Unused MedicationsWhere are we now?

Prepared for: U.S. Drug Enforcement

Administration

By: Dr. Jeanie Jaramillo and Dr. Stevan Gressitt

July 19, 2011

Disclosures

• Poison Center Incentive Grant funded by HRSA

• No other potential conflicts of interest

Context

Acknowledgement

This presentation includes information collected and compiled by the

Pharmaceutical Collection Monitoring Group

through use of thePharmaceutical Collection

Monitoring System™

Purpose for Visit

• There’s an elephant in the room– Not that unused medications are a problem

• Now common knowledge:– Meds as a source of poisonings– Source of abuse (and diversion)– Source of misuse– Source of environmental contamination

• Finding a solution– Band aid approach is no longer enough

• Take back events are a band aid approach

Root Cause Analysis is Needed

1. Define the problem factually2. Gather data and evidence3. Ask “why” and identify causes4. Identify corrective actions that will prevent

recurrence5. Implement actions6. Observe effect

Purpose for Visit

• We’ve hit a brick wall at step #2 (gather data and evidence)

• We need the help of the DEA• Outline

– Discuss successful collection events– Data utility– Share results– Request support

Data Collection

• Numerous take backs across country• Several high-quality data sets

– Gressitt– Mireles– Gottlieb– Jaramillo

• All data sets collected different data points– No consistency– Merging of data difficult if not impossible

Pharmaceutical Collection Monitoring System™ (PCMS)

• Web-based recording and reporting tool• Provides for collection of consistent data

across multiple sites• Accessible by users anywhere that internet

service is available

A Case Report: Car #188

• Amarillo, Texas • Population: ~180,000• Community Medication Take Back Event• Drive through• Collaborative effort with Amarillo Police

Department

Car #188

Car #188

• 2 large boxes• Medications from deceased parents

and cat• Speculatively parents both suffered

from chronic, terminal diseases• Reporting today only the controlled

substances from this vehicle

Controlled Substances from Car #188

Drug Name Strength # ContainersQty

Collected AWPLow-High End

Street Value

diazepam 5 mg 18 2,320 $167 $2,320 - $46,400hydrocodone/ APAP 10/325 mg 4 520 $363 $1,040 - $10,400

Lorcet® 5/500 mg 2 2 $3 $6 - $18

Lyrica® 75 mg 6 84 $227 $420 - $1,680

morphine sulfate 30 mg 61 10,080 $5,352 $80,640 - $302,400

MS Contin® 30 mg 3 6 $17 $90 - $300

oxycodone/APAP 5/500 mg 15 802 $95 $802 - $4,010

temazepam 30 mg 2 180 $32 $180 - $3,600

111 13,994 $6,256 $85,498 - $368,808

Values obtained from NDIC reports. Indicate estimates.

Car #188

• Rare occurrence or more common than we think?

• No data • Of what use would the data be? Would it

really help anything?

What data do we have?

April 30th DEA Take Back Day

• Eight organizations• 11 sites• Conducted events and logged data• Goal: data from at least first 50 participants• Result: data from items of 411 participants

was collected• 3,800 line items logged

April 30th DEA Take Back Day

6%

60%

33%

Percentage Collected by Classification - All Sites Combined

Controlled Substances

Non-Controlled Substances

Over-the-counters

Unknown/unidentified

Most Commonly Collected Controls

Acetaminophen with hydrocodone 22.7%

Acetaminophen with propoxyphene 21.3%

Benzodiazepines11.3%

By Schedule

See handout report• C II• C III• C IV• C V

Medication Utilization/ Wastage

• Controlled substances collected/documented– On average, 67% of dispensed controls were

brought to take back events for disposal– 67% = wasted

• Overprescribed?• Over-marketed?

60% 20%

18%

10%

*total >100% as some participants selected >1 answer

Percentages indicate what event participants would do with meds if event was unavailable.

Why come to the DEA

• Data has utility; greatly needed• Lost participation of sites due to lack of DEA

support• Current directives

– No questions– No counts– No handling of meds

Why come to the DEA?

• Need DEA to be part of the solution– Funding? – Letter of support?– Letter of understanding?

Academia

PCMS

Community Partners.

Local Law Enforcement

.

DEA

Contact Information

Jeanie Jaramillojeanie.jaramillo@ttuhsc.edu(806) 354-1611

Stevan Gressittgressitt@gmail.com

(207)441-0291