Collecting Unwanted Medications: The Legal & Safe Way

Transcription

1 Collecting Unwanted Medications: The Legal & Safe Way Lynn Rubinstein Northeast Recycling Council, Inc. January 28, 2009

2 Background What is NERC? Non-profit 10 Northeast states Mission: environmental sustainability through solid waste management EPA, USDA, Community Pharmacy Foundation grants Northeast Recycling Council, Inc. January

3 Why are We Talking About Unwanted Medications? Environmental concerns Public health & safety Opportunity to take action Northeast Recycling Council, Inc. January

4 Presentation Objectives Explain why collection programs for unwanted medications are important to the environment. Explain how to design & implement a legal & safe unwanted medication collection in a pharmacy. Northeast Recycling Council, Inc. January

5 Routes of Environmental Exposure Metabolites & excretion Disposal of unwanted medication Northeast Recycling Council, Inc. January

6 Intentionally Down the Drain Households Nursing homes Hospice Pharmacies Hospitals & other healthcare facilities Northeast Recycling Council, Inc. January

7 It s Flushed, So What? Wastewater Treatment Does Not Treat Most do not remove pharmaceutical pollution Septic tanks no treatment... and medications can interfere with removal of other pollutants Northeast Recycling Council, Inc. January

8 So you Put it in the Trash Solid Waste Concerns Scavenging Humans Animals Landfill leachate Northeast Recycling Council, Inc. January

9 Environmental Concerns USGS 2000 study 139 streams studied & 80% of samples detected pharmaceuticals Acetaminophen Steroids & hormones Blood pressure medication Codeine Antibiotics & antimicrobials Ibuprofen Northeast Recycling Council, Inc. January

10 Press Coverage Prescription drugs found in drinking water across U.S. AP story (CNN, USA Today) March 10, 2008 Wildlife affected by drugs Boston Globe, March 10, 2008 Northeast Recycling Council, Inc. January

11 Environmental & Health Effects Feminization of amphibian & fish species Unknown effects from chronic exposure to low concentrations of multiple pharmaceuticals Northeast Recycling Council, Inc. January

12 Disposal Conundrum White House/U.S. EPA don t flush/flush it APhA do not flush Many pharmacists & doctors flush it Poison Control flush it Wastewater treatment toss in trash Northeast Recycling Council, Inc. January

13 What Should the Advice Be? Buy carefully Look for collection opportunity If must, put in trash but very, very carefully Leave in original container with name of medication legible, but obliterate personal information Tape container closed, seal in opaque bag, & throw in trash Never put in food container, with food or feces Northeast Recycling Council, Inc. January

14 What Can the Pharmacist Community Do? Promote sensible purchasing Do not encourage flushing Hold or participate in an unwanted medication collection Northeast Recycling Council, Inc. January

15 Is the Disposal of Unwanted Medications Contributing to this Problem? 1 woman - 2,500 Combipatch estradiol/norethindone acetate transdermal system 50/40

16 Average Collection Data Volume per person (P/P) Volume controlled substances P/P % controlled substances per event 1.1 gallons 0.1 gallon 15% % prescription per event 67% by # items % hazardous waste 10%

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18 What is an Unwanted Medication Collection? Opportunity for public to safely dispose of medications at no cost NOT reuse, recycling, return Medication is destroyed Opportunity for pharmacist to provide leadership & strengthen customer relations Northeast Recycling Council, Inc. January

19 Essentials of an Unwanted Medication Collection

20 Strategy Segregate controlled substances goes to law enforcement (incineration) Hazardous waste disposal (incineration) for all non-controlled substances Northeast Recycling Council, Inc. January

21 Federal Drug Laws are Key Controlled substances: Once dispensed cannot be in possession of registrants Cannot be in possession of anyone other than to whom dispensed Except law enforcement Northeast Recycling Council, Inc. January

22 State Laws Are Critical Too! Board of Pharmacy Massachusetts Department of Public Health Non-criminal evidence limitations Northeast Recycling Council, Inc. January

23 Collection Details Pharmacist Students/ Pharmacy Techs Law enforcement Hazardous waste hauler Northeast Recycling Council, Inc. January

24 The Public Arrives Northeast Recycling Council, Inc. January

25 Role of Pharmacist Determines status of medications Inventories medications Provides advice Northeast Recycling Council, Inc. January

26 Non-Regulated Materials Controlled Substances Drug Dosage Amount Drug Dosage Amount Daily Acetaminophen/ 100 multivitamins cod #3 10 Aceon 4 mg 84 Acetaminophen/ cod #3 4 Acepromazine 5 mg 6 Acetaminophen/ cod #3 24 Acetaminophen 325 mg 3 Acetaminophen/ cod #3 24 Acetaminophen 160 mg 96 Alprazolam 0.25 mg 30 Acetaminophen 80 mg 120 Ambien 10 mg 1 Acetaminophen 500 mg 2 Ambien 10 mg 197 Acetaminophen, aspirin, caffeine 200 Clonazepam 0.5 mg 177

27 Role of Students/Techs Identify unknown medications Help with inventory Northeast Recycling Council, Inc. January

28 Role of Law Enforcement Takes possession of controlled substances Ensures witnessed destruction Provides security Northeast Recycling Council, Inc. January

29 Disposal of Controlled Substances Witnessed destruction: Law enforcement Supervised transport to U.S. DEA-authorized destruction (incineration) Northeast Recycling Council, Inc. January

30 Packing for Disposal Medication stays in original containers Drums for non-controlled substances Controlled substances packed separately Cardboard packaging removed

31 Hazardous Waste Destruction Non-controlled substances incinerated as hazardous waste Some medications are hazardous waste Difficult to separate from non-hazardous Total destruction Tight security & tracking to prevent diversion Northeast Recycling Council, Inc. January

32 Examples of P-Listed Pharmaceuticals

33 Examples of U-Listed Pharmaceuticals Northeast Recycling Council, Inc. January

34 Role for Reverse Distributors? Maybe, but not clear how. Northeast Recycling Council, Inc. January

35 Key Considerations Public Perception - Good service to provide - More business & new customers - Medications not resold, reused, & no refunds Northeast Recycling Council, Inc. January

36 Key Considerations Legal & Licensing - Registrant under DEA system - Permission from regional US DEA - Permission from Board of Pharmacy - Permission from MA DPH - Destruction/possession controlled substances - HIPPA & data destruction Northeast Recycling Council, Inc. January

37 Key Considerations Physical - Space to hold event - Not behind counter - Traffic flow - Indoors - Where law enforcement feels safe - Signage in store - Access to electricity - Computer & printer other than prescription filling system Northeast Recycling Council, Inc. January

38 Key Considerations - Time limited - Staffing: Event Law enforcement Pharmacist & Techs/Students Greeter Data entry Supervisor Hazardous waste company Northeast Recycling Council, Inc. January

39 Key Considerations Costs Advertising must do Staffing Hazardous waste disposal Controlled substance destruction Law enforcement Supplies, garbage, recycling Northeast Recycling Council, Inc. January

40 Key Considerations It Can Be Done! Eaton Apothecary CVS Maine & Connecticut Big Y Grocery Connecticut Ukrop s Super Markets Virginia Northeast Recycling Council, Inc. January

41 For More Information NERC website has case studies & guidance documents unwanted_medications_collections.html Northeast Recycling Council, Inc. January

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44 Contact Information Lynn Rubinstein Northeast Recycling Council, Inc. Brattleboro, VT Northeast Recycling Council, Inc. January