Data Collected Independent of DEA

Transcription

1 PDMP Training and Technical Assistance Center Webinar Series February 11, 2015 Heather Stewart, Pharm D 1 Recognize the need for successful and sustainable medication disposal programs. Discuss the impact that medication disposal data can have on public health and healthcare policy as it relates to prescription medication prescribing patterns and trends. Explain the importance of involving multiple stakeholders in medication disposal programs and data collection. Identify some techniques that can be implemented to minimize medication waste, abuse, misuse, and diversion and improve patient outcomes. Heather Stewart 2 Data Collected Independent of DEA Purpose: To collect data regarding unused medications to inform healthcare providers and public health policy officials about the amount and types of prescription medication waste in order to promote actions that could lead to fewer unused medications. Goal: To elevate awareness of medication waste within our communities and its contribution to increased poisonings and abuse, misuse, and diversion of prescription medications. Heather Stewart 3 Background Why should you care? Results Examples Collection data Brief comparison of methods Conclusion How can you make a difference? Heather Stewart 4 Nonmedical use of medications: use without a prescription or simply for the experience or feeling the medication caused National Survey on Drug Use and Health the intentional use of a medication without a prescription, in a way other than as prescribed, or for the experience or feeling it causes National Institute on Drug Abuse and Health Why should you care? Heather Stewart 5 Heather Stewart 6 1

2 Health care expenditures Prescription Medications: $325.9 billion (2012) Increase of 5.9 billion since 2011 Dietary Supplements: $30 billion (2011) Over-the-Counter: $17.4 billion (2011) Medication adherence Developed countries rates between 30-80% Hospital admissions cost an estimated $100 billion annually 33-69% of all medication-related admissions Heather Stewart 7 Adverse health outcomes 11-17% of patients will suffer from an adverse drug event (ADE) after discharge Estimated 1.5 million preventable ADEs annually Cost of ADEs is approximately $3.5 billion annually Heather Stewart National Drug Threat Assessment Nonmedical use of medications has higher prevalence rates than all other illicit substances (excluding marijuana). Pain relievers are most common Admissions for treatment increased 68% (2007 to 2010). Emergency department visits increased 91.4% (2006 to 2010). Heather Stewart National Drug Threat Assessment 1307 agencies report nonmedical use of medications as the greatest drug threat Increase in the availability of controlled medications without a valid prescription from 40.7% in 2007 to 75.4% in Regional data suggests New England suffers disproportionately from the rest of the United States 41.1 % of prescription medication use is nonmedical versus 28.1%, respectively Heather Stewart Drug Abuse Warning Network 1.24 million drug-related emergency department visits (51%) related to nonmedical use of medications. 132% increase in long term trends (2004 to 2011) Almost all of the 200,000 medication-related suicide attempts involved either prescription or over-thecounter medications. 41% increase in long term trends (2004 to 2011) 2011 Drug Abuse Warning Network Accidental poisonings (children 5 years old) involving medications accounted for 318 visits per 100,000 children 68.7% of all accidental poisoning visits in 2011 The availability of prescription medications has significantly contributed to these issues. Heather Stewart 11 Heather Stewart 12 2

3 2012 National Survey on Drug Use and Health 2.9 million people ( 12 years old) used an illicit substance in the last 12 months Nonmedical use of medications accounted for 26% of those Obtaining medications for nonmedical use 54% report they received it from a friend or relative for free 10.9% bought it from a friend or relative 4% stole it from a friend or relative Heather Stewart 13 Heather Stewart 14 Heather Stewart 15 Heather Stewart 16 Portland Scarborough 376 Participants 318 Participants Logged 4,828 individual medications Logged 3,107 individual medications Collected 210,143 Units* Collected 115,996 Units* 73.2% Waste 76.2% Waste Belfast Scarborough Drop Box 60 Participants 3 Participants Logged 644 individual medications Logged 1,327 individual medications Collected 23,298 Units* Collected 50,019 Units* 67.9% Waste 79.8% Waste *capsules, tablets, milliliters, patches, or grams Heather Stewart 18 3

4 Biddeford Long Term Care Facility (LTCF) 53 Participants 10 Participants Logged 381 individual medications Logged 510 individual medications Collected 12,845 Units* Collected 11,751 Units* 83.7% Waste 72.3% Waste** Standish Saco 8 Participants Logged 87 individual medications Collected 3,112 Units* 74.1% Waste 221 Participants Logged 2,715 individual medications Collected 125,855 Units* 80.1% Waste *capsules, tablets, milliliters, patches, or grams **excludes Biddeford LTCF 20 Heather Stewart 19 Percent Returned from Dispensed By Unit Count* Total = 13,599 Items TOTAL 1,049 Participants Logged 13,599 individual medications Collected 553,019 Units* 69.7% Waste** Total Original Units 1 724,997 Total Units Returned 553,019 *capsules, tablets, milliliters, patches, or grams **after exclusion for missing original counts Heather Stewart 21 *capsules, tablets, milliliters, patches, or grams Percent Returned From Dispensed = 69.7% Heather Stewart 22 Medication Returns by Classification Medication Returns by Unit Count* 32% 3% 3% 1% 2% 2% Schedule II 1% Schedule III Schedule IV Schedule V All Noncontrolled Rx Over-the-Counter Schedule II Noncontrolled Rx Schedule III % Over-the-Counter Unknown Nonmedication Item Schedule IV Nonmedication Schedule V 5386 Unknown 5413 Heather Stewart 23 *capsules, tablets, milliliters, patches, or grams Heather Stewart 24 4

5 Medication Returns by Controlled Substance Classification** Percent Returned from Dispensed by Classification Nonmedication Item ; 11% Schedule IV ; 25% 18337; 36% 14371; 28% Schedule II Schedule III Schedule IV Schedule V Noncontrolled Rx Schedule V Schedule II Schedule III All ** Classification as a controlled substance is defined by the Controlled Substance Act of 1974 Heather Stewart 25 Over-the-Counter 69.7 Heather Stewart 26 Medication Category 1 Original Units 2 Returned Units 3 Waste (%) 4 Non-controlled Rx Over-the-Counter Schedule II Rx Schedule III Rx Schedule IV Rx Non-medication Item Unknown Medication Schedule V Rx Total Combined Units Note. Rx = prescription medication Cardiovascular Miscellaneous* Gastrointestinal Hormone Antidepressant Anticonvulsant Antibiotics Asthma NSAID Medication category based upon Micromedex classification. Controlled substance schedule is based upon the Controlled Substance Act of Original units (capsules, tablets, milliliters, patches, or grams) are obtained from the returned bottle label (prescription or over-the-counter). Diuretics Returned units are based on manual counting. 4. Percent waste is calculated by units returned divided by original units dispensed. If the original units were missing the medication was * Includes all other noncontrolled therapeutic categories. excluded from the total percent waste calculation. Heather Stewart 27 Heather Stewart 28 Antihistamine Hypoglycemics Anticoagulants Topical Steroid Sedative/Hypnotic/Antipsychotic Antacids Muscle Relaxants Opioid (noncontrolled) Electrolytes & Minerals Antispasmodic Heather Stewart 29 Antineoplastic Antifungal Anticholinergic Antiparasitic Lithium Analgesic Nasal Antiviral Topical Anesthetic Ophthalmic Otic Total Non-controlled Units Note. NSAID = nonsteroidal anti-inflammatory drug Therapeutic class based upon Micromedex American Association of Poison Control Centers (AAPCC) coding. 2. Original units (capsules, tablets, milliliters, patches, or grams) are obtained from the returned bottle label (prescription or over-the-counter). 3. Returned units are based on manual counting. 4. Percent waste is calculated by units returned divided by original units dispensed. 5. Percent waste is ±15.3% due to some missing original units. Heather Stewart 30 5

6 Dietary Supplements Gastrointestinal NSAID Aspirin APAP Alone Antihistamine Miscellaneous* Botanical Cold and Cough Antacid Other Topical** APAP Combination Antihistamine/Decongestant w/out PPA APAP/Antihistamine/Decongestant w/out PPA Hormonal Antidiarrheal Amino Acids Homeopathic Nasal Preparations Ophthalmic Topical Anesthetic Throat Topical Antibiotic Topical Antifungal Otic Analgesic NSAID Total = nonsteroidal Over-the-Counter anti-inflammatory drug; APAP Units = acetaminophen; PPA Therapeutic class based upon Micromedex American Association of Poison Control phenylpropanolamine (AAPCC) coding Note. = 1. Centers 2. Original units (capsules, tablets, milliliters, patches, or grams) are obtained from the returned bottle label (prescription or over-the-counter). 3. Returned units are based on manual counting. 4. Percent waste is calculated by units returned divided by original units dispensed. Percent waste is ±13.7% due to some missing original units. Heather Stewart Heather Stewart 31 * Includes all other over-the-counter therapeutic categories. ** Includes all other over-the-counter topical therapeutic categories. 32 Medication Returns by Number of Units and Percentage Waste for Each Controlled Substance Category Controlled Substance Category 1 Original Units 2 Returned Units 3 Waste (%) 4 Schedule III APAP & Hydrocodone Schedule II Opioid (Oxycodone) Schedule IV Benzodiazepam Schedule V Opioid (Codeine) Schedule II Opioid (Morphine) Schedule V Other* Schedule II APAP & Oxycodone Schedule III APAP & Codeine Schedule II Stimulant (Methamphetamine) Schedule IV APAP & Propoxyphene Schedule IV Sedative/Hypnotic Schedule II Opioid (Hydromorphone) * Lyrica, Potiga, Vimpat, Promethazine & Codeine, Lomotil/Lonox Heather Stewart 33 Medication Returns by Number of Units and Percentage Waste for Each Controlled Substance Category continued Controlled Substance Category 1 Original Units 2 Returned Units 3 Waste (%) 4 Schedule III Other** Schedule IV Other*** Schedule II Stimulant (Amphetamine) Schedule II Opioid (Methadone) Schedule II Opioid (Fentanyl) Schedule III Cannabinoid Schedule III Opioid Schedule II Opioid (Meperidine) Schedule II Opioid (Codeine) Schedule II Barbiturate Total Controlled Substance Units Note. APAP = acetaminophen 1. Controlled substance schedule is based upon the Controlled Substance Act of Original units (capsules, tablets, milliliters, patches, or grams) are obtained from the returned bottle label (prescription or over-the-counter). 3. Returned units are based on manual counting. 4. Percent waste is calculated by units returned divided by original units dispensed. Percent waste is ±16.2% due to some missing original units. ** Aspirin, Codeine & Butalbital, Androgens, Antihistamin/Decongestant without phenylpropanolamine, Ibuprofen & hydrocodone *** ABHR suppositories, Armodafinil, Butorphanol, Carisoprodol, Codeine & Guaifenesin, Modafinil, Phenobarbital Heather Stewart Brief comparison of methods /30/ /29/2011 4/28/2012 9/29/2012 4/27/ /26/2013 Heather Stewart 35 Heather Stewart 36 6

7 Enabled through state legislation Public Law 2003, Chapter 679 An Act to Encourage the Proper Disposal of Unused Pharmaceuticals Sponsored by Senator Lynn Bromley Prototype model (statewide and national replication) for the disposal of unused household medications (controlled and noncontrolled) Anonymous, free way to dispose of unused medications safely and properly High heat incineration, according to Maine s law enforcement drug seizures procedure Utilizes U.S. Postal Service to solve Maine challenges Maine has a high degree of rurality Oldest state in the nation Maine median age 42.7 years old versus U.S years old (2010 U.S. Census Bureau) Heather Stewart 37 A physician told the patient to stop taking the medication or gave the patient a new prescription. (27.3%) Medicine belonged to a deceased family member. (19.6%) The person felt better or no longer needed the medicine. (18%) The person had a negative reaction or allergy to the medicine. (11.9%) Heather Stewart 38 Marketing Status of Returned Medication 17% of total returns were controlled medications How can you make a difference? UNKNOWN marketing status was predominantly associated with missing or insufficient data (e.g. no match for drug name). Heather Stewart 39 Heather Stewart 40 Why do we have so much pharmaceutical waste? Why do we have so much pharmaceutical waste? What are we going to do about it? Heather Stewart 41 Heather Stewart 42 7

8 Why do we have so much pharmaceutical waste? What are we going to do about it? How can we utilize more collection sites to gain the data necessary in order to educate health care providers, government officials, and communities? Heather Stewart 43 Why do we have so much pharmaceutical waste? What are we going to do about it? How can we utilize more collection sites to gain the data necessary in order to educate health care providers, government officials, and communities? How can we obtain funding for the safe removal of these medications along with furthering education efforts? Heather Stewart 44 Medication & Disease state management optimize therapeutic outcomes Individualization Accountable Care Organizations (ACOs) The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. Proactive versus Reactive Sustainable community disposal programs Educational campaigns Prescribers, Dispensers, and Patients COMMUNICATION IS KEY!!! Heather Stewart 45 Heather Stewart 46 All methods collected a significant quantity of medications including scheduled medications. Medication waste high in all collections. The need for legal and sustainable state and national collection programs. Necessary to collect further data Inform public health policy Improve public health Heather Stewart, PharmD University of New England 716 Stevens Avenue Portland, Maine hstewart@une.edu Remove dangerous and addictive medications from residential areas in an environmentally safe manner. Heather Stewart 47 Heather Stewart 48 8

9 Ma CS, Batz F, Juarez DT, Ladao LC. Drug take back in Hawai i: partnership between the University of Hawai I Hilo College of Pharmacy and the Narcotics Enforcement Division. Hawaii J Med Public Health. 2014;73(1): Laba TL, Brien JA, Jan S. Understanding rational non-adherence to medications. A discrete choice experiment in a community sample in Australia. BMC Fam Pract. 2012;13:61 Noureldin M, Plake KS, Morrow DG, Tu W, Wu J, Murray MD. Effect of health literacy on drug adherence in patients with heart failure. Pharmacotherapy. 2012;32(9): Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5): Rifkin DE, Laws MB, Rao M, Balakrishnan VS, Sarnak MJ, Wilson IB. Medication adherence behavior and priorities among older adults with CKD: a semistructured interview study. Am J Kidney Dis. 2010;56(3): Laufs U, Rettig-Ewen V, Bohm M. Strategies to improve drug adherence. Eur Heart J. 2011;32(3): Kripalani S, Roumie CL, Dalal AK, et al. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial. Ann Intern Med. 2012;157(1):1-10. Cardarelli R, Mann C, Fulda K, Balyakina E, Espinoza A, Lurie S. Improving accuracy of medication identification in an older population using a medication bottle color symbol label system. BMC Fam Pract. 2011;12:142. Centers for Medicare and Medicaid Services. Accountable Care Organizations (ACO). Available at: Accessed 3/24/2014. IMS Health. Top Line Market data, Channel distribution by non discounted spending U.S Available at: ca2RCRD. Accessed 3/16/2014. U.S. Department of Justice, Drug Enforcement Administration. National Drug Threat Assessment Summary, Available at: Accessed 3/16/2014. Drug Abuse Warning Network,2011: National Estimates of Drug-related Emergency Department Visits. HHS Publication No. SMA , DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration. Available at: Accessed February 25, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-46, HHS Publication No. SMA Rockville, MD: Substance Abuse and Mental Health Services Administration. Available at: Accessed February 25, Heather Stewart 49 9