Drugs - AP - January 10 2011
Jacobson and 17 others are suspected of involvement in an illegal phramaceutical scheme. Photo by AP
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The Health Ministry is taking steps to reduce the amount of medical waste found in treated sewage used for irrigation, as the presence of such trace medications increases the risk of antibiotic-resistant strains of bacteria developing.

More than 75 percent of the water used to grow crops in this country is treated wastewater. In many other Western countries, the rate is less than 20 percent.

At a conference this week on antibiotic-resistant infections, Prof. Itamar Grotto of the Health Ministry presented a series of measures aimed at reducing the amount of medication entering the sewage system, and thence the treated water used for irrigation.

The ministry will begin supervising the disposal of medical waste at dental and veterinary clinics, both of which use antibiotics often. Until now, the ministry has only supervised medical waste disposal at hospitals and health clinics.

It will also issue guidelines to local authorities on supervising medical waste disposal from businesses such as beauty salons and cosmeticians, which are not involved in healthcare, but sometimes use medicated products. Henceforth, all such waste will have to be sent to the Ramat Hovav dump in the Negev, where it is incinerated to ensure that it won't leach into the groundwater.

The ministry will also seek Knesset authorization to impose tougher penalties on businesses that fail to properly dispose of their medical waste. Currently, such businesses face no real sanctions; the ministry would like to be able to levy administrative fines.

The ministry also plans to expand a project to collect expired medications from the public via the health maintenance organizations. In December 2011, the ministry ordered the HMOs to launch a drive to collect these medications and send them to Ramat Hovav. The two largest HMOs, Clalit and Maccabi, have already begun their drives.

Yet another effort will focus on getting hospitals to give patients smaller quantities of medicine to take home, to reduce the amount that might later be thrown away. Studies done in other Western countries have shown that hospitals are one of the main sources of medical waste that finds its way into the sewage system.

"There are many medications that reach the sewage system because people throw out the drugs they were given," Grotto said at the conference, which took place at the Volcani Institute of Agricultural Research in Beit Dagan. "But it's possible to reduce the dosage of medications, including those given at the hospitals. It's better to treat people with small doses and collect medicines that have expired, to reduce the amount of medical waste."

The concentration of medical waste in Israeli wastewater isn't checked regularly, but various studies indicate that it is present, and our crops are being irrigated with this water. One study, done for the Health Ministry by researchers at Hebrew University, found traces of painkillers such as ibuprofen and of drugs such as Carbamazepine, used to treat epilepsy, in sewage water at various spots around the country. A study done in 2009 by researchers from Tel Aviv University found traces of antibiotics from the penicillin family in the sewage system.

Research done in Holland found that the presence of traces of antibiotics in treated wastewater used to irrigate crops can promote the development of antibiotic-resistant strains of bacteria, such as MRSA. Another study done in Japan warned that traces of flu vaccines found in wastewater could lead to the development of more deadly strains of flu that are resistant to treatment.

But a February 2011 study done in Israel by a team of researchers led by Prof. Benny Chefetz of Hebrew University offered a rosier result: It concluded that cucumbers irrigated with water that contained traces of Carbamazepine aren't dangerous to human health. Eating 200 grams a day of these cucumbers exposes the consumer to only 200 nanograms per day of the drug, which is far too little to affect a person's health. The standard dosage for an epileptic who weighs 70 kilograms would be 70 milligrams a day.

Another major source of antibiotic-resistant bacteria is the consumption of meat from animals that have been given antibiotics. The Health Ministry has also been working to reduce this practice in recent years.