Rx15 pharma wed_300_1_egan-gregory_2gray

Pharmacy Track:
Lessons Learned from
Rx Disposal Programs
Presenters:
• Kathleen Egan, MS, Research Associate, Department of Social
Science & Health Policy, Wake Forest School of Medicine
• Eric Gregory, EdD, CPS, Executive Director, Save Our Kids
Coalition
• Jeffrey Gray, PharmD, RPh, Associate Professor, Gatton
College of Pharmacy, & Adjunct Professor, College of Public
Health, East Tennessee State University
Moderator: Dan Smoot, Director of Drug Prevention & Education,
Appalachia High Intensity Drug Trafficking Area (HIDTA)

Disclosures
• Kathleen Egan, MS, has disclosed no relevant, real, or apparent
personal or professional financial relationships with proprietary
entities that produce healthcare goods and services.
• Eric Gregory, EdD, CPS, has disclosed no relevant, real, or apparent
personal or professional financial relationships with proprietary
entities that produce healthcare goods and services.
• Jeffrey Gray, PharmD, RPh, has disclosed no relevant, real, or
apparent personal or professional financial relationships with
proprietary entities that produce healthcare goods and services.
• Dan Smoot has disclosed no relevant, real, or apparent personal or
professional financial relationships with proprietary entities that
produce healthcare goods and services.

Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– Kelly Clark – Employment: Publicis Touchpoint Solutions;
Consultant: Grunenthal US
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
– Carla Saunders – Speaker’s bureau: Abbott Nutrition

Learning Objectives
1. Describe the Rx drug disposal methods of
DEA take-back events, permanent drop boxes
and retail pharmacies.
2. Evaluate the effectiveness of these disposal
methods.
3. Identify best practices for implementing
these disposal methods.

Disclosure
• Kathleen Egan, M.S., has disclosed no relevant, real
or apparent personal or professional financial
relationships with proprietary entities that produce
health care goods and services.
• Eric Gregory, Ed.D., CPS has disclosed no relevant,
real or apparent personal or professional financial
relationships with proprietary entities that produce
health care goods and services.

• Describe the Rx drug disposal methods of DEA-
approved take-back events, permanent drop boxes
and retail pharmacies.
• Evaluate the effectiveness of these disposal methods.
• Identify best practices for implementing these
disposal methods.

Between 1991 and 2010, prescriptions for opioid analgesics increased from
30 million to 180 million (Phillips, 2013).
Millions of pounds of prescription medications go unused each year in the
United States (Shrank, 2011).
Source: AwareRXSource: Nova Southeastern University

 To prevent diversion of RX drugs for misuse & abuse.
“Providing individuals with a secure and convenient way to dispose of medications
will help prevent diversion and abuse, and help to reduce the introduction of drugs
into the environment.” (ONDCP, 2011; Stewart et al., 2014)
“Proper disposal is crucial in countering this illegal activity.” (Herring et al., 2008).
 To prevent accidental poisoning among children.
(Gray and Hagermeier, 2012; Stewart et al., 2014)
 To prevent crime in communities.
“Medication storage can increase the risk of home invasions.” (Stewart et al., 2014)
 To prevent environmental hazards.
“Proper disposal of drugs is a straightforward way for individuals to prevent
pollution.” (U.S. Environmental Protection Agency, 2010)

• The Galaxy Project
– The Partnership
– Objectives & Research Questions
– DEA Take-Back Events & Permanent Disposal Units
– Collections Assessment
– Results
• Implications for the Field

Permanent Disposal Units at
Law Enforcement Offices
Bi-annual DEA-Sponsored
Take-Back Events
Source: Bangor Daily News

• Minimal published reports on pill count and substance type
Source: http://www.dea.gov/docs/results_final.pdf
• Primarily weight-based assessments

Save Our Kids Coalition
Wake Forest School
of Medicine
LifeSkills, Inc.
Law Enforcement Agencies
Pharmacists
SparksInitiatives, Inc.

Objectives
• To examine the potential impact of RX disposal through the assessment of
collections from DEA-sponsored take-back events and permanent disposal units
using a community-based participatory research (CBPR) approach.
• To disseminate our findings with researchers, practitioners, & policy-makers.
Research Questions
1) What is disposed at take-back events and in permanent disposal units (i.e.,
controlled prescription medications, non-controlled medications, trash, etc.)?
2) How many & what type of controlled prescription medications are collected?
3) How does the collection compare to what is dispensed in the participating
communities?
4) Is the assessment protocol feasible?

10/26/2013 4/26/2014
6/13/2014
-
6/20/2014
8/15/2014
-
8/22/2014
10/25/2014
11/14/2014
-
11/21/2014
2/20/15
–
2/27/15
Take Back
Event
Take Back
Event
Permanent
Disposal
Permanent
Disposal
Take Back
Event
Permanent
Disposal
Permanent
Disposal

DEA Take-back Events Permanent Disposal Units
Number Conducted 3 4
Number of LEAs Participated
Event/Permanent Collection #1
2-3
2 agencies
3 agencies
3 agencies
NA
4 – 7
7 agencies
6 agencies
4 agencies
6 agencies
Timeframe 1 Day from 10am-2pm 1 Week
Location
Agency #1
Agency #2
Agency #3
Police Department
High School Parking Lot
Sheriff’s Department
Law Enforcement Offices
Procedure • Events were advertised by
law enforcement agencies
hosting the events.
• Boxes were emptied
immediately prior to the
start of the collection.
• Medications were
collected after 1 week.
• No additional advertising
the week of collection.

• Collection assessment occurred in the office of the local Drug
Task Force (DTF).
– Collections were transported to assessment location by Law
Enforcement Officers of the home collection.
• Assessment was conducted by Eric Gregory (Assessment
Supervisor), Law Enforcement Officers, Pharmacist, three
Pharmacy Technicians, and two additional assistants.
• Collection assessment was divided into four stages:
1) Pre-Sort
2) Sort & Drug Identification
3) Measurement
4) Analysis

• Collections were pre-sorted:
– First stage of trash reduction
– Safety inspection using magnet & Turtle Skin LE Search Gloves (28 ga)
– Handling of bottles, blister packs, and loose pills

• Sort collection into controlled, non-controlled, and trash
– Removed and identified pills from bottles or packs
– Identified loose pills
– Used color-coded bins to separate controlled, non-controlled, & trash
• Controlled prescription medications were identified and
recorded by generic name.

• Trash and non-controlled substances were measured by weight (g/kg)
• Controlled pills measured by weight (g/kg) and counted by pill
• Controlled liquids measured by weight (kg) and volume (ml)
• Controlled patches measured by weight (g/kg) and counted by patch
• Two scales: Royal DG200 and Acculab VI-1200

• Hand written forms were converted
to Excel files by Assessment
Supervisor and transferred to Wake
Forest School of Medicine (WFSM).
• Supplemental anecdotal report
provided by Assessment Supervisor.
• WFSM Team compiled, reviewed,
and analyzed the data.
– Pills, liquids, and patches were converted
to “units.”
– Unit = 1 pill, 1 ml, or 1 patch (Stewart et
al., 2014)

263
101
80
38
94
35
80
26
6 14 0
0
50
100
150
200
250
300
Take Back Events (n=3) Permanent Disposal (n=3)
Weight(kg)
Overall Weight
Total
Trash
Non-controlled pills
Non-controlled liquids
Controlled pills
Controlled liquids
% of Total Weight
Take Back & Permanent
Trash = 30%; 38%
Non-controlled = 66%; 61%
Controlled = 4%; 1%

18069
3435
9554
2418
4784
848
3065
92130 50
536
28
0
5000
10000
15000
20000
Take Back Events (n=3) Permanent Disposal (n=4)
Overall Units of Controlled RX Medication Collected
Total Pain Reliever Tranquilizer Stimulant Muscle Relaxer Other
Numberofunits

988
4857
959
45
3845
425106
2006
953
0 0 096
981
315
0
1000
2000
3000
4000
5000
10/26/2013 (n=2) 4/26/2014 (n=3) 9/27/2014 (n=3)
Numberofunits
All Agencies (range; n=2-3)
988
2068
659
45
490
47106 176 00 0 096 346 254
0
1000
2000
3000
4000
5000
10/26/2013 (n=2) 4/26/2014 (n=2) 9/27/2014 (n=2)
Numberofunits
Restricted to agencies that participated at all events (n=2)

491
703
141
714
235
84
3
526
0 0 25 67
3 0 0
47
0 0 0 28
0
200
400
600
800
June '14 (n=4) Aug. '14 (n=4) Nov. '14 (n=4) Feb. '15 (n=4)
NumberofUnits
Restricted to agencies that participated in all assessments (n=4)
491
737
141
764
235
84
0
526
0 0 25 67
3 0 0
47
0 0 28
0
200
400
600
800
June '14 (n=7) Aug. '14 (n=6) Nov. '14 (n=4) Feb. '15 (n=6)
NumberofUnits
All Agencies (range; n=4-7)

• Total Controlled Units Dispensed
• Units dispensed in 2013 based on KASPER reports.
• Units Used
• Estimate based on 30% of “Total Controlled Units Dispensed”
(Stewart et al., 2014).
• Units Disposed:
• Estimate based on an average of the four permanent collections
multiplied by 52.
• Estimate based on an average of the three DEA Sponsored Take-
Back Events multiplied by 2.
• Units left in Community
• Total Dispensed – (Used + Disposed)

County Population*
Total
Controlled
Dispensed
Units Used
Units
Disposed
Units left in
Community
County A 113,792 13,288,979 3,986,694 22,832 9,279,453
County B 42,173 5,318,516 1,595,555 33,982 3,688,979
County C 17,327 2,214,703 664,411 3,717 1,546,575
Estimated Units
Used
30%
Estimated Units
Disposed
1%
Estimated Units
in Community
69%
County B
*2010 Census

• All collections were weighed, sorted, and categorized within one day.
• Assessments were conducted ~ 9 individuals (Assessment Supervisor, Law
Enforcement Officers, Pharmacist, three Pharmacy Technicians, and two
additional assistants).
• The protocol was adapted during the first two assessments based on
lessons learned.
• While assessment of a limited number of collections over the year is
feasible, assessment of collections over an entire year is likely not feasible
or efficient.
• It may be difficult to get agencies who collected substances to participate
in all assessments.
– Two out of seven agencies participated in every collection.

• RQ 1: What is disposed (based on weight)?
– ~3% Controlled Substances, ~65% Non-Controlled Substances, ~32% Trash
• RQ 2: How many controlled RX medications were collected?
– 21,504 units were collected from 3 take-back events (18,069) and 4 week-
long permanent disposal collections (3,435).
– Pain relievers followed by tranquilizers were the most common controlled
substances.
• RQ 3: How does the collection compare to what is dispensed in the
participating communities?
– Disposed controlled prescription medications accounted for ~1% of all
dispensed into the community.
• RQ 4: Is the assessment protocol feasible?
– Yes, but maybe not on an annual or more frequent basis.

• What is the denominator (# of doses dispensed)?
– Availability of information
– Timeframe
– Location
• Limited information about how many of dispensed
medications are actually used (as intended).
• Variability in context of communities and disposal
opportunities.

• Importance of conducting collection assessments
• Disposal is only one strategy to reduce the number
of controlled prescription drugs in communities
• Value of partnerships
– Law Enforcement, Pharmacists, Prescribers, Community
Coalitions, Researchers

• Improve disposal efforts
– *New policy* Authorized collectors - manufacturers, distributors,
reverse distributors, narcotic treatment programs, hospitals/clinics with
an on-site pharmacy, and retail pharmacies - can now register to
participate in Rx collection
– Engage in local partnerships
– Advertise disposal locations & educational information on medicine
bottles, materials, and in the pharmacy
• National and long-term assessments of disposal efforts

Gray, J. A., & Hagemeier, N. E. (2012). Prescription drug abuse and DEA-sanctioned drug take-back events: characteristics
and outcomes in rural Appalachia. Archives of internal medicine, 172(15), 1186-1187.
Herring, M. E., Shah, S. K., Shah, S. K., & Gupta, A. K. (2008). Current regulations and modest proposals regarding disposal of
unused opioids and other controlled substances. JAOA: Journal of the American Osteopathic Association, 108(7), 338-
343.
Phillips, J. (2013). Prescription drug abuse: Problem, policies, and implications. Nursing outlook, 61(2), 78–84.
doi:10.1016/j.outlook.2012.06.009.
Shrank, W. H. (2011). Our Bulging Medicine Cabinets — The Other Side of Medication Non-adherence. New England
Journal of Medicine, 364(17), 1591–1593. doi:10.1056/NEJMp1011624.
Stewart, H., Malinowski, A., Ochs, L., Jaramillo, J., McCall III, K., & Sullivan, M. (2015). Inside Maine’s Medicine Cabinet:
Findings From the Drug Enforcement Administration's Medication Take-Back Events. American journal of public
health, 105(1), e65-e71.
Office of National Drug Control Policy. (2011). Prescription Drug Abuse. Retrieved April 5, 2013, from
http://www.whitehouse.gov/ondcp/prescription-drug-abuse
U.S. Environmental Protection Agency. (2010). Pharmaceutical and Personal Care Products (PPCPs). Retrieved October 29,
2013, from http://www.epa.gov/ppcp/basic2.html

• Joy White, Lifeskills Regional
Prevention Center
• Michael Sparks, M.A.,
SparksInitiatives, Inc.
• Mark Wolfson, PhD, Wake Forest
School of Medicine
• Funding: Partnerships for Success
II, Substance Abuse and Mental
Health Services Administration
• Tommy Loving, Director, Warren
County Drug Task Force
• Tod Young, Detective, Warren
County Drug Task Force
• Amy Stillwell, The Save Our Kids
Coalition
• Lisa Mason, The Save Our Kids
Coalition
• Missy Greathouse, Pharmacist
• Alan Hudson, Pharmacy Tech
• Cindy Whitmore, Pharmacy Tech
• Jana Young, Pharmacy Tech
• Latasha Bunton, Pharmacy Tech

Lessons Learned from a Rx Disposal
Program in NE Tennessee
April 8, 2015
Jeffrey A Gray, PharmD, CDE
Associate Professor, ETSU College of Pharmacy
Adjunct Professor, ETSU College of Public Health

Disclosure Statement of
Unapproved/Investigative Use
I, Jeff Gray,
DO NOT have a financial interest/arrangement or
affiliation with one or more organizations that
could be perceived as a real or apparent conflict of
interest in the context of the subject of this
presentation.
DO NOT anticipate discussing the
unapproved/investigative use of a commercial
product/device during this activity or presentation.

Prevention
1° 2° 3° 4°(?)
Non-use Death
Rx Monitoring
Programs &
Diversion Control
Dependence Addiction
1st
Initiation
Traditional &
Medically Assisted
Treatment
Dissemination &
Implementation of Effective
Prevention Programs
Overdose Reversal
with Naloxone
Level of Prevention
Neonatal Abstinence Syndrome:
Treatment of Mother, Infant &
Preventing Second Pregnancy
Evidence-
Based Drug
Courts
Health Professions
Training & Continuing
Education
Screening, Brief
Intervention &
Referral to Tx

Study Objectives
• List quantitative metrics for reoccurring (Live
Take Back) and consistently available
(Amnesty Box) donation options
• Describe donor tendencies related to
medications storage and destruction
• Explain population density variables which
influence donation behaviors
• Identify characteristics of a successful public
awareness campaign

Methodology
• Active partnership with the DEA and local law
enforcement
• Onsite donor survey (LTB only), sorting,
identification, label interpretation, counting,
and recording
• Research sites
– 5 Live Take Back Sites over 18 months
– 5 + 3 Amnesty Box Sites over 30 months
• Awareness campaign (TV, print)

Data Collected
• Total donation weight (lbs)
• Total Controlled Substance (CS) weight (lbs)
• CS Active ingredient (C II- CV)
• Therapeutic category (Opioids, Stimulants, etc)
• Quantity of CS in dosage units
– Tablet, capsule, film, lozenge, nasal spray
– Milliliter, patch, syringe, suppository, IV drip
• Date of dispensing
• Donation location
• Municipality population as 2012

Controlled Substances Collected
25859
6585
436
3018
Units of Controlled Substances Collected, by Therapeutic Class
Opioids Sedative/ Hypnotics Stimulants Miscellaneous

Donations by Weight
0
50
100
150
200
250
300
350
400
450
500
Blountville Bristol Elizabethton Johnson City Jonesborough
213.5
497
250.5
301.2
388.5
14 18 10.5 16.3 23
Total Pounds of Rx and Controlled Substances Collected, by Municipality
Total Rx CS

Donations by CS Units
0 2000 4000 6000 8000 10000 12000
Blountville
Bristol
Elizabethton
Johnson City
Jonesborogh
Units Collected
Units of Controlled Substances Collected, by Municipality

Dispensing to Donation Time
56.72
67.36
59.27
42.39
0.00
10.00
20.00
30.00
40.00
50.00
60.00
70.00
80.00
Sedative/ Hypnotics Miscellaneous Opioids Stimulants
MeanNumberofMonths
Average Number of Months Between Dispensing and Donation,
By Therapeutic Class

Public Awareness Campaign
Baseline 2013, Intervention 2014
Total Donation Wt (lbs)
Spring 2013 Fall 2013 Spring 2014 Fall 2014
Blountville 40.6 19 157 37.5
Bristol 154 253 154 90
Elizabethton 60 29.5 140 81
Johnson City 141 79.2 133 89
Jonesborough 116 12.5 342 34
904.8 1,257.5
39% Increase

Controlled Substances Collected
97560
28031
2481
7102
Total Controlled Substance Units Collected by Drug Class
Opioids Sedative Hypnotics Stimulants Misc.

Donations by Weight
0
500
1000
1500
2000
2500
966
313.5
518
1380
444.5
2184
82
261.5
58.5 11 22 55 31.5
96
4 21.5
Pounds
Total Pounds of Rx and Controlled Substances by Collection Site
Total Rx Controlled Substances

Donations by CS Units
0 5000 10000 15000 20000 25000 30000 35000 40000 45000
Blountville
Bristol
Elizabethton
Johnson City
Jonesborough
Kingsport
Mt. City
Rogersville
Units of Controlled Substances By Collection Site

Dispensing to Donation Time
53.93
43.32
41.52
50.00
0
10
20
30
40
50
60
Opioids Sedative Hypnotics Stimulants Misc.
Mean Number of Months Between Dispensing and Donation

Monthly Donations/1,000 Residents
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0
50
100
150
200
250
S1 S2 S3 S4 S5 S6 S7 S8 Total
MonthlyAveragelbsper1000Residents
MonthyAverage#ofPillsper1000Residents
Average Monthly CS Donations per 1000 Residents, by Pounds and
Number of Pills
Monthly pills per 1000 Monthly lbs per 1000
Pop. Over 10,000Pop. Under 10,000
American Journal of Public Health (Approved with Revision March 2015)

Amnesty and Take Back
0
10
20
30
40
50
60
Blountville Bristol Elizabethton Johnson City Jonesborough Average
14
18
10.5
16.3
23
16.36
31.5
11
22
41
31.5
27.4
Pounds of Controlled Substances Collected from Amnesty Boxes and Drug Take Back Events, by
Municipality, May 2013 - October 2014
Take Back Amnesty

0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
8.0%
Percent Controlled Substance for Amnesty and Take Back
Collections, May 2013-October 2014
Take Back
Amnesty
0
10
20
30
40
50
Pounds of Controlled Substances for Amnesty and Take Back Collections,
May 2013-October 2014
Take Back
Amnesty

Donor Storage Tendencies
Number of Months Between Dispensing and Donation by
Therapeutic Class
Class Mean Median
Take Back Amnesty Take Back Amnesty
Opioids 59 54 45 38
Sedative/
Hypnotics
57 43 40 28
Stimulants 42 42 32 22
Misc. 67 50 77 29

Conclusions
• Amnesty Box and traditional Take Back options
are effective primary prevention mechanisms
• Amnesty Box donations outpace Live Take Back
donations in the same municipalities (total & CS)
• CS donation percentage by weight is similar
between the two options
• The number of CS dosage units collected is higher
per capita for Amnesty Box donors
• Time from dispensing to donation is
approximately six months earlier for Amnesty Box
donations

Diversity-promoting Institutions Drug
Abuse Research Program Team
NIH/NIDA R24 – Sponsored Research 2013-18

Rx15 pharma wed_300_1_egan-gregory_2gray

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Ähnlich wie Rx15 pharma wed_300_1_egan-gregory_2gray

Ähnlich wie Rx15 pharma wed_300_1_egan-gregory_2gray (20)

Mehr von OPUNITE

Mehr von OPUNITE (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Rx15 pharma wed_300_1_egan-gregory_2gray

Hinweis der Redaktion