Survey: Pharmacies Can Improve Medication Disposal Education Efforts

A recent telephone survey conducted by researchers from UC San Francisco found opportunities for improving pharmacies’ role in educating patients about the proper disposal of unused medications.¹

The findings were reported in the Annals of Internal Medicine.

Appropriate disposal of old or unused medications, both OTC and prescription, can help reduce the risk of misuse, childhood poisoning, antibiotic resistance, and pollution. Pharmacists are well positioned to assist in the education of proper removal of such medications by raising awareness about efficient disposal methods.

Over the course of 2 months in early 2018, the researchers posed as parents of children who had recently had surgery to investigate the information approximately 900 California pharmacies have given regarding unused antibiotics and opioids. The researchers used 2 leftover medications as examples: sulfamethoxazole-trimethoprim (Bactrim) and liquid hydrocodone acetaminophen (Hycet).¹

According to their findings, fewer than half of the pharmacies provided disposal instructions meeting FDA guidelines and 10% followed the FDA’s preferred recommendations to take back unused medications from their customers. Just 47% of pharmacies gave correct instructions on how to dispose of antibiotics and only 19% gave correct instructions for opioids, according to the survey.¹

“This clearly points to the need for better dissemination of information on proper medication disposal,” senior author Hillary Copp, associate professor of urology at UCSF, said.² “The FDA has specific instructions on how to dispose of these medications and the American Pharmacists Association has adopted this as their standard. Yet it’s not being given to the consumer correctly the majority of the time.”

Copp noted that pharmacies should not be held solely responsible for disseminating disposal information. “Managing leftover medications is a complex problem that should be addressed from multiple angles,” she added.² However, pharmacists are in an ideal position to help provide accurate information on how to properly dispose of each medication.

Related: How Pharmacists Can Encourage the Disposal of Unused Prescriptions

In addition, the survey found that 91 pharmacies said they had a program for antibiotic disposal and 82 said they had a program for opioid disposal.¹

When a drug take-back program is not readily available, the FDA recommends certain ways to properly dispose of unused medications at home. For example, some medicines, such as opioids, have specific instructions to immediately be flushed down the sink or toilet if there is no take-back option. Many medications can also be disposed in household trash, but the agency recommends mixing them in with something undesirable, such as coffee grounds, dirt, or cat litter.³

Despite the survey results, many pharmacies and legislators nationwide have more recently taken steps to increase the disposal of unused prescription medications.

For example, some pharmacies offer mail-back programs and disposal kiosks for patients. In August, the California Department of Health Services’ MAT Expansion Project received grant funding to provide disposal bins at participating establishments throughout the state, including pharmacies, hospitals with pharmacies, and law enforcement departments.

In July 2019, Texas Governor Greg Abbot signed into law HB 2088, which requires all Texas pharmacists who dispense Schedule II controlled substances provide written notice on the safe disposal of controlled substances, unless the dispensing pharmacy is authorized to take back those drugs for disposal, regularly accepts those drugs for safe disposal, or provides patients (at no cost) “chemicals to render the unused drugs unusable” or a mail-in pouch. The law went into effect on January 1, 2020.⁴

References:

• Selekman RE, Gaither TW, Kornberg Z, et al. Unwanted medication disposal: Audit of California pharmacy advice. Annals of Internal Medicine. December 31, 2019. Doi: 10.7326/M19-2409.   

• Pharmacies Leaving Customers Hanging When It Comes to Disposing of Antibiotics and Opioids [news releases]. https://www.ucsf.edu/news/2019/12/416331/pharmacies-leave-customers-hanging-when-it-comes-disposing-antibiotics-and. Accessed January 2, 2020.

• FDA. Where and How to Dispose of Unused Medicines. FDA’s website. May 1, 2019. https://www.fda.gov/consumers/consumer-updates/where-and-how-dispose-unused-medicines. Accessed January 2, 2020.

• Texas’ Safe Drug Disposal Law in Effect January 1, DisposeRx Helps Pharmacists and Pharmacies Respond [news release]. https://disposerx.com/download/press/Texas-Legislation-News-Release.pdf. Accessed January 2, 2020.