Solving the Drug Disposal Problem

1
Solving the Drug Disposal Problem Through
Product Stewardship
Executive Office Briefing December 12, 2006
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The Drug Disposal Problem

• Many serious problems association with unwanted,
  unused, and stored drugs.
• Need to get them out of circulation in a safe
  secure and environmentally sound way.
• Current practices (flushing or garbage) must
  change.
• Solution is take-back provide by pharmaceutical
  companies at retail pharmacies for secure,
  controlled destruction at hazardous waste
  facilities.
• Tremendous and diverse support for this solution.

3
The Problem Human Health and Community Safety

• Stored and unwanted pharmaceuticals are adding to
  poisonings, accidental deaths, abuse and crime.
• Child and adult poisonings and deaths.
• Teen pharming.
• Abuse by family members.
• Crime burglaries, illegal drug sales and use.

4
The Problem Human Health and Community Safety

• Washington Poison Center 40 of exposure calls
  were for children under the age of six. Of those,
  17.5 were poisoned by medications in their
  homes.
• October 23, 2006, man arrested on Bainbridge on
  suspicion of burglarizing 22 homes for
  prescription medications.
• Partnership for a Drug Free America Study
• 1 in 11 teens abusing over the counter
  medications
• 1 in 5 teens abusing prescription drugs

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The Drug Disposal Problem

• Prescription drugs being found in surface and
  groundwater systems. (USGS and WA studies)
• Cant be removed by water treatment plants.
• Impacts showing up on aquatic organisms.
• Need to protect our safe water supplies.
• Traditional disposal method of flushing must
  stop.

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No Safe Options Available

• Currently no safe and secure alternative to
  flushing.
• Problems with disposal as garbage
• Access pets, children, abusers, workers
• Pharmaceuticals move through landfill leachate
• Not technically legal in some places Sno Co
• Problems with disposal at local HHW drop-off
  facilities

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No Safe Options Available

• Problems with disposal at local HHW drop-off
  facilities
• Inadequate convenience to effectively address
  problem.
• Not legal or endorsed by Drug Enforcement Agency
  or Board of Pharmacy.
• Security issues.
• Snohomish Health District has asked that we
  develop other alternatives.

8
No Safe Options Available

• DEA likes idea of disposal at Sheriffs offices
• Numerous problems
• Ineffectual
• Estimate 285 lbs. of controlled substances
  captured throughout WA if this were put in place
• Estimate 7,300 lbs. of controlled substances
  captured throughout WA if pharmacy take-back put
  in place
• Burden on agencies
• Relies on public, not private, funding

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Who Has the Disposal Problem?

• Especially
• Residents
• Residential Care Facilities
• Schools (unclaimed meds at end of year)
• Hospice
• Hospitals (have some options)
• Users of veterinary supplies
• People and facilities associated with someone
  using medications.

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Product Stewardship SolutionReturn to Pharmacy

• Drugs returned to pharmacies for safe, secure
  destruction as hazardous waste (HHW incineration,
  landfilling or other process)
• Ultimately, have pharmaceutical manufacturers
  finance and manage system.

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Closest Model British Columbia

• Pharmaceutical manufacturers finance and manage
  through a third party organization
• Over 800 pharmacies voluntarily participate
• 52,800 lbs. collected in 2004
• Cost
• 170,000/ year
• 3.25 per lb.

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British Columbia Program
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British Columbia Program
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B.C. Pharmaceutical Program
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B.C. Pharmaceutical Program
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Establishing a Program in Washington

• Asked to advise on strategy to develop
  pharmaceutical take-back program 2003.
• Strategy in process of implementation and has
  broad support.
• Includes establishing pilot pharmacy take-back
  programs and collection for adult care, hospice
  and others.
• Viewed as a national model.

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Pharmaceuticals from Households A Return
Mechanism (PHARM)

• Solid Waste Management Division has a lead role
  in working with other agencies and stakeholders.
• Also taking the lead on a number of specific
  pilot tasks, including secure container design.
• Program modeled off of our electronics Take it
  Back Network.

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PHARM Team and Affiliates
Washington State Department of Ecology Washington
State Board of Pharmacy Snohomish County Solid
Waste Management Division Interagency Resource
for Achieving Cooperation (IRAC) Local Hazardous
Waste Management Program in King County Public
Health Seattle King County Northwest Product
Stewardship Council Washington Citizens for
Resource Conservation Bartell Drugs Group Health
Cooperative Pacific NW Pollution Prevention
Resource Center (PPRC) DSHS, Aging and
Disabilities Services Other Interested Parties
(partial list)

• President of WA State Senior Citizens Lobby
• Residents Councils of Washington
• Executive Director of the Washington Association
  of Sheriffs and Police Chiefs
• Tacoma Fire Department
• Boarding Home Advisory Council
• People for Puget Sound
• City of Seattle, Office of Sustainability
• Seattle Chief of Police
• Washington State Pharmacists Association
• Washington State Nurses Association
• Residential Care Survey
• King County Industrial Pretreatment
• Mercer Island Police Department
• University of Washington

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Pharmaceuticals from Households A Return
Mechanism (PHARM)

• Pilot to run minimum of two years.
• 54 Bartell Drug Pharmacies, 24 Group Health
  Clinic Pharmacies (first locations Nov 06)
• Secure collection, transport and witnessed
  destruction using several collection-at-pharmacy
  models.
• Program expansion to more locations, adult care
  facilities, hospice, etc. in 2007.
• Protocols are developed and approved by Board of
  Pharmacy.

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PHARM Pilot Models Collection

• Behind the Counter and In-Front of Counter
• Self-serve or Pharmacist Receives Medications
• Various Container Types
• - Self-serve metal security drop-box
• - 650 each plus bucket cost
• - Heavy plastic security toter
• - 200 each
• - B.C. bucket system behind counter
• - 5 each

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Prototype Design of Steel Drop Box (second
generation)
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Manufactured Prototype Metal Drop Box (first
generation)
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Prototypes of Secure Plastic Toters (first
generation)
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B.C. Bucket System
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PHARM Pilot Transport

• Pharmaceutical bucket or container is sealed with
  security tape and double witnessed.
• Each bucket or container is tracked.
• Reverse delivery back to warehouse for secure
  consolidation and storage using same staff and
  security that delivers pharmaceuticals to
  pharmacy.

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PHARM Pilot Destruction

• Consolidated Pharmaceuticals picked up and
  delivered to Hazardous Waste incinerator or
  Hazardous Waste landfill for witnessed
  destruction.
• For pilot, Board of Pharmacy is providing
  investigator to accompany licensed reverse
  distributor for transport from consolidation to
  incinerator.

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PHARM Pilot Destruction
Group Health Clinic
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Group Health Decal
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Group Health Flier
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Next Steps Executive Support

• Support Waiver Request to DEA so PHARM pilot can
  manage and destroy controlled substances.
• Champion effort local, state, national.
• Incorporate project into Executive priorities and
  initiatives where possible.
• Prepare to support legislative effort in 2008
  session.