Drug disposal

This is a drug disposal receptacle in the lobby of a hospital.It is a product which commercial company Inmar sells to health care providers who wish to present a Consumer Drug Take-Back Program.

Drug disposal is the discarding of drugs. Individuals commonly dispose of unused drugs that remain after the end of medical treatment.[1] Health care organizations dispose of drugs on a larger scale for a range of reasons, including having leftover drugs after treating patients and discarding of expired drugs. Failure to properly dispose of drugs creates opportunities for others (of whom the drug is unintended) to take them inappropriately.[1] Inappropriate disposal of drugs can also cause drug pollution.[1]

People dispose of drugs in various ways; even organizations with expertise on drugs may give inconsistent information to consumers about drug disposal.[2]

Sources of drugs to dispose

Consumers who have unused drugs tend to store them rather than disposing of them.[1]

Sometimes normal use of a drug can result in waste. For example, when someone uses a dermal patch, after the patch is used, it will still retain significant potency, necessitating safe disposal.[3]

Reasons for disposal of drugs

Medical authorities advise that consumers not store any drug that they would not have a reason at present to possess.[1] Storing drugs creates a possibility that someone will use them inappropriately and suffer harm.[1] Accidental ingestion of medications prescribed for another individual is a leading source of poisonings in American households. According to Poison Control Centers in the United States, in 2007, approximately 23,783 of 255,732 cases involving inappropriate medication use were associated with inadvertent exposure.[4] 5,000 of these cases involved children under the age of 6.[4] Due to the variations in the way children's bodies metabolize drugs, medication poisoning in children can be extremely fatal.[5]

Methods for disposal

Disposal for individuals and communities

The most obvious way for individuals to dispose of drugs is through the household waste management service.[1] Experts advise checking other options first, because simply discarding drugs with other trash creates the possibility that someone could use them and be harmed.[1] Medical authorities recommend against disposing of drugs by passing them on to other consumers.[3]

The best source of local advice will be the community pharmacy.[1] Pharmacies already handle drugs and will recommend what sort of disposal method is most appropriate.[1] Many pharmacies will collect drugs and dispose of them as a community service.[1] Some regions have special government services that offer to take back and dispose of drugs.[1] Sometimes, either a pharmacy or government service will provide a way to mail drugs to a special drug disposal facility.[1] If there are no other options and one must put drugs into the trash, a recommended safer way to do so is by mixing the drug with unattractive trash.[1] Putting pills into the toilet can cause drug pollution, but this might be justified as a way to quickly disposing of dangerous drugs.[1]

There have been many attempts in the United States to encourage consumers to bring their leftover drugs to disposal centers.[6] Some examples of disposal programs include having a special event at a community center with prior advertisements for people to bring their drugs to the event, or otherwise educating individuals and concerned organizations about the correct way to dispose of drugs.[6] One study reviewing the efficacy of these programs found that their impact was too low to have the desired result of decreasing community access to leftover drugs.[6]

Disposal for organizations and industry

Disposal of large amounts of drugs can cause drug pollution and negatively impact the environment.[7] Organizations might choose to dispose of large amounts of drugs by returning them to the manufacturer, putting them in landfills, using Incineration, or dumping the drugs into sewers.[7]

Disposal of controversial drugs

Drugs associated with substance abuse and prohibited drugs receive special attention in their disposal.[8] The police might seize such drugs as contraband, and then have to destroy them.[8] In other cases, some legal drugs create risks for abuse and need more attention in disposal than drugs that are not attractive for abuse.[9] It is challenging for governments to discuss how to properly dispose of controversial drugs.[9]

One small regional study in the United States reported the outcomes of a public health program to take back unused opioids.[10] This study found that individuals who returned opioids tended to return more than half of what they were prescribed, which could be an indication that these people had twice as much medication as they wanted.[10] The study was too limited to form a general conclusion, but it provided information to guide further discussion and research on whether people would participate in opioid take back programs, what sorts of drugs are more likely to be returned, and how much people would return.[10]

There is a list of medications in which the U.S. Food and Drug Administration recommends to be disposed of via flushing down the toilet if consumers are unable to take these drugs to a drug take-back program. These medications contain controlled substances (drugs with high abuse or addition potential) that are dangerous to pets and other people in the home and should be disposed of immediately when no longer needed. Examples include Dilaudid (hydromorphone hydrochloride) tablets and morphine sulfate oral solution.[11]

National Prescription Drug Take Back Days

In the United States, the Drug Enforcement Administration (DEA) created National Prescription Drug Take Back Days that occur twice annually in April and October.[12] These Take Back Days are part of a mission to create safe medication disposal sites, prevent drug diversion, and provide education for the public.[12] In April 2017, the 13th National Drug Take Back Day included 5,498 collection sites across the country and 450 tons of collected unused or expired prescription medicines.[12] Additionally, The National Association of Drug Diversion Investigators (NADDI) sponsors a website to locate Rx Drug Drop Boxes for safe medication disposal outside of National Prescription Drug Take Back Days.[13]

Secure and Responsible Drug Disposal Act of 2010

The "Secure and Responsible Drug Disposal Act of 2010" was proposed to amend the "Controlled Substances Act" created in 1970 which prohibits the disposal of controlled substances unless a member of law enforcement has authorization from the DEA to directly receive and dispose of the controlled substance. This bars drug take back programs from being able to receive and dispose of controlled medications for members of the public, which in turn can lead to the potential misuse of these drugs. Misuse of prescription medications has been a growing epidemic, with deaths from opioids quadrupling since 1999. [14] It was shown that in 2006, about 1/3 of new prescription drug abusers were 12-17 year olds. [15] With these statistics, Congress decided to take an active role in trying to make drug take back programs more readily available. Therefore, the "Secure and Responsible Drug Disposal Act of 2010" was created to allow the Attorney General permission in creating new policies to provide citizens “convenient and safe” disposal of their unwanted medications to authorized people or facilities. [16] Congress created this act with a goal of preventing drug diversion and environmental harm/pollution by these drugs.[17]

Examples of State Board of Pharmacy Regulations

California State Board of Pharmacy

In California, entities including pharmacies in retail and hospital settings may host drug take-back programs as long as they follow requirements under Article 9.1 of Division 17 of Title 16 of the California Code of Regulations.[18] These pharmacies must have collection receptacles located in authorized locations and have liners that are certified to meet American Society for Testing Materials standards.[18] The pharmacies must also follow protocols like accepting prescription drugs to be sent back to an authorized DEA destruction site.[18] The pharmacy may not sort, count, or review the unwanted prescription medications once collected.[18] It is important to note that these pharmaceutical take-back programs only take prescription medications, not drug samples or medical waste.[18]

See also

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Skinner, Ginger (20 March 2017). "Easy Steps for Getting Rid of Unused Medication". Consumer Reports. Retrieved 30 March 2017.
  2. ↑ Kuspis, DA; Krenzelok, EP (February 1996). "What happens to expired medications? A survey of community medication disposal". Veterinary and human toxicology. 38 (1): 48–9. PMID 8825752.
  3. 1 2 Office of the Commissioner (25 April 2016). "Consumer Updates - How to Dispose of Unused Medicines". www.fda.gov. Retrieved 30 March 2017.
  4. 1 2 Bronstein, Alvin C.; Spyker, Daniel A.; Jr, Louis R. Cantilena; Green, Jody L.; Rumack, Barry H.; Heard, Stuart E. (2008-01-01). "2007 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 25th Annual Report". Clinical Toxicology. 46 (10): 927–1057. doi:10.1080/15563650802559632. ISSN 1556-3650. PMID 19065310.
  5. ↑ Research, Center for Drug Evaluation and. "Safe Disposal of Medicines - Medicine Disposal: Questions and Answers". www.fda.gov. Retrieved 2017-11-15.
  6. 1 2 3 Egan, Kathleen L.; Gregory, Eric; Sparks, Michael; Wolfson, Mark (31 October 2016). "From dispensed to disposed: evaluating the effectiveness of disposal programs through a comparison with prescription drug monitoring program data". The American Journal of Drug and Alcohol Abuse. 43 (1): 69–77. doi:10.1080/00952990.2016.1240801.
  7. 1 2 World Health Organization (1999). Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies (PDF). World Health Organization. ISBN 978-0119854985.
  8. 1 2 Crimesider Staff (26 May 2014). "How are authorities destroying seized drugs?". Retrieved 5 May 2017.
  9. 1 2 Herring, ME; Shah, SK; Shah, SK; Gupta, AK (July 2008). "Current regulations and modest proposals regarding disposal of unused opioids and other controlled substances". The Journal of the American Osteopathic Association. 108 (7): 338–43. PMID 18648027.
  10. 1 2 3 Welham, Grace C.; Mount, Jeanine K.; Gilson, Aaron M. (4 March 2015). "Type and Frequency of Opioid Pain Medications Returned for Disposal". Drugs - Real World Outcomes. 2 (2): 129–135. doi:10.1007/s40801-015-0019-4.
  11. ↑ "Flushing of Certain Medicines". U.S. Food and Drug Administration. 6 October 2017. Retrieved 30 October 2017.
  12. 1 2 3 "National Prescription Drug Take Back Day". www.deadiversion.usdoj.gov. Retrieved 2017-10-30.
  13. ↑ "Rx Drug Drop Box". rxdrugdropbox.org. Retrieved 2017-11-15.
  14. ↑ CDC. "Drug overdose deaths in the United States continue to increase in 2015". cdc.gov. Retrieved 9 November 2017.
  15. ↑ One Hundred Eleventh Congress of the United States of America. "An Act" (PDF). Retrieved 5 January 2010.
  16. ↑ One Hundred Eleventh Congress of the United States of America. "An Act" (PDF). Retrieved 5 January 2010.
  17. ↑ One Hundred Eleventh Congress of the United States of America. "An Act" (PDF). Retrieved 5 January 2010.
  18. 1 2 3 4 5 California, State Board of Pharmacy. "California SBOP - Prescription Drug Take-Back Services" (PDF).
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