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UMaine Center on AgingMaine Benzodiazepine Study Group
Camden Hall 25 Texas Avenue
Bangor, Maine 04401207-262-7920
www.mainecenteronaging.org
IMPLEMENTING A STATEWIDE MAIL BACK PROGRAM FOR
EXPIRED AND UNUSED PRESCRIPTION DRUGS
IMPLEMENTING A STATEWIDE MAIL BACK PROGRAM FOR
EXPIRED AND UNUSED PRESCRIPTION DRUGSImproving Patient Safety through Informed Medication
Prescribing and Disposal PracticesOctober 31, 2007
Historic State LegislationHistoric State LegislationHistoric State LegislationHistoric State Legislation
• Public Law 2003, Chapter 679 – Maine Unused Pharmaceutical Disposal Program– Program administration – Maine Drug
Enforcement Agency– Maine Drug Return Implementation Group
• LD 411 “An Act To Establish a Pilot Program for Return of Unused Prescription Drugs by Mail” (Sponsored by Representative Anne Perry) (Signed 6/27/07)
Maine’s Prescription Maine’s Prescription Drug ProblemDrug Problem
Maine’s Prescription Maine’s Prescription Drug ProblemDrug Problem
• In 2002, nearly 90% of Maine drug deaths were caused by prescription drugs (Maine Department of Health and Human Services, Office of Substance Abuse, 2005)
• Maine Drug Enforcement Agency arrests for prescription drug misuse or diversion has increased dramatically to 16% of all arrests (Maine Department of Health and Human Services, Office of Substance Abuse, 2005)
• In terms of greatest drug threat and the relationship of pharmaceuticals to violent crime and property crime, Maine ranks number one in the country (National Drug Intelligence Center, 2006)
• Maine ranks second in terms of the availability of pharmaceuticals for abuse (National Drug Intelligence Center, 2006)
Project OverviewProject OverviewProject OverviewProject Overview
• Unique opportunity to test and refine state-wide field model
• Phased mail-in return program• Funded by the U.S. Environmental Protection
Agency (EPA)• Working prototype for state and beyond• Future full scale establishment of Maine
Unused Pharmaceutical Disposal Program
Project GoalsProject GoalsProject GoalsProject Goals
• Remove unneeded prescription drugs from circulation
• Disposal in compliance with applicable state and federal laws and sound environmental practices
Project ObjectivesProject ObjectivesProject ObjectivesProject Objectives
• Quantification by weight, type and hazardous characteristics by actual pill count and classification
• Cost feasibility of rollout
• Education campaign concerning proper disposal
Phased Phased ImplementationImplementation
Phased Phased ImplementationImplementation
• Two-phase, 18-24 month project1. 1,800 mailers available to consumers
through distribution by a pharmacy
2. Refine process; 7,200 mailers available
Number of mailers distributed in both phases has increased by 50% to 9,000 pieces
Phase IPhase IPhase IPhase I
• 1,800 mailers available through distribution centers at approximately 7 pharmacies
• Aroostook, Cumberland, Kennebec, and Penobscot counties
• No formal campaign to drive individuals into pharmacies to return medications
Phase IIPhase IIPhase IIPhase II
• 7,200 mailers available through statewide network of participating pharmacies
• Statewide rollout – 16 counties• Refinements based on Phase I
experience• Public communications to drive
individuals into the distribution centers
Key ComponentsKey ComponentsKey ComponentsKey Components
• Secure and manage network of distribution points (pharmacies) where individuals pick up mailers to return medication
• Create and issue to distribution centers informational materials for pharmacists, staff, and individuals acquiring mailers
Key ComponentsKey ComponentsKey ComponentsKey Components
• Create and distribute to distribution centers 9,000 mailers and accompanying surveys for those returning medications
• Collect, inventory and destroy returns in compliance with applicable state and federal laws and sound environmental practices
• Conduct activities in a four-county region in Phase I and statewide in Phase II
Key ComponentsKey ComponentsKey ComponentsKey Components
• Generate, analyze and report on survey and inventory data in manner that allows physicians, pharmacists, insurance companies, patients and others to modify behaviors to minimize unused medications
• Disseminate related educational information through statewide network of community health promotion organizations and municipal health officers
Project Collaborations and Project Collaborations and AdvisementAdvisement
Project Collaborations and Project Collaborations and AdvisementAdvisement
Maine-Based Organizations
• Maine Benzodiazepine Study Group (MBSG) & Drug Disposal Group
• Maine Department of Environmental Protection
• Maine Drug Enforcement Agency• Maine Office of Substance Abuse• Maine Department of Health• Maine Office of the Attorney General• Maine Office of Elder Services• Maine Pharmacy Association• Maine Independent Pharmacies• Maine RSVP Programs
• Margaret Chase Smith Center Policy Center
• Northern New England Poison Center
Federal & National Organizations
• U.S. Drug Enforcement Administration• U.S. Postal Service• Community Medical Foundation for
Patient Safety• National Council on Patient Information
and Education• Office of the U.S. Attorney General• Rite Aid Corporation• American Pharmacists Association
The Benefits of a Maine The Benefits of a Maine ProjectProject
The Benefits of a Maine The Benefits of a Maine ProjectProject
• Large rural regions and urban centers• 38th in population density; < 10 residents per
square mile in over half of state– Distribution/collection and financial challenges– Chronic illness and related drug use higher in rural
areas
• Oldest state– Median age 41.2 years (United States Census, 2005)
– Americans 65+ account for over 1/3 of prescriptions dispensed, but only 13% of the national population
Drug Collection BenefitsDrug Collection BenefitsDrug Collection BenefitsDrug Collection Benefits
• Prevent environmental exposure– aquatic ecosystem
• Minimize accidental overdoses and poisonings
– people, pets and wildlife
• Limit “pharming” and drug-related theft• Provide alternative to drug stockpiling• Preclude bad drug donations• Reduce inefficiency in the health care
system
Project Data CollectionProject Data CollectionProject Data CollectionProject Data Collection
• Geographic and demographic patterns of prescription drug accumulation
• Pharmacoeconomic assessments – Waste – Implications for prescribing, insurance
reimbursement, and dispensing policies
The MailersThe MailersThe MailersThe Mailers
• Full compliance for mailing– USPS/State/Federal requirements
• Postage-paid mailers accommodate a range of contents
• Padded mailers nondescript and not easily identifiable to a criminal element
Drug Inventory & DisposalDrug Inventory & DisposalDrug Inventory & DisposalDrug Inventory & Disposal
• Compliance with Maine Drug Enforcement Agency, Department of Environmental Protection– 2 law enforcement officers (double
verification)– Secure consolidation facility at an MDEA
location– Repeat count of number of packages
received– Proper disposal of all drugs collected
Insuring Insuring Elder InvolvementElder Involvement
Insuring Insuring Elder InvolvementElder Involvement
• Community Advisory Board created with older adults from each county– Membership reflects state’s diversity
• Community members will serve as Distribution Site Educators– Deliver mailers and materials to distribution sites– Educate site pharmacists and staff on the process– Refer pharmacists and staff to toll-free project
number and web site• Educators will promote the benefits of
returning unwanted medications
Projected OutcomesProjected OutcomesProjected OutcomesProjected Outcomes
• Understanding practicality and costs associated with mail back medication return program
• Information on best methods to educate older adults concerning hazards of unused medications and improper disposal
• Reduction in medications available for improper disposal, diversion or poisoning
• Heightened awareness by public-at-large and older adults that could lead to reduction in accidental deaths, human and animal poisonings, and suicides caused by unused medications
Projected OutcomesProjected OutcomesProjected OutcomesProjected Outcomes
• Hundreds, if not thousands, of pounds of unwanted medications collected from households in Maine and disposed of in prudent fashion
Want to Know More Want to Know More About the Project?About the Project?
Want to Know More Want to Know More About the Project?About the Project?
Please contact:
Daily operations:
jennifer.crittenden@umit.maine.edu
Project administration:
len.kaye@umit.maine.edu
Technical issues:
gressitt@uninets.net
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