Lessons Learned from a Rx Disposal Program in NE Tennessee
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1 Lessons Learned from a Rx Disposal Program in NE Tennessee June 16, 2016 Jeffrey A Gray, PharmD, CDE Associate Professor, ETSU College of Pharmacy Adjunct Professor, ETSU College of Public Health
2 Disclosure Statement of Unapproved/Investigative Use I, Jeff Gray, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation. DO NOT anticipate discussing the unapproved/investigative use of a commercial product/device during this activity or presentation.
3 Prevention Dissemination & Implementation of Effective Prevention Programs Rx Monitoring Programs & Diversion Control Traditional & Medically Assisted Treatment Overdose Reversal with Naloxone Dependence Addiction Non-use 1 st Initiation Level of Prevention (?) Death Health Professions Training & Continuing Education Screening, Brief Intervention & Referral to Tx Neonatal Abstinence Syndrome: Treatment of Mother, Infant & Preventing Second Pregnancy Evidence- Based Drug Courts
4 Study Objectives List quantitative metrics for reoccurring (Live Take Back) and consistently available (Amnesty Box) donation options Describe donor tendencies related to medications storage and destruction Explain population density variables which influence donation behaviors Identify characteristics of a successful public awareness campaign
5 Methodology Active partnership with the DEA and local law enforcement Onsite donor survey (LTB only), sorting, identification, label interpretation, counting, and recording Research sites 5 Live Take Back Sites over 36 months Amnesty Box Sites over 30 months Awareness campaign (TV, print)
6 Data Collected Total donation weight (lbs) Total Controlled Substance (CS) weight (lbs) CS Active ingredient (C II- CV) Therapeutic category (Opioids, Stimulants, etc) Quantity of CS in dosage units Tablet, capsule, film, lozenge, nasal spray Milliliter, patch, syringe, suppository, IV drip Date of dispensing Donation location Municipality population as of 2012
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8
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10 Live Take Back Donor Demographics and Tendencies
11 70.0% Gender: Rural versus Urban 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Rural Urban Female Male
12 80.0% Donor Motivations, Rural vs. Urban 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Clean out medicine cabinet Environmental concerns Poisoning concerns Rural Urban
13 35.0% Past Disposal Methods, Rural vs. Urban 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Trash Flushing Home storage Other Rural Urban
14 60.0% Event Promotion, Rural vs. Urban 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% "Newspaper" "Flyer or Poster" "TV" "Radio" " " "Friend" "Pharmacy" "Other" Rural Urban
15 Live Take Back Collections
16 Live Take Back Day Volunteers
17 Controlled Substances Collected Units of Controlled Substances Collected, by Therapeutic Class Opioids Sedative/ Hypnotics Stimulants Miscellaneous
18 Donations by Weight Total Pounds of Rx and Controlled Substances Collected, by Municipality Blountville Bristol Elizabethton Johnson City Jonesborough Total Rx CS
19 Donations by CS Units Units of Controlled Substances Collected, by Municipality Jonesborogh Johnson City Elizabethton Bristol Blountville Units Collected
20 Dispensing to Donation Time Average Number of Months Between Dispensing and Donation, By Therapeutic Class Mean Number of Months Sedative/ Hypnotics Miscellaneous Opioids Stimulants
21 Public Awareness Campaign Baseline 2013, Intervention 2014 Spring 2013 Fall 2013 Spring 2014 Fall Apr Sep Apr-16 Blountville Bristol, TN Elizabethton Johnson City Jonesborough Total
22 Total Controlled Substance Units Donated , by Semester Number of Medication Units Donated Spring Fall
23 Public Awareness Campaign Baseline 2013, Intervention 2014 Fall 2013 Spring 2014 Fall Apr Sep Apr-16 Blountville Bristol, TN Elizabethton Johnson City Jonesborough Total
24 Amnesty Box Collections
25 Permanent Drug Disposal Boxes
26 Controlled Substances Collected Total Controlled Substance Units Collected by Drug Class Opioids Sedative Hypnotics Stimulants Misc.
27 Donations by Weight 2500 Total Pounds of Rx and Controlled Substances by Collection Site Pounds Total Rx Controlled Substances
28 Donations by CS Units Units of Controlled Substances By Collection Site Rogersville Mt. City Kingsport Jonesborough Johnson City Elizabethton Bristol Blountville
29 Dispensing to Donation Time Mean Number of Months Between Dispensing and Donation Opioids Sedative Hypnotics Stimulants Misc.
30 American Journal of Public Health (Approved with Revision March 2015) Monthly Donations/1,000 Residents Monthy Average # of Pills per 1000 Residents Average Monthly CS Donations per 1000 Residents, by Pounds and Number of Pills Pop. Under 10,000 Pop. Over 10,000 S1 S2 S3 S4 S5 S6 S7 S8 Total Monthly pills per 1000 Monthly lbs per Monthly Average lbs per 1000 Residents
31 Combined
32 Amnesty and Take Back 60 Pounds of Controlled Substances Collected from Amnesty Boxes and Drug Take Back Events, by Municipality, May October Blountville Bristol Elizabethton Johnson City Jonesborough Average Take Back Amnesty
33 8.0% Percent Controlled Substance for Amnesty and Take Back Collections, May 2013-October % 6.0% 5.0% 4.0% 3.0% 2.0% Take Back Amnesty 1.0% 0.0% 50 Pounds of Controlled Substances for Amnesty and Take Back Collections, May 2013-October Take Back Amnesty 0
34 Donor Storage Tendencies Number of Months Between Dispensing and Donation by Therapeutic Class Class Mean Median Take Back Amnesty Take Back Amnesty Opioids Sedative/ Hypnotics Stimulants Misc
35 Conclusions Amnesty Box and traditional Take Back options are effective primary prevention mechanisms Amnesty Box donations outpace Live Take Back donations in the same municipalities (total & CS) CS donation percentage by weight is similar between the two options The number of CS dosage units collected is higher per capita for Amnesty Box donors Time from dispensing to donation is approximately six months earlier for Amnesty Box donations
36 Diversity-promoting Institutions Drug Abuse Research Program Team NIH/NIDA R24 Sponsored Research
37 Lessons Learned from a Rx Disposal Program in NE Tennessee Jeffrey A Gray, PharmD, CDE Associate Professor, ETSU College of Pharmacy Adjunct Professor, ETSU College of Public Health
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