Clean Out That Medicine Cabinet

Save A Life: Getting Your Patients To Clean Out That Medicine Cabinet

As an industry insider, you know that abuse of prescription medications is an ongoing epidemic, and that it claimed the lives of 22,767 people in 2013, according to the National Institute on Drug Abuse.  Maybe you also know that according to an Associated Press investigative report, the drinking water of 46 million Americans contains traces of antibiotics, anti-convulsants, mood stabilizers and sex hormones.

This month’s National Prescription Drug Take-Back Day is an opportunity to urge your customers to properly dispose of their unwanted, unneeded, or expired medications, for the safety of their family and friends, as well as the environment.

This Saturday, September 26, will be the tenth year the Drug Enforcement Agency has sponsored this nationwide event that involves healthcare professionals and law enforcement.  The event provides disposal services that are free and anonymous, with no questions asked.  Collection site locations can be found here.

In the previous nine years these events inspired Americans to turn over 4,823,251 pounds (2,411 tons) of unwanted, unneeded, or expired drugs.  All of these medications are eventually incinerated.

There is no doubt that the majority of patients receiving prescription medicines are truly in need of and are not abusing their medication.  However, the sad fact is that because not all pharmaceutical courses are completed, or because prescriptions often change before finishing a course, and most medicines are kept in a convenient easy to reach location, many prescription medications are diverted and abused or improperly disposed, causing real harm.

DRUG ABUSE

According to various government estimates this diversion and subsequent abuse of prescription medications sends more than 420,000 people to emergency rooms each year, with at least 62 persons dying each day from an overdose, based on 2013 statistics.

While the Substance Abuse and Mental Health Services Administration is expected to publish statistics for 2014 sometime this month, in 2013 there were 6.5 million current nonmedical users of prescription-type drugs in 2013, including 4.5 million nonmedical users of prescription pain relievers.

The National Institute on Drug Abuse has found that the number one reason teens abuse prescription drugs is that they are “easy to get from parent's medicine cabinets.”  The Partnership for Drug Free Kids believes one in four teens has misused prescription medication at least once in their lives, and that 90 percent of all adults with drug or alcohol problems started abusing these substances before the age of 18.

The names of the most popular medications diverted for non-medical use are familiar powerful pain relievers: codeine, fentanyl (Duragesic and generics), hydrocodone (Vicodin and generics), meperidine (Demerol and generics), morphine and oxycodone (Oxycontin, Percocet and generics).

ENVIRONMENTAL CONTAMINATION

Pharmaceuticals, not including those used in hospital or nursing home facilities, end up in the water table mostly due to human excretion of unmetabolized medication.  The second most prevalent source of contamination from individual Americans, not institutions, is disposing their unwanted, unneeded, or expired medications down the toilet and sink, or in the trash.

Via the sewer or the dump, these medications seep into the water table, then into our reservoirs, and eventually into our drinking water.  Water treatment plants, while aware of the issue, are not all equipped to filter out these chemicals.

It is thought that the amount of pharmaceuticals in our drinking water is miniscule, but the long-tem effects of exposure even to these small amounts has not been adequately analyzed.  Tests results from a study on fish described in an article in Salon, where their genetic material was altered, are a little alarming.

That said, the Federal Drug Administration, the CDC and the Office of National Drug Control Policy recommends not flushing prescription drugs down the toilet, except as a last resort to ensure prescription medication is not abused.

WHAT TO RECOMMEND

It is up to the end user, the person who received the prescription, to control their medication and dispose of it properly.  To that end, the pharmacist can do and advise the following:

1. You know your customers, and so you likely have a good idea what medications they have in their possession.  On that basis you can choose who you think would really receive the most benefit from the National Prescription Drug Take-Back Day and make the pitch.
2. In general you should encourage your customers to take a moment to take stock of what they have in their medicine cabinet and whether they really need it, and advise them on what they can do to dispose of it.
3. Your pharmacy may already have a system of receiving unused prescription medications.  Get smart about it.  Your location may offer mail-back envelopes or have a drop box.
4. However, if your pharmacy does not have a program, find out where your nearby authorized collection site locations are for your customers to take their unused medications for proper disposal.  They may be a retail pharmacy, a hospital or clinic pharmacy, and for the drug take-back event, law enforcement locations.  The DEA Office of Diversion Control’s Registration Call Center can also assist in identifying authorized collection sites and can be called at 1-800-882-9539.
5. As a last resort (Part 1), you can recommend disposal in the trash following these FDA recommended steps:
   1. Mix medicines (do not crush tablets or capsules) with an unpalatable substance such as dirt, kitty litter, or used coffee grounds;
   2. Place the mixture in a container such as a sealed plastic bag;
   3. Throw the container in your household trash;
   4. Scratch out all personal information on the prescription label of your empty pill bottle or empty medicine packaging to make it unreadable, then dispose of the container.
   5. As a last resort (Part 2), you can recommend disposal by flushing them down the toilet or down the sink, but only certain medications.  The FDA recommended list with disposal instructions is here, but you will need Adobe Acrobat Reader to view it.