Helen Pervanas PharmD, R.Ph. Assistant Professor Pharmacy Practice MCPHS-Manchester/Worcester

 I have no financial relationships to disclose

 List the concerns associated with improper medication disposal  Describe the steps involved in organizing a medication disposal event  Discuss the results of a community based medication collection event

 Prescription and Over-the-Counter drug use continues to increase  Exceeded $200 billion in the U.S. in 2007*  65 and older population projected to increase from 12.4% in 2000 to 19.6% in 2030 *Sources: IMS Health and US Census Bureau, NERC photo

 Flushing medication down the toilet  Rinsing down the sink  Throwing medication in the trash  Stockpiling medications/sharing with others

 Environmental concerns  Unintentional ingestion  Drug diversion

 Active Pharmaceutical Ingredients (API) in surface and groundwater  Detected pharmaceutical agents  Estrogen hormones  Anti-infectives  Anticonvulsants  Mood stabilizers Source: US Geological Survey

 Threat to pets and humans  95% of unintentional deaths were drug related  Opioid pain medications Source: CDC

Source: NH Department of Environmental Services, April NH deaths up 350% Exceeded traffic deaths in NH

 Abuse of controlled substances doubled from 7.8 million in 1992 to 15.1 million in 2003  Prescription drugs are the drug of choice for teens; 12 and 13 years of age  Pain medications  Ranked 2 nd highest abused drug(marijuana 1 st ) Source: Washington State Dept of Ecology and D.A.R.E.

 Local Health Plan-Anthem BC/BS (400,000 lives), Manchester, NH  Earth Day, April 22, 2009 (9am-1pm)

 Research  Contact regulatory agencies  Review federal and state laws  Choose a venue

 NH Board of Pharmacy (BOP)  NH Drug Enforcement Agency (DEA)  NH Department of Environmental Services (DES)

 Law enforcement required for controlled substance collection  Procurement of a temporary Environmental Protection Agency (EPA) identification number  Arrangements for pharmaceutical and hazardous waste disposal

 Staffing/Volunteers  Purchase supplies  Advertising

Press Release Senior Centers to employees Local Newspaper Public TV

ITEMCOST (dollars) Supplies$200 Giveaways for consumers$200 Gift cards for volunteers$100 Waste Disposal Fee$50* Hazardous Waste Disposal$510 Traffic Control by MPD$250 Total Expenses$1310 * Cost was minimal due to MPD

 Police officials  Health Plan employees  Pharmacists  Student Pharmacists

 Lap top computer/printer  Flash drive  Counting trays  Drug identification resources  Plastic bins/bags  Non-latex gloves  Face mask  Reflective vest  Bin for recyclables

 Consumers drop off medications in a drive- thru fashion  Greeted by health plan volunteers  Patient information distributed on proper disposal  Procedure for drop off  Drive up to entrance where pharmacist inspects medications  Medications transferred to counting area by police official

The White House Office of National Drug Control Policy recommends that you:  Take unused, unneeded or expired prescription drugs out of their original containers and throw them in the trash.  Mix prescription drugs with an undesirable substance, such as used coffee grounds or kitty litter and put them in impermeable, non-descript containers, such as empty cans or sealable bags.  Don’t flush prescription drugs down the toilet unless the label or accompanying patient information specifically instructs doing so.  Take advantage of community pharmaceutical take- back programs that allow the public to bring unused drugs to a central location for proper disposal.

Greeters welcome consumers Provide information Pharmacist inspects medications Remove patient information

 Pharmacists and student pharmacists collect, sort, count and document  Place medications in collection bins  Controlled substances  Hazardous waste  All other medications

 Total of 41,601 units  Weighing ~100 lbs  40 consumers attended MedicationsPercentUnits Non-Controlled78%32,305 Over-the- Counter 18%7,618 Controlled3%1356 Hazardous Material 1%322

 Top controlled substances  Anxiolytics and narcotic pain meds  Top non-controlled substances  Phosphate binders and psychiatric meds  Top OTC substances  Vitamins  Top hazardous waste substances  Mercaptopurine  Warfarin

NameNumber (%) Lorazepam16% Hydrocodone APAP15% Hydrocodone/ Homatropine Syrup13% Oxycodone/APAP12% Pregabalin8%

NameNumber (%) Calcium Acetate10% Risperidone6% Olanzapine5% Furosemide5% Doxazocin4%

NameNumber (%) Multivitamin11% Calcium + vitamin D8% Iron products8% Docusate sodium8% Sennoside7%

 Early and extensive advertising  Hold event on weekend day  Explicit information regarding acceptable medications i.e. original containers

 “Relieved to have them out of the house and away from grandchildren”  “Wonderful! Been holding on to medication for over a year”  “Can’t flush, no one wants them”  “Great to have this program. Did not know what to do with them”  “Waiting for event to dispose”  “Great service to the public”  “Delighted this program is being held”