SAFE MEDICINE DISPOSAL FOR ME

***A way for Maine’s citizens to safely and properly get rid of unused or

expired medicine

Funded by the U.S. EPA (Grant #CH-83336001-0)

Presentation OutlinePresentation Outline

History of the Safe Medicine Disposal for History of the Safe Medicine Disposal for ME Program and its developmentME Program and its development

Overview of program model and Overview of program model and participant instructionsparticipant instructions

Preliminary phase I data reviewPreliminary phase I data review Phase II and program expansionPhase II and program expansion

Why Maine?: The State’s Why Maine?: The State’s Prescription Drug ProblemPrescription Drug Problem

In 2007, nearly 90% of Maine drug deaths were In 2007, nearly 90% of Maine drug deaths were caused by prescription drugscaused by prescription drugs

Maine Drug Enforcement Agency arrests for Maine Drug Enforcement Agency arrests for prescription drug misuse or diversion has prescription drug misuse or diversion has increased dramatically to 23% of all arrests increased dramatically to 23% of all arrests

In terms of the relationship of pharmaceuticals to In terms of the relationship of pharmaceuticals to violent crime and property crime, Maine ranks violent crime and property crime, Maine ranks number one in the country number one in the country

Maine ranks second in terms of the availability of Maine ranks second in terms of the availability of pharmaceuticals for abuse pharmaceuticals for abuse

Large rural regionsLarge rural regions 38th in population density; < 10 residents per 38th in population density; < 10 residents per

square mile in over half of statesquare mile in over half of state Distribution/collection and financial challengesDistribution/collection and financial challenges Chronic illness and related drug use higher in rural Chronic illness and related drug use higher in rural

areas areas Oldest stateOldest state

Median age 41.2 years Median age 41.2 years (United States Census, 2005)(United States Census, 2005) Americans 65+ account for over 1/3 of Americans 65+ account for over 1/3 of

prescriptions dispensed, but only 13% of the prescriptions dispensed, but only 13% of the national populationnational population

Why Maine? The Challenges Why Maine? The Challenges of a Rural and Aging State of a Rural and Aging State

It curtails childhood overdosesIt curtails childhood overdoses It restricts household drug theftIt restricts household drug theft It limits accumulation of drugs by the It limits accumulation of drugs by the

elderly and other high userselderly and other high users It protects our physical environmentIt protects our physical environment It restrains improper drug donationsIt restrains improper drug donations It eliminates waste in the health care It eliminates waste in the health care

system system

Drug Collection Drug Collection BenefitsBenefits

Coalition BuildingCoalition Building Began with Maine Benzodiazepine Study Began with Maine Benzodiazepine Study

Group and Maine Drug Enforcement Group and Maine Drug Enforcement Agency Agency

Convened a group stakeholders from Convened a group stakeholders from children’s advocacy, environmental children’s advocacy, environmental organizations, medical associations, and organizations, medical associations, and others to create legislative solutionothers to create legislative solution

Public Law 2003, Chapter 679 Public Law 2003, Chapter 679 Maine Unused Pharmaceutical Disposal ProgramMaine Unused Pharmaceutical Disposal Program Program administration – Maine Drug Enforcement Program administration – Maine Drug Enforcement

AgencyAgency Maine Drug Return Implementation GroupMaine Drug Return Implementation Group

LD 411 “An Act To Establish a Pilot Program for LD 411 “An Act To Establish a Pilot Program for Return of Unused Prescription Drugs by Mail” Return of Unused Prescription Drugs by Mail” (Sponsored by Representative Anne Perry) (Sponsored by Representative Anne Perry) (Signed 6/27/07)(Signed 6/27/07)

Historic State Historic State LegislationLegislation

Proper Drug Disposal Day Proper Drug Disposal Day Proclamation Proclamation

First proclamation in the nation First proclamation in the nation on safe drug disposal on safe drug disposal endorsed by a governor endorsed by a governor

Signed by Maine’s governor on Signed by Maine’s governor on October 31, 2007October 31, 2007

Recognizes the negative Recognizes the negative impact to public health and the impact to public health and the environment of unwanted environment of unwanted consumer pharmaceuticalsconsumer pharmaceuticals

Recognizes the lack of Recognizes the lack of effective and efficient methods effective and efficient methods of drug disposal has resulted of drug disposal has resulted in negative social, cultural, in negative social, cultural, ecological, and global effectsecological, and global effects

Urges proper adherence by all Urges proper adherence by all citizens to medication and citizens to medication and appropriate drug disposalappropriate drug disposal

International International Coalition BuildingCoalition Building

Athens DeclarationAthens Declaration developed at 2 developed at 2ndnd International International Conference on the Environment Conference on the Environment

Endorses disposal options available to citizens Endorses disposal options available to citizens and the 6 reasons for disposal: and the 6 reasons for disposal:

1. To curtail childhood overdoses1. To curtail childhood overdoses

2. To restrict household drug theft2. To restrict household drug theft

3. To limit accumulation of drugs by the elderly3. To limit accumulation of drugs by the elderly

4. To protect our physical environment4. To protect our physical environment

5. To restrain improper international drug donations5. To restrain improper international drug donations

6. To eliminate waste in the international health care systems 6. To eliminate waste in the international health care systems of all countries of all countries

Program OverviewProgram Overview

Unique opportunity to test and refine state-Unique opportunity to test and refine state-wide field modelwide field model

Phased mail-in return programPhased mail-in return program Funded by the U.S. Environmental Funded by the U.S. Environmental

Protection Agency (EPA)Protection Agency (EPA) Working prototype for state and beyondWorking prototype for state and beyond Future full scale establishment of Safe Future full scale establishment of Safe

Medicine Disposal for MEMedicine Disposal for ME

Postage-paid medicine return Postage-paid medicine return envelopes are distributed to envelopes are distributed to selected pharmacies and selected pharmacies and organizations across the state at organizations across the state at no costno cost

Staff members then give the Staff members then give the envelopes and an instruction envelopes and an instruction packet to interested participantspacket to interested participants

Program ModelProgram Model

Program ModelProgram Model

Program Participants

Secure delivery to Maine Drug Enforcement Agency

Envelopes received, logged, catalogued and destroyed under MDEA custody

Program GoalsProgram Goals

Remove unneeded prescription drugs from Remove unneeded prescription drugs from circulationcirculation

Disposal in compliance with applicable Disposal in compliance with applicable state and federal laws and sound state and federal laws and sound environmental practicesenvironmental practices

Project ObjectivesProject Objectives

Calculate the weight, type and hazardous Calculate the weight, type and hazardous characteristics by actual pill count and characteristics by actual pill count and drug classificationdrug classification

Calculate the cost of such a programCalculate the cost of such a program Offer an education campaign concerning Offer an education campaign concerning

proper use and disposal of prescription proper use and disposal of prescription drugsdrugs

Phased ImplementationPhased Implementation Allows for monitoring of the program and Allows for monitoring of the program and

piloting of protocols piloting of protocols Phase I: Four-county model Phase I: Four-county model

Pharmacies as the point of distribution for Pharmacies as the point of distribution for program envelopesprogram envelopes

Limited press/marketingLimited press/marketing No public education effortNo public education effort Selected sites within the designated areaSelected sites within the designated area Only for people 65 and older and caregivers Only for people 65 and older and caregivers

Geographic and demographic patterns of Geographic and demographic patterns of prescription drug accumulationprescription drug accumulation

Pharmacoeconomic assessments Pharmacoeconomic assessments Waste Waste Implications for prescribing, insurance Implications for prescribing, insurance

reimbursement, and dispensing policies reimbursement, and dispensing policies

Data Collection StrategyData Collection Strategy

Full compliance for mailingFull compliance for mailing USPS/State/Federal requirementsUSPS/State/Federal requirements

Postage-paid mailers accommodate a Postage-paid mailers accommodate a range of contentsrange of contents

Padded mailers nondescript and not easily Padded mailers nondescript and not easily identifiable to a criminal elementidentifiable to a criminal element

The EnvelopesThe Envelopes

Participant InstructionsParticipant Instructions

Participants can use a Participants can use a black permanent marker black permanent marker to write over the name to write over the name of the of the personperson who was who was prescribed the prescribed the medicine.medicine.

They should They should notnot write write over the name of the over the name of the medicinemedicine or the or the dosedose..

Preparing the medicine Preparing the medicine bottlesbottles

Up to 4 oz of liquids or creams are wrapped in a paper towel,

and placed in a Ziploc bag and sealed.

Liquid or cream Liquid or cream medicinemedicine

Participants place sealed medicine bottles into the envelope

along with the sealed Ziploc bag containing the liquid and cream medicine.

When the medicine is When the medicine is ready…ready…

Needles or sharps cannot Needles or sharps cannot be returned through this be returned through this program.program.

Participants are instructed Participants are instructed to contact their health care to contact their health care provider or pharmacist for provider or pharmacist for information about information about disposing of these items.disposing of these items.

Survey is Survey is completed and completed and placed into the placed into the envelope with envelope with their medicine. their medicine.

Survey is completedSurvey is completed

Participants write down the Participants write down the envelope code on the envelope code on the corner of the medicine corner of the medicine return envelope.return envelope.

After the envelope has After the envelope has been mailed, participants been mailed, participants call the program helpline at call the program helpline at 1-866-637-9743 1-866-637-9743 and leave a and leave a message with the envelope message with the envelope code and date it was code and date it was mailed.mailed.

Envelope Code

Code # reportingCode # reporting

The envelopes are mailed The envelopes are mailed like any other letter or like any other letter or package.package.

What happens to the What happens to the envelopes envelopes

The Maine Drug Enforcement The Maine Drug Enforcement Agency receives the envelopes Agency receives the envelopes with the medicine.with the medicine.

The medicine is cataloged by The medicine is cataloged by project pharmacists.project pharmacists.

The participant surveys are The participant surveys are returned to the Center on Aging returned to the Center on Aging for analysis.for analysis.

What happens to the What happens to the surveys?surveys?

The toll-free helpline phone number is The toll-free helpline phone number is 1-866-637-97431-866-637-9743..

Participants can call any time and leave Participants can call any time and leave a message.a message.

Phone calls are returned by Center on Phone calls are returned by Center on Aging staff.Aging staff.

Pharmacies or other organizations can Pharmacies or other organizations can also inquire about the program through also inquire about the program through the helpline. the helpline.

Program HelplineProgram Helpline

The website address is The website address is www.safemeddisposal.comwww.safemeddisposal.com

Information about the project is Information about the project is available on the website.available on the website.

Pharmacists and project participants Pharmacists and project participants can also e-mail questions to the Center can also e-mail questions to the Center on Aging project staff at on Aging project staff at info@safemeddisposal.cominfo@safemeddisposal.com

Program WebsiteProgram Website

Compliance with Maine Drug Compliance with Maine Drug Enforcement Agency, Department of Enforcement Agency, Department of Environmental ProtectionEnvironmental Protection Double verification of returnsDouble verification of returns Secure consolidation facility at an MDEA Secure consolidation facility at an MDEA

locationlocation Repeat count of number of packages Repeat count of number of packages

receivedreceived Proper disposal of all drugs collectedProper disposal of all drugs collected

Drug Inventory & Drug Inventory & DisposalDisposal

Elder InvolvementElder Involvement

Community Advisory Board created with older Community Advisory Board created with older adults and RSVP volunteers from each countyadults and RSVP volunteers from each county Membership reflects state’s diversityMembership reflects state’s diversity Collaboration among 5 RSVP programs statewideCollaboration among 5 RSVP programs statewide

Community members serve as Distribution Site Community members serve as Distribution Site EducatorsEducators Deliver mailers and materials to distribution sitesDeliver mailers and materials to distribution sites Educate site pharmacists and staff on the processEducate site pharmacists and staff on the process

Educators promote the benefits of returning Educators promote the benefits of returning unwanted medicationsunwanted medications

Program Partners and National Program Partners and National Advisory BoardAdvisory Board

Maine-Based OrganizationsMaine-Based Organizations Center on Aging, University of MaineCenter on Aging, University of Maine Maine Association of Psychiatric PhysiciansMaine Association of Psychiatric Physicians Maine Benzodiazepine Study Group Maine Benzodiazepine Study Group

(MBSG) & Drug Disposal Group(MBSG) & Drug Disposal Group Maine Council for Child & Adolescent Maine Council for Child & Adolescent

PsychiatryPsychiatry Maine Department of Health and Human Maine Department of Health and Human

ServicesServices Maine Department of Environmental Maine Department of Environmental

ProtectionProtection Maine Drug Enforcement AgencyMaine Drug Enforcement Agency Maine Office of Adult Mental Health Maine Office of Adult Mental Health

ServicesServices Maine Office of Substance AbuseMaine Office of Substance Abuse Maine Center for Disease Control and Maine Center for Disease Control and

PreventionPrevention Maine Office of the Attorney GeneralMaine Office of the Attorney General Maine Office of Elder ServicesMaine Office of Elder Services Maine Pharmacy AssociationMaine Pharmacy Association Maine Independent PharmaciesMaine Independent Pharmacies Maine RSVP ProgramsMaine RSVP Programs Maine Office of Adult Mental Health Maine Office of Adult Mental Health Maine Medical Association Maine Medical Association

Margaret Chase Smith Center Policy Margaret Chase Smith Center Policy Center, University of MaineCenter, University of Maine

Northern New England Poison CenterNorthern New England Poison Center

Federal & National OrganizationsFederal & National Organizations

American Pharmacists Association American Pharmacists Association Community Medical Foundation for Patient Community Medical Foundation for Patient

SafetySafety National Council on Patient Information and National Council on Patient Information and

EducationEducation Office of the U.S. Attorney GeneralOffice of the U.S. Attorney General Rite Aid CorporationRite Aid Corporation U.S. Drug Enforcement AdministrationU.S. Drug Enforcement Administration U.S. Environmental Protection AgencyU.S. Environmental Protection Agency U.S. Postal ServiceU.S. Postal Service Villanova University Center for the Villanova University Center for the

EnvironmentEnvironment

Phase 1 Data Collection Phase 1 Data Collection (August 2008)(August 2008)

Points of data collection:Points of data collection:

Survey of participants returned with drugs Survey of participants returned with drugs in the envelopein the envelope

Phase 1 Data Collection Phase 1 Data Collection

Cataloging of returned Cataloging of returned drugs by project drugs by project pharmacistspharmacists

Initial Phase 1 Drug Returns Data Initial Phase 1 Drug Returns Data

90% of returns were 90% of returns were prescription drugs, 10% over prescription drugs, 10% over the counterthe counter

10% of drugs returned were 10% of drugs returned were controlled drugs, consistent controlled drugs, consistent with findings from other drug with findings from other drug take-back eventstake-back events

Radiological testing confirms Radiological testing confirms that there are no radioactive that there are no radioactive hazards present in the hazards present in the returns returns

Observations from the Initial Observations from the Initial Drug Returns Analysis (Phase 1)Drug Returns Analysis (Phase 1)Interesting/anecdotal findings:Interesting/anecdotal findings: Many of the mailers contained full bottles of Many of the mailers contained full bottles of

unused drugs from mail-order pharmacies or VA unused drugs from mail-order pharmacies or VA pharmacy services pharmacy services

Received full bottles of very costly antiretroviral Received full bottles of very costly antiretroviral drugs (HIV/AIDS drugs)-Wasted healthcare $$drugs (HIV/AIDS drugs)-Wasted healthcare $$

Older meds not uncommon-some of the returns Older meds not uncommon-some of the returns were noted to be as many as 7 years oldwere noted to be as many as 7 years old

Estimated that one envelope contained enough Estimated that one envelope contained enough unused narcotics to net $7,000 if sold on the unused narcotics to net $7,000 if sold on the streetstreet

Observations from the Initial Drug Observations from the Initial Drug Returns Analysis (Phase 1) (cont.)Returns Analysis (Phase 1) (cont.)

Interesting/anecdotal findings:Interesting/anecdotal findings: A mix of local and mail order pharmacies A mix of local and mail order pharmacies

is not uncommon among those who use is not uncommon among those who use the program-but who has the entire the program-but who has the entire medication record for these patients?medication record for these patients?

This includes patients who are receiving This includes patients who are receiving the same medication via a local the same medication via a local pharmacy and a mail-order pharmacy pharmacy and a mail-order pharmacy

Initial Participant Survey Data Initial Participant Survey Data from Phase 1from Phase 1

Average age of program participants: Average age of program participants: 70 years old70 years old

Top reasons for accumulation: Top reasons for accumulation: Death of a relative or loved oneDeath of a relative or loved one Medicine expired or outdated Medicine expired or outdated Doctor told patient to stop taking the Doctor told patient to stop taking the

medicine medicine

Initial Participant Survey Data Initial Participant Survey Data from Phase 1 (cont.)from Phase 1 (cont.)

15% of respondents did not know what kind of 15% of respondents did not know what kind of medicine they were returningmedicine they were returning

57% were returning medicine for themselves 57% were returning medicine for themselves

53% were returning medicine for a relative. 53% were returning medicine for a relative.

Top reason for using the program: It’s best for Top reason for using the program: It’s best for the environment (83%), Safety for themselves the environment (83%), Safety for themselves and their families was second (8%)and their families was second (8%)

Phase II: The Program Goes Statewide Phase II: The Program Goes Statewide Pharmacies as primary point of distribution for Pharmacies as primary point of distribution for

program envelopesprogram envelopes Extensive press/marketing of the programExtensive press/marketing of the program Public education Public education Expansion of distribution beyond pharmacies Expansion of distribution beyond pharmacies

• Home health, Dr’s offices, social service programs, Home health, Dr’s offices, social service programs, Area Agencies on AgingArea Agencies on Aging

Expansion to other age groups Expansion to other age groups

Next Steps: Phase IINext Steps: Phase II

7,200 mailers available through statewide 7,200 mailers available through statewide network of participating pharmacies and network of participating pharmacies and partnering sites (over 100 sites)partnering sites (over 100 sites)

Refinements based on Phase I experienceRefinements based on Phase I experience

Next Steps: Phase IINext Steps: Phase II

Want to know more about the Want to know more about the project? project?

Daily operations:Daily operations:Jennifer Crittenden, M.S.W.Jennifer Crittenden, M.S.W.

Project DirectorProject DirectorResearch AssociateResearch Associate

UMaine Center on AgingUMaine Center on Agingjennifer.crittenden@umit.maine.edu

Project administration:Project administration: Lenard Kaye, D.S.W./Ph.D.Lenard Kaye, D.S.W./Ph.D.

Principal InvestigatorPrincipal InvestigatorDirector and ProfessorDirector and Professor

UMaine Center on Aging UMaine Center on Aging len.kaye@umit.maine.edu

Technical/Scientific issues:Technical/Scientific issues:Stevan Gressitt, M.D.Stevan Gressitt, M.D.

Co-Principal InvestigatorCo-Principal InvestigatorMedical Director, Adult Mental Health ServicesMedical Director, Adult Mental Health Services

Maine Department of Health and Human ServicesMaine Department of Health and Human Servicesstevan.stevan.gressitt@maine.govmaine.gov

General Project Information:General Project Information:Phone:  1-866-ME-RX-RID (1-866-637-9743)

Email: info@safemeddisposal.comWebsite:Website: http://www.safemeddisposal.com/

Maine Benzodiazepine Study GroupCamden Hall

25 Texas Avenue Bangor, Maine 04401-4324

Phone: (207) 262-7920 Fax: (207) 262-7921

Email: mbsg@mainebenzo.orgWeb: http://www.mainebenzo.org/