These days, doctors can prescribe medications that can cure or treat a range of illnesses. But estimates say that one-third of prescription and over-the-counter medicines go unused or expire, creating questions on how to safely dispose of them.
A new federal law signed by President Barack Obama in October will allow states to create takeback programs for prescription and over-the-counter medications, allowing for their safe and legal disposal.
Pharmacists sort through medicines at a collection event in Duluth, Minn., in January 2010. A new federal law will allow states to create takeback programs for unwanted prescription and over-the-counter drugs, ensuring their safe disposal.
Photo by Stephanie Hemphill, courtesy Associated Press
The need for such programs is clear. Americans use more prescription drugs than a decade ago, with one out of 10 people using five or more, according to the National Center for Health Statistics.
To address the growing problem, the Department of Justice’s Drug Enforcement Administration held its first National Prescription Drug Take Back day on Sept. 25, 2010. Approximately 3,000 state and local law enforcement agencies across the United States participated, and they collected more than 121 tons of drugs. The effort was so successful that DEA will hold another national takeback day on April 30.
The public health problem of drug disposal is threefold, said Margaret Shield, PhD, a policy liaison with the King County, Wash., Hazardous Waste Management System. More than 7 million Americans abuse prescription drugs, sometimes taking them from medicine cabinets where the unused drugs are being stored. In 17 states, overdose is the leading cause of accidental death, Shield said.
Second, unused prescription drugs pose a poisoning hazard to children if left unsecured. In 2009, more than 30 percent of the accidental poisoning deaths among children involved the ingestion of prescription or over-the-counter medications, according to the American Association of Poison Control Centers.
And finally, recent studies have detected trace amounts of many common prescription drugs in drinking water. The drugs likely enter the water system two ways: after being expelled by the body and when people flush unused or expired medications down the toilet. Though the amount of drugs in drinking water is small, public health experts say it is not clear what effect ingestion of those drugs could be having on the public.
“Prescription drugs are an emerging pollutant of concern,” Shield told The Nation’s Health. “The old advice of flushing medicine you don’t need just ends up sending medicine out into the environment.”
The Environmental Protection Agency advises against flushing medication unless the label specifically recommends it. Instead, to make the drugs unpalatable to illicit users and young children, EPA and the President’s Office of National Drug Control Policy recommend mixing the drugs with cat litter or coffee grounds and then placing the mixture into a sealed container or bag before disposing of it in the trash.
But Shield said that method also has problems, because drugs can leach out into the environment over time.
The best solution for prescription and over-the-counter drug disposal is incineration, Shield said. Hospitals and pharmacies send their unused and expired drugs to be incinerated, but only recently have residents in some states had the same opportunity.
Shoppers pick up a prescription at a Miami store in August 2007. Takeback programs help consumers get rid of unwanted drugs.
Photo by Joe Raedle, courtesy Getty Images
Another problem, up until Obama signed the Secure and Responsible Drug Disposal Act Oct. 12, was that it was illegal under the Controlled Substances Act to transfer prescription drugs from one person to another, even for disposal. The law removes that barrier and opens the door for states or other groups to create takeback programs, Shield said.
In about a year, DEA is expected to write regulations governing the collection of controlled substances. The way such regulations are written could greatly expand states’ ability to run takeback programs, said Jeanie Jaramillo, PharmD, of the Texas Panhandle Poison Control Center.
Her group has sponsored six takeback events since 2009, at which it has collected about a ton of unused or expired drugs, Jaramillo said. But because of the Controlled Substances Act, the organization has been required to have law enforcement officers at each event to handle the narcotics. Among other options DEA is considering, the new rule could allow pharmacies to collect drugs without law enforcement oversight.
Washington state is considering other takeback options as well. A bill introduced in the state Legislature in January would begin that process. H.B. 1370 would establish a program in which pharmaceutical companies would create an umbrella group that would pay for the pickup and disposal of drugs that are dropped off at certain locations, such as pharmacies. A companion bill, S.B. 5234, has been introduced in the state Senate.
Such programs already exist in 12 of Washington’s 39 counties, but the programs are funded by the counties rather than by the pharmaceutical companies, said state Rep. Kevin Van De Wege, who introduced the bill in the state House.
As a firefighter and paramedic, Van De Wege has seen firsthand what can happen when children ingest leftover medications. Sometimes the medications were left by someone such as a grandparent who died or moved into a nursing home and the family did not know how to dispose of the drugs.
“There’s no coordination right now,” Van De Wege told The Nation’s Health. “If a county chooses to do that, they bear the costs and have to pay for transport to the one location in the state where medical waste is incinerated.”
A group of pharmaceutical companies would be able to better coordinate and pay for a takeback program, according to Van De Wege, who said he expects to meet tough opposition to his bill. This is the third time a takeback bill has been introduced in Washington state, but this time, takeback proponents have tried to address the concerns of pharmaceutical companies. The bill contains a $2.5 million cap on the cost of the takeback program, meant to address pharmaceutical companies’ concerns about such programs being too expensive.
“We’re trying to meet a lot of the industry’s arguments against the bill,” he said.
A program in British Columbia could serve as a model for the program Washington advocates would like to establish, Shield said. The program, created by the Post Consumer Pharmaceutical Stewardship Association, a group created by pharmaceutical manufacturers, allows consumers to return unused or expired medications to participating pharmacies at no charge.
Pill bottle courtesy Donald Erickson, iStockphoto
In the United States, there are a variety of other takeback programs in place, though many are geographically or otherwise limited.
Walgreen’s, for example, sells specially designed envelopes for $2.99 that customers can use to mail prescription or over-the-counter medications they no longer use to a disposal facility.
But Shield said charging customers a fee to dispose of their medications is a barrier to participation. It would be better, she said, to look at the end-handling of the medication and figure out a way to pay for it that does not involve charging consumers.
Other states with takeback programs include Maine, which offers free mailing envelopes to residents, and Colorado, where a pilot program operating in some parts of the state accepts some drugs, but not narcotics. In Duluth, Minn., the Western Lake Superior Sanitary District holds events about four times a year to which residents can bring their medications.
Jaramillo said the Texas Panhandle Poison Control Center has surveyed participants in its takeback programs, finding that 60 percent of them would otherwise have kept the drugs in their homes.
“These are the people we’re really trying to reach,” she said.
More information about DEA’s National Prescription Drug Take Back Day is available online at www.deadiversion.usdoj.gov/drug_disposal.
- Copyright The Nation’s Health, American Public Health Association
