__________________

If you have questions please contact:

Daily operations:

Jennifer Crittenden, M.S.W.

Project Director

Research Associate

UMaine Center on Aging

jennifer.crittenden@umit.maine.edu

Project administration:

Technical/Scientific issues:

Stevan Gressitt, M.D.

Co-Principal Investigator

Medical Director

Adult Mental Health Services, DHHS

stevan.gressitt@maine.gov

Lenard Kaye, D.S.W./Ph.D.

Principal Investigator

Director and Professor

UMaine Center on Aging

len.kaye@umit.maine.edu

____________________________________

*Phases I & 2 funded by the U.S. EPA – Grant #CH-83336001-0; Additional short-term funding

for subsequent phases is anticipated from LD 411, introduced by Representative Anne Perry of

Calais, Maine, and signed into law in 2007

For interested sites or individuals with questions about disposal/program

locations: Website: http://www.safemeddisposal.com/

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

Safe Medicine Disposal for ME Program*

Program Research Report

April 13, 2009

1

Table of Contents

Page

Overall Program Profile Information 2

Information form Drug Cataloguing 3

Information from Participant Surveys 5

Selected Photos from the Cataloguing Sessions 8

Program Model 10

Program Partners 11

Participating Program Distribution Sites 12

Program Distribution Site Wait List 15

Governor’s Proper Drug Disposal Day Proclamation 16

Athens Declaration 17

2

Overall Program Profile Information

∗ Over 100 established distribution channels including pharmacy sites, medical facilities,

and community agencies. Envelopes are also distributed by community volunteers during

outreach presentations and envelopes can be requested via the helpline. 27 new sites on

the wait list, 7 awaiting re-stock

∗ Number of envelopes distributed as of 4/8/09: 7230

∗ Envelopes returned to date: 2264

∗ Envelope size (XPak Mailer by Polyair Manufacturing size #1): 7.25" x 12"

∗ Average weight of each envelope: 7 oz

∗ Total weight of returns: 972 lbs

∗ Return rate (as of 4/8/09): 31.3%

∗ 56% of participants call in their envelope code number(s) to the helpline prior to mailing

them out.

∗ Envelopes opened, sorted and cataloged (research): 1,802

∗ An estimated 190,000 pills cataloged to date (does not include gels, creams, inhalers, or

other items)

∗ Surveys returned: 509

∗ Survey response rate: 28.3%

∗ # of calls received on the helpline (both questions and envelope number reporting): 1,508

∗ # of e-mails received and responded to via info@safemeddisposal.com: 115

3

Information from Drug Cataloging

Cataloging Data fields

The cataloging database features the following variables: envelope code number, site of

distribution, zip code of origin, drug name, drug synonyms/trade names, concentration or dosage,

measure, form, quantity, prescription/OTC, and controlled drug status.

Drugs are then classified into the following therapeutic categories: coagulation modifiers,

cardiovascular agents, CNS agents, anti-infectives, psychotherapeutic agents, gastrointestinal

agents, metabolic agents, and respiratory agents.

Current case entries in the drug database: 4,520

Each prescription/OTC drug collected is cataloged individually into its own case.

∗ Average # of prescriptions/types of drugs in each envelope: 4.4

NOTE: Due to the amount of time needed to clean and analyze drug returns data, the

following analysis is based on a smaller dataset of 1,872 entries and not on the current set of

4,520 entries.

∗ Drug classifications (Based on the Drug Abuse Warning Network – DAWN -

Classification Scheme):

Class Frequency

CNS Agents 24.4%

Cardiovascular Agents 19.1%

Psychotherapeutic Agents 12.3%

Gastrointestinal Agents 7.1%

Metabolic Agents 6.8%

Respiratory Agents 6.7%

Anti-Infectives 6.4%

Hormones 4.7%

Nutritional Products 3.3%

Topical Agents 3.1%

Coagulation Modifiers 2.3%

Drug Unknown 1.8%

Misc. Agents 1.5%

Antineoplastics .33%

Alternative Medicines .27%

Immunologic Agents .05%

4

Controlled Substance Schedule Frequency

Non-controlled substance 86.1%

II 4.8%

III 3.8%

IV 5.3%

V .06%

∗ The therapeutic class of the drugs returned differed significantly by gender. Males

returned more Anti-infectives, cardiovascular agents and metabolic agents. Females

returned more gastrointestinal agents, hormones, psychotherapeutic agents and

respiratory agents [Chi sq. = 39.52, df = 14, p < .000].

∗ Younger respondents (under 50) were less likely to return most classes of drugs, with

the exception of psychotherapeutic agents. That class accounted for 31% of that group’s

returned drugs, while the older groups averaged roughly 12%. Cardiovascular agents

were most frequent among those aged 75 or older (19%), hormones among those 65 to

74 (7%), and metabolic agents among those aged 50 to 64 (17%). Overall, age category

was a significant predictor of class of drug returned [Chi Sq. = 64.38, df = 42, p = .015].

∗ The vast majority of returned drugs are in the form of pills (86%). Liquids and sprays

each comprised only 3%. All other forms had very infrequent occurrences. The form of

drug returned did not vary significantly by age category or gender of the sender.

∗ The rate of controlled substances returned increased slightly with age (from 12% for

those under 50 to 15% for those over 75), but the differences were not significant.

∗ Males returned almost exclusively prescription drugs (96%) and few OTC drugs (4%),

while females returned relatively fewer prescription drugs (86%) and slightly more

OTC drugs (14%). [That difference was significant, Chi Sq. = 12.70, df = 1, p < .001].

∗ There was a notable relationship between age category and type of drug returned.

Younger respondents (those under 50 and those between 50 to 64) returned more

prescription drugs (96% and 98% respectively) while older respondents (those aged 65

to 74 and those over age 75) returned 91% and 87% prescription drugs, respectively.

[That difference was also significant, Chi Sq. = 12.35, df = 3, p = .006].

∗ Controlled substances were equally likely to be returned by males (14%) and females

(15%) (no statistically significant difference).

5

Information from Participant Surveys

∗ 14% of our program users are “repeat users” either returning more than one envelope at a

time or using the program more than once.

∗ Average age of participants: 58 years old

18 – 49 years of age 29%

50 – 64 years age 38%

65 – 74 years age 20%

75 years of age 13%

It is interesting to note that this age has dropped considerably from Phase I (avg. age = 68.7)

to Phase II (avg. age = 58). In Phase I, older adults and caregivers were specifically targeted.

In the current phase, individuals of all ages are invited to participate in the program.

Whose medicine?

In order of most frequent response to least frequent:

∗ 59% are returning medicine for themselves

∗ 41% are returning for a relative

∗ 18% are returning for a deceased relative or friend

∗ 5% are returning medicine for a friend

∗ 3% return pet meds

∗ 2% do not know whose medicine they are returning

Where in Maine are they coming from?

Zip code of residence as reported by participants:

∗ Bangor, 04401, is one of the top zip codes of origin for medicine that has been

returned (7.7%)

∗ Portland, 04103, is the 2nd

most common zip code of origin for returned medicines

(6.7%)

∗ Winslow/Waterville, 04901, is 3rd

with 5%

∗ Scarborough, 04074 is the 4th

most common zip code reported (4.5%)

Gender of participants

∗ 62% female, 36% male, and 2% returned medicine on behalf of both genders (mixed

returns)

6

Who lives in the household?

Our phase I users had older household demographic profiles:

∗ 8% had at least one child, newborn to 10 years of age living in the household

∗ 14% had at least one person ages 11-20 living in the household

∗ 51% had an adult ages 21-64 living in the home

∗ 51% had at least one person living in the household who was age 65 and up

Method of disposal used prior to using the mailback program (question added to the

survey in Phase II of the program)

∗ 46% reported flushing medicine down the toilet

∗ 34% placed their medicine in the household trash

∗ 6% of program users reported attending a community drug collection event

∗ 11% did not know how medicines were disposed of in the household prior to using the

program

Self-identified returns

Based on participant PERCEPTION, the following drug types were returned:

In order of most frequent response to least frequent:

∗ 35% returned pain or anti-inflammatory drugs

∗ 33% reported returning heart, blood, or cholesterol medicine

∗ 33% returned “other” kinds of medicine including OTCs, hormones, psychotropic drugs,

etc.

∗ 18% returned sleep or anti-anxiety medicine

∗ 19% did not know what kind of medicine they were returning

∗ 17% reported returning antibiotics

∗ 10% reported returning allergy medicine

Where did participants obtain these medicines?

In order of most frequent response to least frequent:

∗ Local pharmacy: 82%

∗ Mail order 15%

∗ Other including deceased family members: 13%

∗ Samples from doctor’s offices: 10%

∗ Internet pharmacy: 4%

∗ Friends or family: 4%

7

Reasons for needing disposal

In order of most frequent response to least frequent:

∗ Meds expired or outdated: 42%

∗ “Other” (deceased family member was top write-in response): 26%

∗ Doctor told person to stop taking the medicine: 28%

∗ Doctor gave a new prescription: 22%

∗ Person didn’t want anyone else to use the medicine: 22%

∗ Person felt better or no longer needed the medicine: 18%

∗ Had a reaction or allergy: 14%

∗ Experienced a side effect: 13%

∗ Did not want to take the medicine: 8%

Why do people use our program?

∗ Best for the environment: 80%

∗ Safest for me and my family: 13%

∗ Free to use: 4%

∗ Most convenient: 4%

How helpful is this program?

∗ “Helpful” or “very helpful”: 99%

∗ “Somewhat helpful” or “not helpful”: 1%

Comments from open-ended responses (most common comments selected)

∗ Thank you for this program-great as is

∗ Make envelopes more available/have more sites

∗ Advertise more

∗ Bigger envelopes

∗ This is such a waste of medicine. This could be used for the uninsured

elderly/homeless/those in need, etc.

Additional comments:

∗ This is a fantastic program. The meds of a deceased love one are an emotional reminder

of that person. Thank you for offering a private method of disposal. You saved me

many tears.

∗ My brother and I have tried to find a safe and responsible way to dispose of these meds

for 18 months! We have not found any other way after several attempts with local

police, hazardous waste, pharmacy, hospice, etc.

8

Selected Photos from the Cataloguing Sessions

Old returns, like this bottle of formaldehyde

are not uncommon.

One program participant provided a homemade

pill guide for us to follow.

Two bottles of Plavix, 2 bottles of Namenda,

and a bottle of Aricept, all unopened and

unused.

Four nearly full bottles of Tramadol.

Drugs in foreign languages have also been

returned via the mailback.

7 full bottles of Depakote

9

An example of a day’s worth of drug

inventorying

10

Program Model

Program participants pick up envelope at distribution site

Secure delivery to Maine Drug Enforcement Agency

Envelopes received, logged, catalogued and destroyed under MDEA custody

Prep medicine according to instructions

11

Program Partners

Additional partners (logos not pictured)

Maine Council for Child and Adolescent Psychiatry

Margaret Chase Smith Policy Center

Maine Pharmacy Association

Maine Office of the Attorney General

Villanova University Center for the Environment

12

Participating Program Distribution Sites

(Check www.safemeddisposal.com for updated envelope stock information)

* Denotes sites with multiple locations/sites

1. Airline Pharmacy, Brewer

2. Aroostook Area Agency on Aging, Presque Isle

3. Aroostook Wellness, Caribou

4. Belfast PD, Belfast

5. Bucksport Community Pharmacy, Bucksport

6. CVS, Auburn

7. CVS, Augusta

8. CVS, Bath

9. CVS, Brunswick

10. CVS, Cape Elizabeth

11. CVS, Lewiston

12. CVS, Portland (Auburn St.)

13. CVS, Portland (Congress St.)

14. CVS, Sanford

15. CVS, South Portland

16. CVS, Waterville

17. CVS, Westbrook

18. CVS, Windham

19. Davis Pharmacy, East Millinocket

20. DFD Russell Medical Center, Leeds

21. DFD Russell Medical Center, Monmouth

22. DFD Russell Medical Center, Turner

23. Eastern Area Agency on Aging, Bangor

24. Eliot Police Department, Eliot

25. Hannaford Pharmacy, Bangor

26. Hannaford Pharmacy, Ellsworth

27. Hannaford Pharmacy, Farmington

28. Health Access Network, Lincoln

29. Homecare and Hospice, multiple locations*

30. Houlton Council of Catholic Women, Houlton

31. Kennebec Pharmacy and Homecare, Rockport

32. Kennebec Valley Council of Governments

33. Kennebunk Police Department

34. Kennebunk Village Pharmacy, Kennebunk

35. Maine Department of Public Safety, internal distribution for employees

36. Maine General Hospital physician practices*

37. Martin's Point Pharmacy, Portland

38. Medical Center Pharmacy, Brunswick

13

39. Miller Drug, Bangor

40. Oxford County Sheriff’s Office

41. PCHC Old Town, Bangor

42. PCHC Pharmacy, Bangor

43. Penobscot Bay Medical Center Pharmacy, Rockport

44. Penobscot Nation Health Center Pharmacy, Indian Island

45. Randolph Community Pharmacy, Randolph

46. Rite Aid (Belfast Ave.), Augusta

47. Rite Aid (Hospital St), Augusta

48. Rite Aid, Bar Harbor

49. Rite Aid, Belfast

50. Rite Aid, Bethel

51. Rite Aid, Blue Hill

52. Rite Aid, Boothbay Harbor

53. Rite Aid, Bucksport

54. Rite Aid, Buxton

55. Rite Aid, Calais

56. Rite Aid, Camden

57. Rite Aid, Caribou

58. Rite Aid, Cornish

59. Rite Aid, Damariscotta

60. Rite Aid, Dover-Foxcroft

61. Rite Aid, Ellsworth

62. Rite Aid, Fairfield

63. Rite Aid, Farmington

64. Rite Aid, Fryeburg

65. Rite Aid, Guilford

66. Rite Aid, Houlton

67. Rite Aid, Lewiston

68. Rite Aid, Lincoln

69. Rite Aid, Machias

70. Rite Aid, Milo

71. Rite Aid, Pittsfield

72. Rite Aid, Portland

73. Rite Aid, Rumford

74. Rite Aid, Saco

75. Rite Aid, Scarborough

76. Rite Aid, Skowhegan

77. Rite Aid, South Paris

78. Rite Aid, Topsham

79. Rite Aid, Waterville

80. Rite Aid, Yarmouth

81. Riverside Pharmacy, Bangor

82. Saco Community Pharmacy, Saco

83. Searsport Police Department, Searsport

84. Senior Companion Program, Statewide*

14

85. SeniorsPlus – AAA, Lewiston

86. South Paris AARP Group

87. Specialized distribution at the 2008 Blaine House Conference on Aging to 200 older

adult delegates

88. Togus VA Hospital, Augusta

89. Unity Pharmacy, Unity

90. Volunteers of America housing complexes, Statewide*

91. Wal-Mart, Falmouth

92. Winterport Family Medicine,Winterport

93. York Hospital Apothecary, York

94. York Hospital Pharmacy, Berwick

95. York Hospital, Wells

96. York Police Department, York

* Denotes sites with multiple locations/sites

15

Program Distribution Site Wait List

1. Arlington Grange, Whitefield

2. Chans Home Healthcare, Brunswick

3. Cranberry Island Sustainability Initiative, Isleford

4. Good for All Pharmacy, East Waterboro

5. Goodnow Pharmacy, Rockland

6. Hannaford Pharmacy #0155, Millinocket

7. Heart Health Institute, York

8. Islands Community Medical Services Inc., Vinalhaven

9. Kno-Wal-Lin Homecare/Hospice, Rockland

10. LaMaison Acadienne, Madawaska

11. MaineGeneral, Waterville

12. Marshwood High School, South Berwick

13. North Haven (community), North Haven

14. Oakland Pharmacy, Oakland

15. Osco Pharmacy,Westbrook

16. Rite Aid, Kittery

17. Rite Aid, Oakland, Oakland

18. Saint Andrews Hospital, Boothbay Harbor

19. Saint John Valley Pharmacy, Fort Kent

20. Scarborough Veteran's Home, Scarborough

21. Sunbury Primary Care, Bangor

22. Target Pharmacy, Bangor

23. The Medicine Shoppe, Lewiston

24. UNUM, Portland

25. Veteran’s Center, Bangor

26. Walgreens, Augusta

27. Wal-Mart Pharmacy, Windham

16

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