points with easy access from the street for pharmaceutical waste, for pharmaceutical pollution“, mentioned the initiator of the law, Adrian Wiener, for “Adevărul”.
For example, in Bucharest we found five state hospitals where expired medicines are collected: “Matei Balș” Institute, “Floreasca” Emergency Hospital, “Marius Nasta” Institute, “Bagdasar-Arseni” Hospital and “Ioan Cantacuzino” Hospital.
In some, there are one-way containers, located at the hospital gate. But at others, such as the “Ioan Cantacuzino” Hospital, people can hand in expired or unused medicines only on Thursdays from 9:00 a.m. to 10:00 a.m.
Likewise in many other hospitals in the country such as those in Cluj, Vaslui, Arad, Târgu Mureș or Timișoara. “Probably the units that follow the idea of programming and timetables want to put an employee to control what each person throws in the respective containers. Our vision was to make things simple, to leave no stone unturned. The law is one thing, the application is another. From my point of view, as a citizen, if you make me follow a laborious bureaucratic procedure, with telephones, with appointments, with fixed hours, the tendency is to leave myself a wreck. From my point of view, things should be as simple as possible and as little bureaucratic as possible precisely to encourage that man to come and get rid of them. We have to make things as simple and easy as possible, so that people have a reason to leave home to throw away 5 pills or 3 ampoules“, explains Dr. Cătălin Apostolescu, director of the National Institute of Infectious Diseases “Prof. Dr. Matei Balș” from Bucharest.
At the “Matei Balș” Institute, a place was set up for the collection of this waste, at the main entrance to the hospital. It is open at all hours.
Costs and Responsibilities
The costs for the collection of expired medicines will be borne from public funds, through transfers from the state budget to the budget of the Single National Health Social Insurance Fund. Hospitals will use the existing contracts with medical waste management companies, but within the limit of 10 lei/kg, as specified by an order of the Ministry of Health.
“The amount is insignificant, the paperwork I have to fill out in this process costs more than what I collect“says the manager of the Institute “Prof. Dr. Matei Balș”, who also adds that “there is no overcrowding” with these containers.
“They don't seem to care”
Initially, pharmacies should also be collection points for expired drugs, but a compromise was reached, so that only hospitals would be collection points, using the already existing contracts with neutralization companies. However, the practical implementation and associated challenges raise questions about the efficiency and sustainability of this new collection system, points out the initiator of the law.
And those responsible for implementation, i.e. the Ministry of Health and the Ministry of the Environment, do not check how the law is applied. “Any actor in the health system has a minimal responsibility for ending the cycle. That's how it should be. Those who should and, by definition, are the executive, that is, those who should, practically, ensure that the law is respected in Romania and that the public interest is served are the two ministries, Health and Environment. They should issue circulars, ask for reports, and so on. And then, just by communicating with the main actors, they will understand that it is important and that the ministry cares about it. Two message lines from the central authority in the system should exist. There is none, zero concern, not at all. There I think is the key, after all, to the implementation of the system. The Ministry of Health and the Ministry of the Environment should get involved, only through messages, only by requesting some reports, some points of view, to find out what difficulties they encounter, to have a dialogue. But don't be interested at all, delay the application rules for months, do nothing more, it seems to me…”adds Adrian Wiener.
In addition, we need information campaigns, more visibility and transparency, “to enter into the reflection of the community”.
“We initially put into law the amendment to the CNA law, so that after the advertising templates that advertise medicines, the message “Return expired medicines to hospitals” should be inserted. From 2026 it will also be written on medicine boxes. But that will be in 2026. By then? Until then, it would be the attribute of the ministry. But they don't seem to care. So twice I asked the people from the Ministry of Health to make the rules, that is, what was in the law, with the deadline for making the rules, had to be done through requests and through insistence and phone calls and official calls. It's the most destructive thing, that you have the tools, you have the regulation and you don't care”, concludes Adrian Wiener.
Drug pollution is a major problem, with an estimated 1,500 tons of expired drugs entering nature annually, severely affecting water and soil quality.
Where can you take expired medicines?
Bucharest
• Bucharest Emergency University Hospital (SUUB) – Has a collection point for expired medicines.
• National Institute of Infectious Diseases “Prof. Dr. Matei Balș” – Has a collection point for expired medicines.
• “Marius Nasta” Pneumophthisiology Institute – Has a collection point for expired drugs.
• Floreasca Emergency Clinical Hospital: Accepts expired medicines through the pharmacy department.
• Emergency Clinical Hospital “St. Ioan” – It has a medical waste collection program: every Thursday, between 9:00 and 10:00.
• “Grigore Alexandrescu” Emergency Clinical Hospital for Children – Collects expired medicines through its pharmacies.
• Hospitals in the Regina Maria private network – fill out a document at the reception.
• Hospitals in the Medlife private network – They have a medical waste collection schedule, you must call the reception in advance.
Hospitals in the country
• Vaslui County Emergency Hospital – Schedule: Monday, Wednesday and Friday, between 10:00 and 12:00.
• Târgu Secuiesc Municipal Hospital – Schedule: The second and fourth Tuesday of every month, between 10:00 and 14:00.
• Municipal Emergency Hospital “Elena Beldiman” Bârlad – Schedule: every Tuesday, between 09:00-10:00.
• “Dimitrie Castroian” Huși Municipal Hospital – Schedule: every Monday and Friday, between 09:00 and 10:00.
• Murgeni Psychiatric Hospital – Schedule: On the 3rd of every month, between 10:00 and 12:00.
• Recumed Hospital, Vaslui – Schedule: Last Wednesday of the month, between 10:00-11:00.
• Spitalis Negresti – Schedule: Monday to Friday, between 12:00 and 14:00.
• Arad County Emergency Clinical Hospital – Schedule: Every Wednesday, between 09:00-11:00.
• “Pius Brînzeu” Timișoara County Emergency Clinical Hospital – Schedule: Tuesday and Thursday, between 11:00-12:30.
• Municipal Hospital “Dr. Eugen Nicoară”, Reghin – Schedule: Tuesday and Thursday, between 10:00-11:00.
• CFR Hospital in Timișoara – Schedule: Tuesday and Thursday, between 10:00 and 11:00.
• Cluj Municipal Clinical Hospital – Schedule: Thursday, between 12:00-14:00.
• Brașov County Emergency Clinical Hospital – Schedule: Monday, Wednesday and Friday, between 10:00 and 12:00.
• Iasi County Emergency Clinical Hospital – will be collected after June 1.
