SAFE MEDICINE DISPOSAL FOR ME

***A way for Maine’s citizens to safely and properly get rid of unused or

expired medicine

Funded by the U.S. EPA (Grant #CH-83336001-0) and an allocation from a Fund for Healthy Maine administered by the Maine Drug Enforcement

Agency

Disclosure

The content of this presentation does not relate to any product of a commercial interest. Therefore, there are no relevant financial relationships to disclose.

Why Maine?: The State’s Prescription Drug Problem

In 2007, nearly 90% of Maine drug deaths were caused by prescription drugs

Maine Drug Enforcement Agency arrests for prescription drug misuse or diversion has increased dramatically to 23% of all arrests

In terms of the relationship of pharmaceuticals to violent crime and property crime, Maine ranks number one in the country

Maine ranks second in terms of the availability of pharmaceuticals for abuse

Large rural regions 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

Why Maine? The Challenges of a Rural and Aging State

Methods of Disposal Flushing

Water pollution Trash

Ends up in water stream Potential for diversion of drugs Overdose by children and pets

Collection Programs and Events Often require law enforcement involvement Sustainability challenges

Coalition Building Began with Maine Benzodiazepine Study

Group and Maine Drug Enforcement Agency

Convened a group stakeholders from children’s advocacy, environmental organizations, medical associations, and others to create legislative solution

Public Law 2003, Chapter 679 Public Law 2003, Chapter 679 Maine Unused Pharmaceutical Disposal ProgramMaine Unused Pharmaceutical Disposal Program Program administration – Maine Drug Enforcement Program administration – Maine Drug Enforcement

AgencyAgency Maine Drug Return Implementation GroupMaine Drug Return Implementation Group

LD 411 “An Act To Establish a Pilot Program for LD 411 “An Act To Establish a Pilot Program for Return of Unused Prescription Drugs by Mail” Return of Unused Prescription Drugs by Mail” (Sponsored by Representative Anne Perry) (Sponsored by Representative Anne Perry) (Signed 6/27/07)(Signed 6/27/07)

Historic State Historic State LegislationLegislation

Program OverviewProgram Overview

Unique opportunity to test and refine state-Unique opportunity to test and refine state-wide field modelwide field model

Phased mail-in return programPhased mail-in return program Funded by the U.S. Environmental Funded by the U.S. Environmental

Protection Agency (EPA) and an allocation Protection Agency (EPA) and an allocation from the Fund for a Healthy Mainefrom the Fund for a Healthy Maine

Phases I and II established a working Phases I and II established a working prototype for state and beyondprototype for state and beyond

Postage-paid medicine return Postage-paid medicine return envelopes are distributed to envelopes are distributed to selected pharmacies and selected pharmacies and organizations across the state at organizations across the state at no costno cost

Staff members then give the Staff members then give the envelopes and an instruction envelopes and an instruction packet to interested participantspacket to interested participants

Program ModelProgram Model

Program ModelProgram Model

Program Participants

Secure delivery to Maine Drug Enforcement Agency

Envelopes received, logged, catalogued and destroyed under MDEA custody

Program GoalsProgram Goals

Remove unneeded prescription drugs from Remove unneeded prescription drugs from circulationcirculation

Disposal in compliance with applicable Disposal in compliance with applicable state and federal laws and sound state and federal laws and sound environmental practicesenvironmental practices

Phased ImplementationPhased Implementation Allows for monitoring of the program and Allows for monitoring of the program and

piloting of protocols piloting of protocols Phase I: Four-county model (1,800 Phase I: Four-county model (1,800

envelopes)envelopes) Pharmacies as the point of distribution for Pharmacies as the point of distribution for

program envelopesprogram envelopes Limited press/marketingLimited press/marketing No public education effortNo public education effort Selected sites within the designated areaSelected sites within the designated area Only for people 65 and older and caregivers Only for people 65 and older and caregivers

7,600 mailers available through statewide 7,600 mailers available through statewide network of participating pharmacies and network of participating pharmacies and partnering sites (over 100 sites)partnering sites (over 100 sites)

Refinements based on Phase I experience: Refinements based on Phase I experience: Expansion of program to target to all age Expansion of program to target to all age

groups groups Expansion of distribution sites beyond Expansion of distribution sites beyond

pharmaciespharmacies Community educationCommunity education

Phase IIPhase II

20,000 mailers available through statewide 20,000 mailers available through statewide network of participating pharmacies and network of participating pharmacies and partnering sites (approx. 150 sites)partnering sites (approx. 150 sites)

Funding in place through 2011Funding in place through 2011

Current OperationsCurrent Operations

Community Education and Outreach

It curtails childhood overdoses It restricts household drug theft It limits accumulation of drugs by the

elderly and other high users It protects our physical environment It restrains improper drug donations It eliminates waste in the health care

system

Drug Collection Benefits

The toll-free helpline phone number is 1-866-637-9743.

Participants can call any time and leave a message.

Phone calls are returned by Center on Aging staff.

Pharmacies or other organizations can also inquire about the program through the helpline.

Program Helpline

The website address is www.safemeddisposal.com

Information about the project is available on the website.

Pharmacists and project participants can also e-mail questions to the Center on Aging project staff at info@safemeddisposal.com

Program Website

Elder Involvement

Community Advisory Board created with older adults and RSVP volunteers from each county

Membership reflects state’s diversity Collaboration among 5 RSVP programs statewide

Community members served as Distribution Site Educators in Phase I

Deliver mailers and materials to distribution sites Educate site pharmacists and staff on the process

Phase II: Educators promote the benefits of returning unwanted medications

Lasting Impact: Community Lasting Impact: Community EducationEducation

  Community volunteers educating others Community volunteers educating others about safe medication management and about safe medication management and disposaldisposal

Participants in community outreach and Participants in community outreach and education presentations range in age from education presentations range in age from 20 to over 80 years old. 20 to over 80 years old.

94% of participants had never participated 94% of participants had never participated in a community drug disposal event prior to in a community drug disposal event prior to attending an education session. attending an education session.

Lasting Impact: Community Lasting Impact: Community EducationEducation

The average exam score on post-The average exam score on post-presentation evaluations was 95/100 presentation evaluations was 95/100 indicating that the training has a high level indicating that the training has a high level of impact on knowledge. of impact on knowledge.

Research and Data CollectionResearch and Data Collection

Geographic and demographic patterns of Geographic and demographic patterns of prescription drug accumulationprescription drug accumulation

Pharmacoeconomic assessments Pharmacoeconomic assessments Waste Waste Implications for prescribing, insurance Implications for prescribing, insurance

reimbursement, and dispensing policies reimbursement, and dispensing policies

Data Collection StrategyData Collection Strategy

Survey is Survey is completed and completed and placed into the placed into the envelope with their envelope with their medicine.medicine.

2,074 surveys 2,074 surveys returned during returned during pilotpilot

Consumer SurveyConsumer Survey

Drug Inventory Drug Inventory

Cataloging of returned Cataloging of returned drugs by project drugs by project pharmacistspharmacists

Pilot Phases Drug Returns Data Pilot Phases Drug Returns Data 3,926 envelopes collected 3,926 envelopes collected 42% return rate42% return rate 2,123 pounds of non-2,123 pounds of non-

controlled drugs controlled drugs 250 pounds of controlled drugs250 pounds of controlled drugs Over 380,000 pills collectedOver 380,000 pills collected 86% of returns are prescription 86% of returns are prescription

drugs, 12% over the counterdrugs, 12% over the counter 31% of returns included mail 31% of returns included mail

order drugsorder drugs

Observations from the Initial Drug Returns Analysis (Phase 1)Interesting/anecdotal findings: Many of the mailers contained full bottles of

unused drugs from mail-order pharmacies or VA pharmacy services

Received full bottles of very costly antiretroviral drugs (HIV/AIDS drugs)-Wasted healthcare $$

Older meds not uncommon-some of the returns were noted to be as old as 30 years old

Estimated that one envelope contained enough unused narcotics to net $7,000 if sold on the street

Observations from the Initial Drug Returns Analysis (Phase 1) (cont.)

Interesting/anecdotal findings: A mix of local and mail order pharmacies

is not uncommon among those who use the program-but who has the entire medication record for these patients?

This includes patients who are receiving the same medication via a local pharmacy and a mail-order pharmacy

Consumer ProfileConsumer Profile

Average age of mailback program users: 59 years of age

Age range of users/those returning medicine through the mailback:

4 years – 95 years of age

Avg. age has dropped considerably from Phase I (avg. age = 70) to Phase II (avg. age = 59).

55.8

46.5

15.1 10

0

10

20

30

40

50

60

% responses

Household MakeupN = 1,759

21-64 year olds

65 and up

11-20 year olds

Children up to 10 yearsof age

Age groups of residents in the household

n= 1645

Survey Data (cont.)Survey Data (cont.)

41% were returning medicine for 41% were returning medicine for themselvesthemselves

35% were returning medicine for a relative35% were returning medicine for a relative Nearly 20% were returning medicine for a Nearly 20% were returning medicine for a

deceased friend or loved onedeceased friend or loved one The decision about what to dispose of can The decision about what to dispose of can

be complex as indicated by the fact that be complex as indicated by the fact that 16% of our respondents did not know what 16% of our respondents did not know what kind of medicine they were returning. kind of medicine they were returning.

How did you normally dispose of your unused and unwanted medicine before today?

5% 4%8%46%

37%

Flush

Trash

Collection event

Don't know

OtherN = 1334

n= 1518

*Percentages add up to more than 100 as respondents are allowed to check off multiple options for this question.

47.4

31.1

27.325.4

24.218 12.2

11.9

7.2

0.7

0

10

20

30

40

50

%

Why do you want to get rid of these medicines?N = 2,041

Expired

Doc told me to stop taking it

Doc gave me new medicine

Did not want anyone else touse itOther

Felt better

Didn't like the side effects

Had a reaction or allergy

Didn't want to take it

I don't knowReason

CommentsComments

““Thank you for this program-great as is”Thank you for this program-great as is” ““Make envelopes more available/have Make envelopes more available/have

more sites”more sites” ““Advertise more”Advertise more” ““Bigger envelopes”Bigger envelopes” ““This is such a waste of medicine. This This is such a waste of medicine. This

could be used for the uninsured could be used for the uninsured elderly/homeless/those in need, etc”elderly/homeless/those in need, etc”

Comments Cont’dComments Cont’d ““This is a fantastic program. The meds of a This is a fantastic program. The meds of a

deceased love one are an emotional deceased love one are an emotional reminder of that person. Thank you for reminder of that person. Thank you for offering a private method of disposal. You offering a private method of disposal. You saved me many tears.” saved me many tears.”

Comments Cont’dComments Cont’d  ” ”My brother and I have tried to find a safe My brother and I have tried to find a safe

and responsible way to dispose of these and responsible way to dispose of these meds for 18 months! We have not found meds for 18 months! We have not found any other way after several attempts with any other way after several attempts with local police, hazardous waste, pharmacy, local police, hazardous waste, pharmacy, hospice, etc.”hospice, etc.”

Program Partners and National Program Partners and National Advisory BoardAdvisory Board

Maine-Based OrganizationsMaine-Based Organizations Center on Aging, University of MaineCenter on Aging, University of Maine Maine Association of Psychiatric PhysiciansMaine Association of Psychiatric Physicians Safe Medicine for MaineSafe Medicine for Maine Maine Council for Child & Adolescent Maine Council for Child & Adolescent

PsychiatryPsychiatry Maine Department of Health and Human Maine Department of Health and Human

ServicesServices Maine Department of Environmental Maine Department of Environmental

ProtectionProtection Maine Drug Enforcement AgencyMaine Drug Enforcement Agency University of New EnglandUniversity of New England Maine Office of Adult Mental Health Maine Office of Adult Mental Health

ServicesServices Husson UniversityHusson University Maine Center for Disease Control and Maine Center for Disease Control and

PreventionPrevention Maine Office of the Attorney GeneralMaine Office of the Attorney General Maine Office of Elder ServicesMaine Office of Elder Services Maine Pharmacy AssociationMaine Pharmacy Association Maine Independent PharmaciesMaine Independent Pharmacies Maine RSVP ProgramsMaine RSVP Programs Maine Office of Adult Mental Health Maine Office of Adult Mental Health Maine Medical Association Maine Medical Association

Margaret Chase Smith Center Policy Margaret Chase Smith Center Policy Center, University of MaineCenter, University of Maine

Northern New England Poison CenterNorthern New England Poison Center

Federal & National OrganizationsFederal & National Organizations

American Pharmacists Association American Pharmacists Association Community Medical Foundation for Patient Community Medical Foundation for Patient

SafetySafety National Council on Patient Information and National Council on Patient Information and

EducationEducation Office of the U.S. Attorney GeneralOffice of the U.S. Attorney General Rite Aid CorporationRite Aid Corporation U.S. Drug Enforcement AdministrationU.S. Drug Enforcement Administration U.S. Environmental Protection AgencyU.S. Environmental Protection Agency U.S. Postal ServiceU.S. Postal Service Villanova University Center for the Villanova University Center for the

EnvironmentEnvironment

Daily operations:Daily operations:Jennifer Crittenden, M.S.W.Jennifer Crittenden, M.S.W.

Project DirectorProject DirectorUMaine Center on AgingUMaine Center on Aging

jennifer.crittenden@umit.maine.edu

Project administration:Project administration: Lenard Kaye, D.S.W./Ph.D.Lenard Kaye, D.S.W./Ph.D.

Principal InvestigatorPrincipal InvestigatorUMaine Center on Aging UMaine Center on Aging len.kaye@umit.maine.edu

General Project Information:General Project Information:Phone:  1-866-ME-RX-RID (1-866-637-9743)

Email: info@safemeddisposal.comWebsite:Website: http://www.safemeddisposal.com/