PROPER DISPOSAL OF UNWANTED MEDICATIONS THE DISPOSAL PROPOSAL
- Slides: 18
PROPER DISPOSAL OF UNWANTED MEDICATIONS “THE DISPOSAL PROPOSAL” PATTI DARBISHIRE, PHARMD CLINICAL ASSOCIATE PROFESSOR, PHARMACY PRACTICE
OBJECTIVES • Describe the entities that have an interest in proper medication disposal and reasons why • List options for proper medication disposal • Discuss research results
ABUSE VS. MISUSE For purposes of this presentation: Abuse: • Intentionally using medications for an unintended purpose or for recreational use Misuse: • Unintentional, but improper and/or unsafe medication use Abuse or Misuse = Harm or Death
Who has a vested interest in proper disposal of medications? • Law Enforcement • Healthcare system • Environmentalists • All of us!
DRUG ABUSE STATISTICS • In the US (2010), ~9 million people abused prescription medications. • The most abused prescription drug categories: 1. Painkillers, 2. Sedative-Hypnotics, 3. Stimulants 1 • 70% of abused pain relievers were not prescribed for the abuser • Obtained from a friend or relative (knowingly or unknowingly)2 • 62% of teens get the prescription drugs from their family’s medicine cabinet 1
MISUSE STATISTICS • 90% of U. S. poisoning deaths due to prescription drugs • Most opioid pain meds, antidepressants and cardiovascular drugs 6 • 77% of prescription, OTC, and illicit drug overdose deaths in Indiana are unintentional 3 12%
OUR CHILDREN AND PETS Over a 10 year period 2. 5 million children in the US <6 years old were poisoned by unintentional ingestion of medications, personal care products, and/or vitamins 6, 7 http: //www. poison. org/stats/ In 2012, the American Society for the Prevention of Cruelty to Animals received more than 25, 000 calls related to pets consuming human prescription medication 8 http: //animals. howstuffworks. com /pets/pet-travel/pet-meds-fortraveling. htm
HC PROFESSIONALS’ INTEREST Expired medications can be dangerous because some chemicals become: • more potent • less potent • degrade into other chemicals Retaining discontinued medications can cause: • confusion in correct therapy • duplication in therapy HC professionals are interested in improving adherence to prescribed therapies, e. g. antibiotics, pain medications
MEDICATION OVERLOAD Annual number of prescriptions per capita 23: • 12 for people ages of 19 - 64 • 28 for people age 65 or older http: //takemedsseriously. org/safe-disposal/disposal-options/ and http: //www. disposemymeds. org
WHY DOES THIS HAPPEN? Prescribing: • Many patients won’t leave the office without a Rx • “Just in case” prescriptions • Full prescription vs. trial dose for new medications Prescription Filling: • Insurance companies encourage large quantities through cost incentives and mail-order • Pharmacy Auto Refill option leads to stockpiling medications
POSSIBLE SOURCES OF DRUG WASTE 2. https: //www. arhp. org/publications-and-resources/contraception-journal/august-2011
DRINKING WATER The problem: • Wastewater treatment plants are not designed to eliminate medication from drinking water • Inability to eliminate drug waste through the sewer or septic systems • Medication from landfill runoff goes straight into the streams and rivers
MEDICATIONS IN THE ENVIRONMENT Many medications can be found in rivers, lakes, groundwater and drinking water • About 80% of water sources contain low levels of medications 10 Includes: • antibiotics • anti-depressants, • steroids/hormones • painkillers • cancer treatments • many others 11 http: //toxics. usgs. gov/regional/emc/environmental_occurrence. html
PERSONAL CARE PRODUCTS AND THE ENVIRONMENT Personal care products are not regulated by the FDA • Many harm the environment • Safety to humans has not been evaluated Microbeads http: //www. huffingtonpost. com/2013/10/3 0/great-lakes-microbeads_n_4178363. html http: //www. amurie. com/learn. html • non degradable plastic bead • absorb and retain toxins • ingested by fish The goodguide. com reviews best environmental products
MEDICATION TAKE BACK OPTIONS • Drop boxes and collection bins • Public take-back events • E. g. Purdue College of Pharmacy http: //thedailynews. cc/2012/0 9/25/montcalm-county-now-home-to-5 -med-drop-off-boxes/ • Pre-paid mailers (purchase at some pharmacies or online) • Pharmacies • Police departments • Drug manufacturers (pre-paid mailers)
PURDUE UNIVERSITY RESEARCH • STUDENT PHARMACISTS HOSTED 15 COMMUNITY MEDICATION TAKEBACK EVENTS BETWEEN 2012 – 2015 • CATEGORIZED ~5000 PRESCRIPTION, OTCS, AND PERSONAL CARE PRODUCTS (FOR BOTH HUMANS AND ANIMALS) - ABOUT 1/3 OF WHAT WAS COLLECTED • RECORDED THE DRUG NAME, DRUG CLASS, CONTROLLED STATUS, AND EXPIRATION DATE • STUDENT AND FACULTY RESEARCHERS DEVELOPED AND ADMINISTERED A SURVEY TO 478 PARTICIPANTS WHO BROUGHT MEDICATIONS TO THE EVENTS • COLLECTED PARTICIPANT DEMOGRAPHICS AND INFORMATION ON PARTICIPANTS’ DISPOSAL PRACTICES AND OPINIONS • EACH SURVEY WAS LINKED TO THE RECORDED MEDICATION DATA BUT NO IDENTIFIABLE PATIENT INFORMATION WAS RECORDED • STUDENTS TALKED TO PARTICIPANTS ABOUT PROPER DISPOSAL METHODS AND EDUCATIONAL BROCHURES ON SAFE DISPOSAL METHODS WERE DISTRIBUTED TO PARTICIPANTS
WHAT HAPPENS TO MEDICATIONS COLLECTED? • The EPA considers medication collected at take-back sites to be household waste and recommends incineration 20, 21 • Medications were taken by police officers to Covanta Energy – incineration facility utilizing specialized air filters to prevent toxins from entering the air Controlled Air Incinerator http: //www. epa. gov/ttnchie 1/ap 42/ch 02/final/c 02 s 03. p df
WHAT WE FOUND • • The average number of medications returned person was 10, and the average number of years the product was expired was 5. 58% of medications returned were prescribed, 40% were purchased over-the-counter and 2% were veterinary medications. The top 3 drug categories collected were analgesics (26%), cough and cold products (16%), and anti-infectives (11%). 24% of analgesics returned were schedule II narcotics, with the most commonly returned medication being the controlled substance hydrocodone/acetaminophen. Upon analysis of antibiotic prescriptions, it was determined that, on average, only 37% of antibiotic therapy is consumed by the patient. 98% of participants recognized that improper medication disposal is harmful to the environment, but only 64% knew where to take medications for proper disposal. 32% of participants continue to throw medication in the trash, 28% report never having previously disposed of medications, and 25% continue to flush medications down the toilet. A slight majority (54. 4%) of participants were not willing to pay for medication disposal services. *References available upon request
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