Green pharmacy pilot program goes national

March 1, 2009

A San Francisco pilot program for ecological collection of consumer pharmaceutical waste is giving pharmacies nationwide the tools and training to create their own drug take-back programs.

Key Points

A green pharmacy pilot program that collected more than 5,000 pounds of consumer pharmaceutical waste in the San Francisco area is going nationwide. The Teleosis Institute, based in Berkeley, Calif., released a Green Pharmacy Toolkit in January. The idea, said Teleosis Executive Director Joel Kreisberg, is to give pharmacies the tools and the training to create their own drug take-back programs.

"[People] don't really know what they should or can do," Kreisberg said. "There is a medication disposal system already available if you know how to use it." Teleosis' initial plan is to expand from 15 to 50 pharmacy take-back sites by the end of the year and to collect 100,000 pounds of unused drugs.

"The biggest issue we have found is money, not ideology," Kreisberg said. "I haven't talked with anyone in pharmacy who is not supportive of the idea of safely destroying unneeded medications. What they're saying is that I can't afford to be the one paying for it."

Kreisberg compared medication take-back programs to electronic waste-collection programs. Both started as scattered community efforts. Electronic waste recycling has become mandatory in many jurisdictions, he said. "Pharmaceutical disposal makes electronics disposal look simple," said Scott Cassel, executive director of the Product Stewardship Institute in Boston. "The level of complexity [with] this issue is astounding."

PSI has established a working group with pharmacy associations, environmental groups, drug-diversion authorities, and state and local governments in 46 states, Cassel said. "The goal is to create a dialogue that leads to a consensus definition of the problem and a range of potential solutions."

Greening pharmacy is just one of many issues, said Sierra Fletcher, PSI associate for policy and programs. Public health officials want to reduce accidental poisonings from medications that accumulate in households. Law enforcement is concerned about diversion. Environmental groups worry about contamination of drinking water supplies. Manufacturers worry about negative publicity and sales. Healthcare facilities wonder about the safest way to dispose of unneeded medications. Everyone worries about adding cost to an already gargantuan healthcare bill.

One solution: Create less waste

Expired aspirin and other NSAIDs represent the most common products collected in pharmacy take-back programs. Simply cutting back on NSAID purchases would reduce waste. Households that buy a 500-tablet bottle of aspirin or ibuprofen but throw away half the bottle when it expires waste money.

"Helping patients buy the right amount of medication ... is even more effective in greening pharmacy than creating a take-back program," Kreisberg said. High-volume users such as prescribers, hospitals, and long-term-care facilities, can adjust inventory and prescribing practices. When physicians order 1 mL, and the hospital pharmacy stocks 5-mL single-use vials, drug waste results.

In San Jose, Calif., Leiter's Pharmacy collects 300 pounds of Rx and OTC products every month. The store spends about $125 monthly on disposal fees and other direct costs. Staff pharmacist Robyn Shalinsky, who started the take-back program in 2007, said it offers a solid return on the investment.

"The take-back program has definitely increased our walk-in business," she said.