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Drug-disposal options in the United States are still evolving, and patients often do not know proper procedures. As the most accessible of healthcare professionals, pharmacists have a responsibility to promote best practices.
Unused medications pose a public safety issue, especially when not handled or disposed of properly. Prescription drugs, when taken without physician supervision or authorization, can lead to accidental poisoning, overdose, and/or abuse. Recent years have shown increases in hospitalizations and deaths related to opioid analgesics and psychoactive medications.
Those who do not dispose of medications may hoard them in their homes or give them to friends or family. These actions directly contribute to drug diversion. Medications are commonly stored in household bathrooms and kitchens, without locks or security measures. This is a concern in the case of adolescents and young adults, who may have unsupervised access.
According to the Centers for Disease Control and Prevention, between 2000 and 2009, fatal poisonings in patients 15 to 19 years of age increased 91%, in part because of a jump in opioid overdoses. Also, college students claim their peers are sources for obtaining medications. Drug-sharing is equivalent to self-medicating and is dangerous, since the identity and purity of the medication cannot be ensured.
Education is crucial if society is to address this issue. According to the Office of National Drug Control Policy and the Food and Drug Administration (FDA), if patients are to discard medications with their trash, they should follow these steps:
These tactics discourage others from rummaging through trash. However, determined individuals will go to great lengths to obtain a drug. Therefore, FDA has compiled a list of especially harmful medications that should be flushed, to reduce the risks of unintentional use. Opioids comprise the bulk of the list.
Questions about these practices may arise, particularly relating to contamination of the water supply. Drug take-back programs remain the gold standard for proper disposal.
Drug take-back programs have become increasingly popular over the last several years. U.S. communities have established programs, often at police precincts or local pharmacies, staffed by pharmacy personnel, other healthcare professionals, and law enforcement officers. In 2010, the Drug Enforcement Administration (DEA) started a take-back initiative, designating certain days as "National Prescription Drug Take-Back Days."
Currently, the Controlled Substances Act does not allow community-based programs to accept controlled substances, unless the DEA has granted permission and law enforcement officers are present to receive them. Therefore, community-based programs must advertise the exclusion of controlled substances or employ law enforcement, which may be inconvenient and costly. Although these programs are beneficial, this restriction prevents communities from protecting the population from the drugs most likely to be diverted.
Fortunately, the Secure and Responsible Drug Disposal Act of 2010 was designed to amend the Controlled Substances Act, allowing the DEA to develop methods to transfer controlled medications for responsible disposal. The proposed regulations will allow drug take-back events, mail-back programs, and collection-box receptacles to accept non-controlled and controlled medications.
Manufacturers, distributors, reverse distributors, and pharmacies may also voluntarily participate in mail-back programs and implement collection-boxes. Until these provisions are permanently adopted, the DEA will continue holding National Prescription Drug Take-Back Days. For information about the initiative and upcoming events, visit the official website at http://www.deadiversion.usdoj.gov/drug_disposal.
Pharmacists are in a unique position to inform patients about disposal, as they are the most accessible healthcare professionals. They are at the forefront of medication information, and that includes knowledge of proper handling of drugs. Student pharmacists also can volunteer and educate.
To prevent overprescribing of medications, it is most important to ensure that patients receive well-targeted doses and optimal therapies with the fewest adverse effects. Counseling on the importance of compliance is also crucial in reducing nonadherence. These best practices can help address this public health issue, with the goal of minimizing drug diversion, abuse, and waste.
Jonathan Sinis a 2014 PharmD candidate at St. John’s University College of Pharmacy and Health Sciences.
Nissa Mazzolais assistant clinical professor, St. John’s University College of Pharmacy and Health Sciences, and an ambulatory care clinical pharmacist for North Shore University Hospital Division of General Internal Medicine.