Proper Medication Disposal

Transcription

1 Proper Medication Disposal MPhA 2014 Annual Conference September Disclosures I have no disclosures relative to this presentation. Carolyn O Donnell Minnesota Multistate Contracting Alliance for Pharmacy (MMCAP) Marketing and National Field Service Manager BS Pharm, MBA, PharmD candidate 2015 Carolyn.ODonnell@state.mn.us (651) Learning Objectives Understand the dangers of keeping unused prescription medication in patients homes Understand availability and process for participating in community medication take back programs Understand the steps involved in proper home disposal of medications Understand which medications are recommended for flushing down toilet, and the risk versus benefit of flushing Review the DEA Final Rule for the Disposal of Controlled Substances Review MN statutes and Board of Pharmacy Position 1

2 Session Schedule Presentation of Information 40 minutes Questions Application Exercise Evaluation 5 minutes 5 minutes 10 minutes 5 minutes Background Proper disposal of unused medications is important because prescription drugs in the household trash can be found and abused, and medications that are flushed down the toilet contaminate the water supply and endanger the environment. Prescription drug abuse has been classified as an epidemic by the CDC Ranks second only to marijuana as the most common drug abuse in the U.S. Family, friends, and the home medicine cabinet are the sources of prescription drugs abused by teenagers. Consumers discard 23% of liquid pharmaceuticals prescribed and 7% of tablets (research in Germany) Concern: Poisoning Accidental poisoning of children Increasing rate of pediatric exposure to adult medications The most serious injuries were from narcotics and diabetes medications Young children have the greatest risk of being poisoned by diabetes and blood pressure medications 2

3 Concern: Poisoning Accidental poisoning of pets 25,000 cases of pets ingesting human prescriptions in 2013 Top three medication types include blood pressure, antidepressant and pain meds Pets commonly ingest medications from countertops and mail order packages Concern: Inappropriate Therapy Taking the wrong medication Taking multiple strengths of the same drug Using expired medication that is ineffective Concern: Drug Seekers Misuse or abuse by teenagers and adults 1 out of 5 Americans admitted to using Rx drugs for nonmedical reasons More Americans die from prescription drug abuse than cocaine, hallucinogens, inhalants and heroin combined Pharm Party Trash Diving 3

4 Concern: Drug Seekers Most often abused prescription drugs include: Opioid pain relievers CNS depressants (for insomnia or anxiety) Stimulants (for ADHD) 70% of teens who abuse prescription meds get them from: Home medicine cabinet Family Friends Concern: Environmental Impact Water pollution From flushing medications down toilet or rinsing down sink Landfill leachate makes its way into the water The main way drugs enter water systems is by passing through peoples bodies 80% of U.S. rivers and streams have low levels of pharmaceuticals including antibiotics, hormones, contraceptives and steroids The presence of 5 parts per trillion of a contraceptive med can cause the collapse of fish populations Concern: Environmental Impact Environmental Impact from 3 disposal options Incineration (after pharmacy take-back) Toilet disposal Landfilling (from trash disposal) Disposal Method API Emissions 50% Incineration & 50% Landfilling 93% * 100 % Landfilling 88% * * vs. Toilet disposal Emissions of active pharmaceutical ingredients (API) Evidence suggests 50% participation in take-back programs is upper bound Environmental Science Technology, May

5 Solution #1 Drug Take-Back Programs Drop off unused medications at community take back programs Drop Boxes Retail Pharmacy Programs National Prescription Drug Take-Back Events Other facilities as authorized by DEA to become collectors Why are Take-Back Days and Drop Boxes needed? Controlled Substances Act did not provide a way for patients to dispose of controlled substances until now! CSA established a closed system of distribution; patients may possess, but not transfer controlled substances Patients cannot return controls to pharmacies Interim measures..operation of medicine disposal programs Law enforcement agencies must retain custody of controlled substances at all times, including destruction Program must obtain permission from DEA Officially published 9/9/14, will take effect 10/9/14 5

6 Officially published 9/9/14, will take effect 10/9/14 DEA s goal in implementing the Act is to expand the options available to safely and securely dispose of potentially dangerous prescription medications on a routine basis Officially published 9/9/14, will take effect 10/9/14 DEA s goal in implementing the Act is to expand the options available to safely and securely dispose of potentially dangerous prescription medications on a routine basis DEA has no plans to sponsor more nationwide Take-Back Days (after the 9/27/14 event) in order to give authorized collectors the opportunity to provide this service to their communities Officially published 9/9/14, will take effect 10/9/14 DEA s goal in implementing the Act is to expand the options available to safely and securely dispose of potentially dangerous prescription medications on a routine basis DEA has no plans to sponsor more nationwide Take-Back Days (after the 9/27/14 event) in order to give authorized collectors the opportunity to provide this service to their communities The Final Rule authorizes certain DEA registrants (manufacturers, distributors, reverse distributors, narcotic treatment programs, retail pharmacies, and hospitals/clinics with an on-site pharmacy) to modify their registration with the DEA to become authorized collectors. 6

7 All collectors may operate a collection receptacle at their registered location, and collectors with an on-site means of destruction may operate a mail-back program All collectors may operate a collection receptacle at their registered location, and collectors with an on-site means of destruction may operate a mail-back program Retail pharmacies and hospitals/clinics with an on-site pharmacy may operate collection receptacles at long-term care facilities All collectors may operate a collection receptacle at their registered location, and collectors with an on-site means of destruction may operate a mail-back program Retail pharmacies and hospitals/clinics with an on-site pharmacy may operate collection receptacles at long-term care facilities Any method of disposal that was valid prior to these new regulations being implemented continues to be valid. 7

8 All collectors may operate a collection receptacle at their registered location, and collectors with an on-site means of destruction may operate a mail-back program Retail pharmacies and hospitals/clinics with an on-site pharmacy may operate collection receptacles at long-term care facilities Any method of disposal that was valid prior to these new regulations being implemented continues to be valid. Law enforcement continues to have autonomy with respect to how they collect pharmaceutical controlled substances from ultimate users, including holding take-back events. Any person or entity DEA registrant or non-registrant may partner with law enforcement to conduct take-back events. The public may find authorized collectors in their communities by calling the DEA Office of Diversion Control s Registration Call Center at Final Rule may be viewed on the DEA website at MN statutes do not allow health care facilities to accept drugs from consumers Includes any drugs, not just controlled substances Includes pharmacies, drug manufacturers, hospitals, clinics, and drug treatment programs Pharmacies may provide mail-in envelopes to consumers to send their drugs to reverse distributors Pharmacies and other health care facilities cannot maintain collection receptacles at this time 8

9 Legislation is being drafted to allow pharmacies to maintain collection receptacles Pharmacies and other health care facilities must follow DEA rules MN Board of Pharmacy with MN Pollution Control Agency During 2015 session of the Legislature Includes pharmacies and other health care facilities MN Board of Pharmacy Position Supports the collection of pharmaceutical waste by pharmacies Has investigated complaints that drugs collected from patients have been re-dispensed or diverted Adequate statutes and rules must be in place Prescription Drug Take-Back Programs Community Based Accept prescription (including controls) and OTC drugs and animal medications From community members, not from pharmacies or healthcare facilities. Drop off is confidential, open 24 hours daily Locations are in conjunction with local law enforcement offices 9

10 Prescription Drug Take-Back Programs Community Based Take It To The Box is a program example Leave medication in original package Do not cross off drug name Remove patient identifying information Free Anonymous Prescription Drug Take-Back Programs Pharmacy Based Pharmacy programs are convenient for patients Some pharmacies charge a fee Pharmacies previously could not accept controlled substances; now may apply to be an authorized collector Pharmacies may not utilize the community drop boxes Pharmacies must arrange for pharmaceutical waste removal service Rules are state-specific Prescription Drug Take-Back Programs Pharmacy Based Health Partners Free prescription take-back (not controls) Year round program in most HP pharmacies Do not have to be their patient Medication must be identifiable, in a labeled container Walgreens Sells packaging envelopes addressed to incinerator facility Patient inserts unused meds and mails off Other Examples? 10

11 Prescription Drug Take-Back Programs National Events Several collection sites throughout the state Watch for announcements once or twice a year You may encourage your local law enforcement offices to participate Minnesota coordinator: GS Jack Henderson Prescription Drug Take-Back Programs National Events The National Prescription Drug Take-Back Day aims to provide a safe, secure, and environmentally responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse and trafficking of medications. Date of Take-Back Pounds Collected Sept. 25, ,000 April 30, ,593 October 29, ,086 April 28, ,161 Sept. 29, ,395 April 27, ,497 Oct. 26, ,211 April 26, ,158 Prescription Drug Take-Back Programs National Events Local law enforcement agencies and the DEA Allows citizens to dispose of unwanted, expired, unused prescription drugs (only pills and patches accepted) Next event: September 27, AM to 2 PM Free and anonymous 11

12 Solution #2 Household Trash Place unused medications in household trash after following precautions Goals: Destroy product to deter drug seekers Seal to prevent leakage into landfills and groundwater Remove patient identification on containers Solution #2 Household Trash Instructions: Take out of original containers Mix with used coffee grounds or kitty litter (undesirable substance) Place in sealable bag or other small container (prevent leaking) Remove identifying information from medication container by scratching off or marking out Use this method if no drop boxes or take back programs are available Solution #2 Household Trash Product for sale at retail pharmacies Place unused medications and narcotics in pouch Add water Seal pouch and place in regular trash Other products on the market? 12

13 Solution #3 Flushing Do not flush medications down toilet Prevent water pollution from drugs flushed down toilet or rinsed down sink. A small portion of prescription drugs are recommended for flushing down the toilet Ex: narcotic pain relievers One dose could be lethal to a child Reduces the danger of overdose or abuse Study Findings Current Patient Practices Regarding Unused Medications Action 24% 10% 34% 32% Keep in Home Trash Flush in Toilet Other Hawaii Narcotics Enforcement Division with University of Hawaii College of Pharmacy in 11 take back events Study Findings Patient attitudes towards pharmacy medication take back programs: Protecting the environment was the primary reason for participating All users saw the program as a valuable service Most respondents saw take back program as a positive reason to choose a pharmacy Over half were favorable to paying per pound for the service Pilot study in a Texas community pharmacy 13

14 Future Changes DEA may recommend no flushing for any product Watch for specific details on the DEA implementation of the Final Act Pharmacies may charge patients or increase current fee for take-back services as regulations around pharmaceutical hazardous waste become more costly Proposed legislation in Maine - provide packaging envelopes to patients, addressed to drug manufacturer for disposal. Watch for proposed legislation in other states. Summary of Learning Dangers of keeping unused prescription medication in patients homes include Accidental poisoning of children and pets Availability to drug seekers adults and teens Inappropriate therapy- wrong dose, overdose, or sub-therapeutic dose Understand availability and process for participating in community medication take back programs National Events Community drop boxes Pharmacy programs Other DEA authorized collectors Summary of Learning Understand the steps involved in proper home disposal of medications Destroy product to deter drug seekers Seal to prevent leakage into landfills and groundwater Remove patient identification on containers Understand which medications are recommended for flushing down toilet, and the risk versus benefit of flushing Narcotic pain relievers may be flushed, due to lethal danger of one dose Flushing increases water pollution 14

15 Summary of Learning Review the DEA Final Rule for the Disposal of Controlled Substances Review MN statutes and Board of Pharmacy Position Questions? References National Institute on Drug Abuse, Burghardt L, Ayers JW, Brownstein JS, et al. Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings. Pediatrics Online, 2013 June American Academy of Pediatrics. American Society for the Prevention of Cruelty to Animals (ASPCA) Ma CS, Batz F, Juarez DR, et al. Drug Take Back in Hawai i: Partnership Between the University of Hawai I Hilo College of Pharmacy and the Narcotics Enforcement Division. Hawai i Journal of Medicine & Public Health Jan; 73(1): Perry LA, Shinn BW, Stanovich J. Quantification of an ongoing communitybased medication take-back program. J Am Pharm Assoc (2003) May 1; 54(3): Thach AV, Brown CM, Pope N. Consumer perceptions about a community pharmacy-based medication take back program. J Environ Manage Sep 30; 127:

16 References Hennepin County Medicine Disposal, Minnesota Pollution Control Agency, Disposing of Unwanted Medications, National Take Back Initiatives, U.S. Department of Justice, Drug Enforcement Administration, Office of Diversion Control, Rice County Chemical Health Coalition, United States Drug Enforcement Agency, United States Environmental Protection Agency, United States Food and Drug Administration, Disposal of Unused Medications: What You Should Know, White House Office of National Drug Control Policy (ONDCP), Application Exercise Create a communication piece unique to your site Target your message to your practice site What are your patients currently doing with unused meds? Which issue would engage their action? What action are they most likely to pursue? Define current resources in your area County information provided Create a plan to encourage proper medication disposal Communication tools Building awareness Reminders and education opportunities Exercise Resources Exercise resources are provided at your table County listing of drop-box locations Local participation in national take back events List of main concerns with keeping unused medications List of solutions Ideas for graphics Ideas for survey of patient current habits and concerns Ideas for message delivery Sample program brochure Minnesota county map 16