Helen Pervanas PharmD, R.Ph.Assistant Professor Pharmacy

PracticeMCPHS-Manchester/Worcester

I have no financial relationships to disclose

List the concerns associated with improper medication disposal

Describe the steps involved in organizing a medication disposal event

Discuss the results of a community based medication collection event

Prescription and Over-the-Counter drug use continues to increaseExceeded $200 billion in the U.S. in 2007*65 and older population projected to

increase from 12.4% in 2000 to 19.6% in 2030

*Sources: IMS Health and US Census Bureau, NERC photo

Flushing medication down the toilet Rinsing down the sink Throwing medication in the trash Stockpiling medications/sharing with

others

Environmental concerns Unintentional ingestion Drug diversion

Active Pharmaceutical Ingredients (API) in surface and groundwater

Detected pharmaceutical agents Estrogen hormones Anti-infectives Anticonvulsants Mood stabilizers

Source: US Geological Survey

Source: CDC

Source: NH Department of Environmental Services, April 2009.

•NH deaths up 350%•Exceeded traffic deaths in NH

Abuse of controlled substances doubled from 7.8 million in 1992 to 15.1 million in 2003

Prescription drugs are the drug of choice for teens; 12 and 13 years of age

Pain medications Ranked 2nd highest abused drug(marijuana

1st)

Source: Washington State Dept of Ecology and D.A.R.E.

Local Health Plan-Anthem BC/BS (400,000 lives), Manchester, NH

Earth Day, April 22, 2009 (9am-1pm)

Research Contact regulatory agencies Review federal and state laws Choose a venue

NH Board of Pharmacy (BOP) NH Drug Enforcement Agency (DEA) NH Department of Environmental

Services (DES)

Law enforcement required for controlled substance collection

Procurement of a temporary Environmental Protection Agency (EPA) identification number

Arrangements for pharmaceutical and hazardous waste disposal

Staffing/Volunteers Purchase supplies Advertising

•Press Release•Senior Centers•Email to employees•Local Newspaper•Public TV

ITEM COST (dollars)

Supplies $200

Giveaways for consumers

$200

Gift cards for volunteers $100

Waste Disposal Fee $50*

Hazardous Waste Disposal

$510

Traffic Control by MPD $250

Total Expenses $1310

* Cost was minimal due to MPD

Police officials Health Plan employees Pharmacists Student Pharmacists

Lap top computer/printer Flash drive Counting trays Drug identification resources Plastic bins/bags Non-latex gloves Face mask Reflective vest Bin for recyclables

Consumers drop off medications in a drive-thru fashion

Greeted by health plan volunteersPatient information distributed on proper

disposalProcedure for drop off

Drive up to entrance where pharmacist inspects medications

Medications transferred to counting area by police official

The White House Office of National Drug Control Policy recommends that you:

Take unused, unneeded or expired prescription drugs out of their original containers and throw them in the trash.

Mix prescription drugs with an undesirable substance, such as used coffee grounds or kitty litter and put them in impermeable, non-descript containers, such as empty cans or sealable bags.

Don’t flush prescription drugs down the toilet unless the label or accompanying patient information specifically instructs doing so.

Take advantage of community pharmaceutical take-back programs that allow the public to bring unused drugs to a central location for proper disposal.

•Greeters welcome consumers•Provide information

•Pharmacist inspects medications•Remove patient information

Pharmacists and student pharmacists collect, sort, count and document

Place medications in collection binsControlled substancesHazardous wasteAll other medications

Total of 41,601 units Weighing ~100 lbs 40 consumers

attendedMedications

Percent Units

Non-Controlled 78% 32,305

Over-the-Counter

18% 7,618

Controlled 3% 1356

Hazardous Material

1% 322

Top controlled substancesAnxiolytics and narcotic pain meds

Top non-controlled substancesPhosphate binders and psychiatric meds

Top OTC substancesVitamins

Top hazardous waste substancesMercaptopurineWarfarin

Name Number (%)Lorazepam 16%Hydrocodone APAP 15%Hydrocodone/Homatropine Syrup 13%Oxycodone/APAP 12%Pregabalin 8%

Name Number (%)Calcium Acetate 10%Risperidone 6%Olanzapine 5%Furosemide 5%Doxazocin 4%

Name Number (%)Multivitamin 11%Calcium + vitamin D 8%Iron products 8%Docusate sodium 8%Sennoside 7%

Early and extensive advertising Hold event on weekend day Explicit information regarding

acceptable medications i.e. original containers

“Relieved to have them out of the house and away from grandchildren”

“Wonderful! Been holding on to medication for over a year”

“Can’t flush, no one wants them” “Great to have this program. Did not

know what to do with them” “Waiting for event to dispose” “Great service to the public” “Delighted this program is being held”