Safe disposal of medications

Report
Helen Pervanas PharmD, R.Ph.
Assistant Professor Pharmacy Practice
MCPHS-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 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
 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
 Threat
to pets and humans
 95% of unintentional deaths were drug
related

Opioid pain medications
Source: CDC
•NH deaths up 350%
•Exceeded traffic
deaths in NH
Source: NH Department of Environmental Services, April 2009.
 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
* Cost was minimal due to MPD
$1310
 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 drivethru 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
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 takeback 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 bins



Controlled substances
Hazardous waste
All other medications
Total of 41,601 units
 Weighing ~100 lbs
 40 consumers attended

Medications
Percent
Units
Non-Controlled
78%
32,305
Over-theCounter
18%
7,618
Controlled
3%
1356
Hazardous
Material
1%
322
 Top

Anxiolytics and narcotic pain meds
 Top


OTC substances
Vitamins
 Top

non-controlled substances
Phosphate binders and psychiatric meds
 Top

controlled substances
hazardous waste substances
Mercaptopurine
Warfarin
Name
Lorazepam
Hydrocodone APAP
Hydrocodone/
Homatropine Syrup
Oxycodone/APAP
Pregabalin
Number (%)
16%
15%
13%
12%
8%
Name
Calcium Acetate
Risperidone
Olanzapine
Furosemide
Doxazocin
Number (%)
10%
6%
5%
5%
4%
Name
Multivitamin
Calcium + vitamin D
Iron products
Docusate sodium
Sennoside
Number (%)
11%
8%
8%
8%
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”

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