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Secure Medicine Return: PH:ARM Pilot in Washington State
Shirley Reitz, Pharm.D., BCPSAssociate Director, Pharmacy Clinical ServicesGroup Health CooperativeSeattle, WA [email protected]
November 2008
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Patient Demand
• 2006 WCRC survey of 400 King County households revealed– 39% have 10 or more medicine containers in their homes
– Only 33% report that they are currently using or plan to use these meds
– 74% stated they would be willing to dispose of the meds in a convenient location
• “We are cleaning out my Grandfather’s house and I have a suitcase full of drugs that we need to get rid of. Can we bring them into your disposal site?”
• “Our neighborhood association (over 400 homes) would like to provide some education to the families in our neighborhood about drugs in their homes – can we tell them to bring their meds to you for disposal?”
• “Please dispose of this medication. Enclosed is a donation….”
namePharmaceuticals in Landfills
Leachate
pumped to sewer treatment plants
possible escape
to groundwater
studies find drugs
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PH:ARM TeamPharmaceuticals from Households: A Return Mechanism
•HEALTH CARE PROVIDERS– Group Health
Cooperative
•BUSINESSES– Bartell Drugs
– Boarding/assisted living homes
•NON-PROFIT AGENCIES– Interagency Resource for
Achieving Cooperation (IRAC)
– Northwest Product Stewardship Council
– Pacific NW Pollution Prevention Resource Center (PPRC)
– WA Citizens for Resource Conservation (WCRC)
•STATE & LOCAL GOVERNMENT– King County Dept. of Natural
Resources & Parks
– Local Hazardous Waste Management Program in King County
– Public Health - Seattle and King County
– Snohomish County Solid Waste Management Division
– WA Department of Ecology
•ADVISORS– WA State Board of Pharmacy
– WA State Dept. of Social and Health Services - Aging and Disability Services Administration
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Group Health’s Goal
• Work with community partners to develop a medication disposal system that is:– Secure– Affordable– Reproducible– Sustainable– Meets all regulatory requirements– Easy for our patients to use
• Remove from the home medications posing risk of unintentional poisoning, overdose, or abuse
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Group Health Pilot Bin Signs
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Group Health Pilot
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Pilot Project
• 25 Group Health clinic pharmacies statewide•12 Bartell Drugstores around Puget Sound• 3 boarding /assisted living homes in Seattle
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Group Health’s ExperienceGroup Health Collected Meds
Percent by Weight1,238 pounds total
16,460 drug containers
Over 14,000 lbs of unwanted medications collected and incinerated from GHC locations over 2 year pilot
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Interesting Findings
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Snapshots of collected materials
14 Doses of Enbrel
$5,600
Migranal Nasal Spray
$120
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What we’ve learned:
• Security is Critical!– Secure drop boxes– Complete tracking of
secure containers– DEA utilization
• Staff Satisfaction– “Makes my job easier”
• Regulatory issues remain
nameNext Steps
• Cost Considerations– Need affordable solutions– Pilot ending this year– Looking for interim
Manufacturer funding
• Pilot project final report– Report expected Jan ’09– www.medicinereturn.com
• Legislative efforts in 2009
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Secure Medicine Return Legislation:A Producer Responsibility Approach
Cheri GrassoLocal Hazardous Waste Management Program in King [email protected]
November 2008
nameNext Steps
• Regulatory Change• Moving Beyond Grants• Washington State Producer Responsibility
Legislation
nameRegulatory Change
• Department of Transportation– Medicines must be in original package
• Requires sorting
• Loose pills shipped in smaller container
• Limits weight of container
• Product Stewardship Institute– Dialogue on regulations Dec 2 - 3– www.productstewardship.us
nameBeyond Grants
• PH:ARM successful in obtaining grants• Search for Sustainable Funding
– Local Governments cannot pay for statewide– Pharmacies have very small profit margin– Producers most logical choice
• Voluntary approach?– Creates unfair level for producers
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Secure Medicine Return Bill
• Producer paid statewide medicine return program
• Passed out of Environmental Health Committee
• Unanimous, bi-partisan vote• Big bill, short session• Set stage for success in ‘09
name2008 EndorsersBusinessBartell DrugsGroup HealthWashington Food IndustryWA State Pharmacy
Association
Civic & Environmental Organizations
Children’s AllianceEnvironment WashingtonLeague of Women Voters of
WAPeople for Puget SoundSenior Citizens’ LobbySierra Club Cascade ChapterWA Citizens for Resource
ConservationWA Organic Recycling
CouncilWashPIRG
GovernmentsCoalition for Clean WaterKing CountyLocal Hazardous Waste Mgmt
Program in King CountyThurston CountyWA Association of Sheriffs and Police
ChiefsYakima County
Health OrganizationsAssoc of Advanced Practice
Psychiatric NursesBreast Cancer FundSchool Nurse Organization of WA WA State Assoc of Occupational
Health NursesWA State Hospice and Palliative Care
Org.WA State Nurses Assoc.
namePolicy:Medicine Return Legislation
• Drug producers design & pay for program– In every county statewide – In all cities with populations > 10,000
• Covers– Over-the-counter drugs– Prescription drugs (including controlled substances)
• From– Households– Residential sources (hospice services,
nursing homes, schools, etc.)
nameMedicine Return Legislation:What does the program look like?
• Producers determine how best to securely and conveniently collect the medicines– Mail back – Pharmacy– Hybrid– Other????
• If they choose a pharmacy model– Pharmacies participate voluntarily– Expect many pharmacies to do so
nameMedicine Return Legislation:
• Hazardous Waste Disposal
• Alternative Technology• Outreach • Board of Pharmacy
– Oversight – Enforcement
nameMedicine Return Legislation:Shared Responsibility
Pharmaceutical brand owners pay for program
Pharmacies give out information on take back and may provide
take-back locations
Consumers return their unwanted medications to
takeback location
Government provides oversight and education
nameNext Steps
• Seeking endorsements• Talking with legislators• Talking with pharmaceutical
manufacturers• Successful passage in ’09!
