Organizing a Medication Disposal Event: Results of a Pilot Project in NH

1. Organizing a Medication Disposal Event: Results of a Pilot Project in NH Helen Pervanas PharmD, R.Ph. Assistant Professor Pharmacy Practice MCPHS-Manchester/Worcester

2. disclosure Information • I have no financial relationships to disclose

3. Learning OBJECTIVES: • 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

4. Medication trends • Prescription and Over-the-Counter drug use continues to increase • Exceeded $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

5. Common disposal practices • Flushing medication down the toilet • Rinsing down the sink • Throwing medication in the trash • Stockpiling medications/sharing with others

6. Improper Disposal can lead to • Environmental concerns • Unintentional ingestion • Drug diversion

7. Environmental concerns • Active Pharmaceutical Ingredients (API) in surface and groundwater • Detected pharmaceutical agents • Estrogen hormones • Anti-infectives • Anticonvulsants • Mood stabilizers Source: US Geological Survey

8. Unintentional poisonings • Threat to pets and humans • 95% of unintentional deaths were drug related • Opioid pain medications Source: CDC

9. NH medication statistics • NH deaths up 350% • Exceeded traffic deaths in NH Source: NH Department of Environmental Services, April 2009.

10. Drug diversion and abuse • 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.

11. Drug Disposal Event in NH: A pilot Project

12. Setting • Local Health Plan-Anthem BC/BS (400,000 lives), Manchester, NH • Earth Day, April 22, 2009 (9am-1pm)

13. First Steps in organizing an event • Research • Contact regulatory agencies • Review federal and state laws • Choose a venue

14. Regulatory agencies • NH Board of Pharmacy (BOP) • NH Drug Enforcement Agency (DEA) • NH Department of Environmental Services (DES)

15. laws and specific requirements • Law enforcement required for controlled substance collection • Procurement of a temporary Environmental Protection Agency (EPA) identification number • Arrangements for pharmaceutical and hazardous waste disposal

16. Additional needs • Staffing/Volunteers • Purchase supplies • Advertising

17. Advertising for the event • Press Release • Senior Centers • Email to employees • Local Newspaper • Public TV

18. Associated Costs * Cost was minimal due to MPD

19. Staffing and volunteers • Police officials • Health Plan employees • Pharmacists • Student Pharmacists

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

21. Procedure for event • Consumers drop off medications in a drive-thru fashion • Greeted by health plan volunteers • Patient information distributed on proper disposal • Procedure for drop off • Drive up to entrance where pharmacist inspects medications • Medications transferred to counting area by police official

22. Schematic of Event

23. Educational Information 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.

24. Drive thru and drop off • Greeters welcome consumers • Provide information • Pharmacist inspects medications • Remove patient information

25. Collection and counting area • Pharmacists and student pharmacists collect, sort, count and document • Place medications in collection bins • Controlled substances • Hazardous waste • All other medications

26. Results • Total of 41,601 units • Weighing ~100 lbs • 40 consumers attended

27. Results: Class of medications • Top controlled substances • Anxiolytics and narcotic pain meds • Top non-controlled substances • Phosphate binders and psychiatric meds • Top OTC substances • Vitamins • Top hazardous waste substances • Mercaptopurine • Warfarin

28. Top controlled Substances

29. Top non-controlled

30. Top OtC medications

31. Lessons Learned • Early and extensive advertising • Hold event on weekend day • Explicit information regarding acceptable medications i.e. original containers

32. Feedback and comments • “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”

33. National DEA Take Back Event

34. Questions ??