IMPLEMENTING A STATEWIDE MAIL BACK PROGRAM FOR EXPIRED AND UNUSED PRESCRIPTION DRUGS

1. IMPLEMENTING A STATEWIDE MAIL BACK PROGRAM FOR EXPIRED AND UNUSED PRESCRIPTION DRUGS Improving Patient Safety through Informed Medication Prescribing and Disposal Practices October 31, 2007

2. Historic 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)

3. Maine’s Prescription Drug 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)

4. Project 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

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

6. Project Objectives • Quantification by weight, type and hazardous characteristics by actual pill count and classification • Cost feasibility of rollout • Education campaign concerning proper disposal

7. Phased Implementation • Two-phase, 18-24 month project • 1,800 mailers available to consumers through distribution by a pharmacy • Refine process; 7,200 mailers available Number of mailers distributed in both phases has increased by 50% to 9,000 pieces

8. Phase 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

9. Phase 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

10. Key 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

11. Key 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

12. Key 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

13. 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 Project Collaborations and Advisement

14. The Benefits of a Maine Project • 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

15. Drug 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

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

17. The 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

18. Drug 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

19. Insuring Elder 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

20. Projected 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

21. Projected Outcomes • Hundreds, if not thousands, of pounds of unwanted medications collected from households in Maine and disposed of in prudent fashion

22. Want to Know More About the Project? Please contact: Daily operations: jennifer.crittenden@umit.maine.edu Project administration: len.kaye@umit.maine.edu Technical issues: gressitt@uninets.net