1. name Secure Medicine Return: PH:ARM Pilot in Washington State Shirley Reitz, Pharm.D., BCPS Associate Director, Pharmacy Clinical Services Group Health Cooperative Seattle, WA 206-901-4334 Reitz.sj@ghc.org November 2008

2. name 2 Patient Demand 2006 WCRC survey of 400 King County households revealed –39% have 10 or more medicine containers in their homes –Only 33% report that they are currently using or plan to use these meds –74% stated they would be willing to dispose of the meds in a convenient location We are cleaning out my Grandfathers house and I have a suitcase full of drugs that we need to get rid of. Can we bring them into your disposal site? Our neighborhood association (over 400 homes) would like to provide some education to the families in our neighborhood about drugs in their homes – can we tell them to bring their meds to you for disposal? Please dispose of this medication. Enclosed is a donation….

3. name Pharmaceuticals in Landfills Leachate pumped to sewer treatment plants –Could leach to groundwater –studies find drugs 9 unlined landfills in Washington State

4. name 4 PH:ARM Team Pharmaceuticals from Households: A Return Mechanism HEALTH CARE PROVIDERS –Group Health Cooperative BUSINESSES –Bartell Drugs –Boarding/assisted living homes NON-PROFIT AGENCIES –Interagency Resource for Achieving Cooperation (IRAC) –Northwest Product Stewardship Council –Pacific NW Pollution Prevention Resource Center (PPRC) –WA Citizens for Resource Conservation (WCRC) STATE & LOCAL GOVERNMENT –King County Dept. of Natural Resources & Parks –Local Hazardous Waste Management Program in King County –Public Health - Seattle and King County –Snohomish County Solid Waste Management Division –WA Department of Ecology ADVISORS –WA State Board of Pharmacy –WA State Dept. of Social and Health Services - Aging and Disability Services Administration

5. name 5 Group Healths Goal Work with community partners to develop a medication disposal system that is: –Secure –Affordable –Reproducible –Sustainable –Meets all regulatory requirements –Easy for our patients to use Remove from the home medications posing risk of unintentional poisoning, overdose, or abuse

6. name 6 Group Health Pilot Bin Signs

7. name 7 Group Health Pilot

8. name 8 Pilot Project 25 Group Health clinic pharmacies statewide 12 Bartell Drugstores around Puget Sound 3 boarding /assisted living homes in Seattle

9. name 9 Group Healths Experience Group Health Collected Meds Percent by Weight 1,238 pounds total 16,460 drug containers Over 15,000 lbs of unwanted medications collected and safely destroyed from GHC locations over 2 year pilot

10. name 10 Interesting Findings

11. name 11 Snapshots of collected materials 14 Doses of Enbrel $5,600 Migranal Nasal Spray $120

12. name 12 What weve learned: Security is Critical! –Secure drop boxes –Complete tracking of secure containers –DEA utilization Staff Satisfaction –Makes my job easier Regulatory issues remain

13. name Next Steps Cost Considerations –Need affordable solutions –Pilot ending this year –Looking for interim Manufacturer funding Pilot project final report –Report expected Jan 09 –www.medicinereturn.comwww.medicinereturn.com Legislative efforts in 2009