Janet Chang, PharmD Candidate 2017Behind astonishing U.S. pharmaceutical sales that reach $400 billion
a year, an alarming 2.8 million pounds of prescription medications go unused. This staggering amount of unused medications raises a public health concern and emphasizes the need for drug take-back.
All players involved in the drug-product chain — pharmaceutical companies, distributors, pharmacies, and the government — must collaborate to design and implement an effective drug disposal and collection system. Pharmacists, in particular, must be proactive in supporting this movement to protect the health and safety of patients and consumers.
Human and environmental hazards
Unused medications are often stored in the home, thrown into the trash, or flushed down the toilet.
Medications stored in homes are dangerous sources of drug diversion that often results in abuse and accidental poisoning. At least 62% of teens use prescription drugs taken from their parents’ medicine cabinets, thinking that Rx meds are safer than illegal drugs such as cocaine and heroin. Prescription drug misuse has contributed to nearly 600,000 visits to U.S. emergency rooms and account for up to 85% of unintentional poisoning and deaths, many involving children and elderly.
It is essential to dispose of unused medications. However, the improper disposal of drugs flushed into our waterways threatens the ecosystem. Pharmaceuticals have been detected in streams and drinking water across the country. Most commonly found are acetaminophen, metformin, and carbamazepine, as well as antibiotics, a grave concern in light of growing bacterial resistance. Traces of medications have disrupted the development and reproduction of aquatic organisms; for example, they have had a feminizing effect on male fish and have altered the male-to-female ratio.
Challenges in today’s system
Biannual events hosted by the U.S. Drug Enforcement Administration (DEA) have not been able to sustain the ongoing public demand. The situation has become more complex now that the DEA has chosen to stop sponsoring national event and instead is allowing entities such as manufacturers and pharmacies to voluntarily provide mail-back programs and on-site drug collection receptacles (kiosks or bins).
Although pharmacies are the most accessible sites for drug disposal, there is often reluctance to install receptacles, because of costs associated with drug collection and incineration, theft, and improper placement by patients of hazardous wastes.
While participation in the take-back program is encouraged. Among big chains and hospitals, however, only Walgreens agreed to install disposal bins in 500 locations in 39 states, primarily in its 24-hour stores.
The Pharmaceutical Research and Manufacturers of America (PhRMA), representing drugmakers, has been refusing to fund drug disposal programs and has forcefully overridden county proposals and ordinances.
PhRMA and its trade associations sued Alameda County for implementing the first Extended Producer Responsibility (EPR) law through the Safe Drug Disposal Ordinance. It requires manufacturers to manage their products’ waste at end-of-life. PhRMA lost when the U.S. Supreme Court announced in May 2015 that it refused to hear the case. Since then, King County (Wash.) and six counties in California have adopted similar ordinances, and counties in other states are considering do so as well.
Meanwhile, lobbying efforts by PhRMA continue unabated. For instance, $250,000 was spent lobbying against Los Angeles County’s proposals on drug take-back. PhRMA partnered with the Consumer Health Product Association to influence residents by stating that implementation of such take-back ordinances would increase their taxes. Residents were urged to write letters to their county supervisors opposing the proposal. PhRMA also defends its opposition by supporting various educational programs and the FDA’s guidance for flushing medicines.
Other countries did it
Canada, Mexico, other South American countries, and countries in Europe have infrastructures that provide consumers with a safe and convenient method of medication disposal. They have implemented nationwide programs with permanent funding paid either fully by manufacturers or divided among manufacturers, wholesalers, and pharmacies.
In the United States, pharmacies are considered the most accessible sites for proper medication disposal by consumers. Although pharmacists have legitimate concerns, they can work with local governments and PhRMA to develop strategies to provide a convenient means of consumer drug disposal.
Meanwhile, to combat the growing issues of drug abuse, poisonings, and environmental damage, pharmacies should work toward becoming authorized drug-disposal locations.
Simple protocols for learning and registration established by the DEA can be found at http://www.deadiversion.usdoj.gov/online_forms_apps.html
Janet Chang is a 2017 PharmD candidate at Touro University, Vallejo, Calif. She would like to thank Aglaia Panos, PharmD, for her assistance in preparation of this article. Contact her at [email protected].