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 Grandfather’s 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 possible escape to groundwater studies find drugs

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 Health’s 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 Health’s Experience Group Health Collected Meds Percent by Weight 1,238 pounds total 16,460 drug containers Over 14,000 lbs of unwanted medications collected and incinerated 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 we’ve 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

14. name Secure Medicine Return Legislation: A Producer Responsibility Approach Cheri Grasso Local Hazardous Waste Management Program in King County cheri.grasso@kingcounty.gov 206-263-3089 November 2008

15. name Next Steps Regulatory Change Moving Beyond Grants Washington State Producer Responsibility Legislation

16. name Regulatory Change Department of Transportation –Medicines must be in original package Requires sorting Loose pills shipped in smaller container Limits weight of container Product Stewardship Institute –Dialogue on regulations Dec 2 - 3 –www.productstewardship.us

17. name Beyond Grants PH:ARM successful in obtaining grants Search for Sustainable Funding –Local Governments cannot pay for statewide –Pharmacies have very small profit margin –Producers most logical choice Voluntary approach? –Creates unfair level for producers

18. name Secure Medicine Return Bill Producer paid statewide medicine return program Passed out of Environmental Health Committee Unanimous, bi-partisan vote Big bill, short session Set stage for success in ‘09

19. name 2008 Endorsers Business Bartell Drugs Group Health Washington Food Industry WA State Pharmacy Association Civic & Environmental Organizations Children’s Alliance Environment Washington League of Women Voters of WA People for Puget Sound Senior Citizens’ Lobby Sierra Club Cascade Chapter WA Citizens for Resource Conservation WA Organic Recycling Council WashPIRG Governments Coalition for Clean Water King County Local Hazardous Waste Mgmt Program in King County Thurston County WA Association of Sheriffs and Police Chiefs Yakima County Health Organizations Assoc of Advanced Practice Psychiatric Nurses Breast Cancer Fund School Nurse Organization of WA WA State Assoc of Occupational Health Nurses WA State Hospice and Palliative Care Org. WA State Nurses Assoc.

20. name Policy: Medicine Return Legislation Drug producers design & pay for program –In every county statewide –In all cities with populations > 10,000 Covers –Over-the-counter drugs –Prescription drugs (including controlled substances) From –Households –Residential sources (hospice services, nursing homes, schools, etc.)

21. name Medicine Return Legislation: What does the program look like? Producers determine how best to securely and conveniently collect the medicines –Mail back –Pharmacy –Hybrid –Other???? If they choose a pharmacy model –Pharmacies participate voluntarily –Expect many pharmacies to do so

22. name Medicine Return Legislation: Hazardous Waste Disposal Alternative Technology Outreach Board of Pharmacy –Oversight –Enforcement

23. name Medicine Return Legislation: Shared Responsibility Pharmaceutical brand owners pay for program Pharmacies give out information on take back and may provide take-back locations Consumers return their unwanted medications to takeback location Government provides oversight and education

24. name Next Steps Seeking endorsements Talking with legislators Talking with pharmaceutical manufacturers Successful passage in ’09!