Collecting Unwanted Medications: The Legal & Safe Way Lynn Rubinstein Northeast Recycling Council, Inc. January 28, 2009
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 2009 2
Why are We Talking About Unwanted Medications? Environmental concerns Public health & safety Opportunity to take action Northeast Recycling Council, Inc. January 2009 3
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 2009 4
Routes of Environmental Exposure Metabolites & excretion Disposal of unwanted medication Northeast Recycling Council, Inc. January 2009 5
Intentionally Down the Drain Households Nursing homes Hospice Pharmacies Hospitals & other healthcare facilities Northeast Recycling Council, Inc. January 2009 6
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 2009 7
So you Put it in the Trash Solid Waste Concerns Scavenging Humans Animals Landfill leachate Northeast Recycling Council, Inc. January 2009 8
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 2009 9
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 2009 10
Environmental & Health Effects Feminization of amphibian & fish species Unknown effects from chronic exposure to low concentrations of multiple pharmaceuticals Northeast Recycling Council, Inc. January 2009 11
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 2009 12
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 2009 13
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 2009 14
Is the Disposal of Unwanted Medications Contributing to this Problem? 1 woman - 2,500 Combipatch estradiol/norethindone acetate transdermal system 50/40
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%
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 2009 18
Essentials of an Unwanted Medication Collection
Strategy Segregate controlled substances goes to law enforcement (incineration) Hazardous waste disposal (incineration) for all non-controlled substances Northeast Recycling Council, Inc. January 2009 20
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 2009 21
State Laws Are Critical Too! Board of Pharmacy Massachusetts Department of Public Health Non-criminal evidence limitations Northeast Recycling Council, Inc. January 2009 22
Collection Details Pharmacist Students/ Pharmacy Techs Law enforcement Hazardous waste hauler Northeast Recycling Council, Inc. January 2009 23
The Public Arrives Northeast Recycling Council, Inc. January 2009 24
Role of Pharmacist Determines status of medications Inventories medications Provides advice Northeast Recycling Council, Inc. January 2009 25
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
Role of Students/Techs Identify unknown medications Help with inventory Northeast Recycling Council, Inc. January 2009 27
Role of Law Enforcement Takes possession of controlled substances Ensures witnessed destruction Provides security Northeast Recycling Council, Inc. January 2009 28
Disposal of Controlled Substances Witnessed destruction: Law enforcement Supervised transport to U.S. DEA-authorized destruction (incineration) Northeast Recycling Council, Inc. January 2009 29
Packing for Disposal Medication stays in original containers Drums for non-controlled substances Controlled substances packed separately Cardboard packaging removed
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 2009 31
Examples of P-Listed Pharmaceuticals
Examples of U-Listed Pharmaceuticals Northeast Recycling Council, Inc. January 2009 33
Role for Reverse Distributors? Maybe, but not clear how. Northeast Recycling Council, Inc. January 2009 34
Key Considerations Public Perception - Good service to provide - More business & new customers - Medications not resold, reused, & no refunds Northeast Recycling Council, Inc. January 2009 35
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 2009 36
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 2009 37
Key Considerations - Time limited - Staffing: Event Law enforcement Pharmacist & Techs/Students Greeter Data entry Supervisor Hazardous waste company Northeast Recycling Council, Inc. January 2009 38
Key Considerations Costs Advertising must do Staffing Hazardous waste disposal Controlled substance destruction Law enforcement Supplies, garbage, recycling Northeast Recycling Council, Inc. January 2009 39
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 2009 40
For More Information NERC website has case studies & guidance documents www.nerc.org/topic_areas/ unwanted_medications_collections.html Northeast Recycling Council, Inc. January 2009 41
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Contact Information Lynn Rubinstein Northeast Recycling Council, Inc. Brattleboro, VT lynn@nerc.org www.nerc.org 802-254-3636 Northeast Recycling Council, Inc. January 2009 44