SAFE MEDICINE DISPOSAL FOR ME ***

1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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) Historic State Legislation

8. Program 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) and an allocation from the Fund for a Healthy Maine • Phases I and II established a working prototype for state and beyond

9. Postage-paid medicine return envelopes are distributed to selected pharmacies and organizations across the state at no cost Staff members then give the envelopes and an instruction packet to interested participants Program Model

10. Program Model Program Participants Secure delivery to Maine Drug Enforcement Agency Envelopes received, logged, catalogued and destroyed under MDEA custody

12. Program Goals • Remove unneeded prescription drugs from circulation • Disposal in compliance with applicable state and federal laws and sound environmental practices

13. Allows for monitoring of the program and piloting of protocols Phase I: Four-county model (1,800 envelopes) Pharmacies as the point of distribution for program envelopes Limited press/marketing No public education effort Selected sites within the designated area Only for people 65 and older and caregivers Phased Implementation

14. 7,600 mailers available through statewide network of participating pharmacies and partnering sites (over 100 sites) Refinements based on Phase I experience: Expansion of program to target to all age groups Expansion of distribution sites beyond pharmacies Community education Phase II

15. 20,000 mailers available through statewide network of participating pharmacies and partnering sites (approx. 150 sites) Funding in place through 2011 Current Operations

16. Community Education and Outreach

17. 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

18. 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

19. 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

20. 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

21. Lasting Impact: Community Education  Community volunteers educating others about safe medication management and disposal Participants in community outreach and education presentations range in age from 20 to over 80 years old. 94% of participants had never participated in a community drug disposal event prior to attending an education session.

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

23. Research and Data Collection

24. Geographic and demographic patterns of prescription drug accumulation Pharmacoeconomic assessments Waste Implications for prescribing, insurance reimbursement, and dispensing policies Data Collection Strategy

25. Survey is completed and placed into the envelope with their medicine. 2,074 surveys returned during pilot Consumer Survey

26. Drug Inventory • Cataloging of returned drugs by project pharmacists

34. Pilot Phases Drug Returns Data • 3,926 envelopes collected • 42% return rate • 2,123 pounds of non-controlled drugs • 250 pounds of controlled drugs • Over 380,000 pills collected • 86% of returns are prescription drugs, 12% over the counter • 31% of returns included mail order drugs

35. 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

36. 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

38. Consumer 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).

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

40. n= 1645

41. Survey Data (cont.) • 41% were returning medicine for themselves • 35% were returning medicine for a relative • Nearly 20% were returning medicine for a deceased friend or loved one • The decision about what to dispose of can be complex as indicated by the fact that 16% of our respondents did not know what kind of medicine they were returning.

43. n= 1518

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

47. Comments • “Thank you for this program-great as is” • “Make envelopes more available/have more sites” • “Advertise more” • “Bigger envelopes” • “This is such a waste of medicine. This could be used for the uninsured elderly/homeless/those in need, etc”

48. Comments Cont’d • “This is a fantastic program. The meds of a deceased love one are an emotional reminder of that person. Thank you for offering a private method of disposal. You saved me many tears.”

49. Comments Cont’d •  ”My brother and I have tried to find a safe and responsible way to dispose of these meds for 18 months! We have not found any other way after several attempts with local police, hazardous waste, pharmacy, hospice, etc.”

50. Program Partners and National Advisory Board Maine-Based Organizations Center on Aging, University of Maine Maine Association of Psychiatric Physicians Safe Medicine for Maine Maine Council for Child & Adolescent Psychiatry Maine Department of Health and Human Services Maine Department of Environmental Protection Maine Drug Enforcement Agency University of New England Maine Office of Adult Mental Health Services Husson University Maine Center for Disease Control and Prevention Maine Office of the Attorney General Maine Office of Elder Services Maine Pharmacy Association Maine Independent Pharmacies Maine RSVP Programs Maine Office of Adult Mental Health Maine Medical Association Margaret Chase Smith Center Policy Center, University of Maine Northern New England Poison Center Federal & National Organizations American Pharmacists Association Community Medical Foundation for Patient Safety National Council on Patient Information and Education Office of the U.S. Attorney General Rite Aid Corporation U.S. Drug Enforcement Administration U.S. Environmental Protection Agency U.S. Postal Service Villanova University Center for the Environment