Download Pharmaceutical Waste and Proper Disposal Techniques

Allison
Del
Bene
Davis
PhD,
RN
March
17,
2011
1
Learning
Objectives
 To
describe
the
impact
of
improper
waste
disposal
 To
identify
proper
methods
to
dispose
of
medications
2
Excess
meds
in
assisted
living
facilities
‐
a
common
issue
 Frequent
changes
in
prescription
medications
 Large
amounts
of
over‐the–counter
medications
 Repeated
hospitalizations
 Expired
medications
 Discontinued
medications
 Unused
medications
Having
unnecessary
medications
sitting
around
can
cause
confusion
for
the
technician
administering
the
medications
and
can
potentially
lead
to
medication
errors.
3
Ways
to
minimize
this
in
the
first
place
 Periodic
review
of
all
medications
by
the
delegating
nurse,
primary
care
physician
or
pharmacist
 Discontinuation
of
medications
that
are
not
needed
 Discussion
of
non
pharmacological
management
of
certain
conditions
IE:
Constipation:
Adequate
fluid
intake,
increased
insoluble
fiber
intake,
increased
activity
To
limit
the
number
of
medications:
‐
Do
not
order
the
medications
if
they
are
not
needed
in
the
first
place.
‐
Periodic
reviews
of
the
patient’s
medications
is
a
good
way
to
minimize
excess.
‐
Try
non‐pharmacological
interventions
first,
before
prescribing
drugs.
4
How
we
used
to
handle
medication
disposal
 Medications
have
traditionally
been
disposed
of
by
flushing
them
down
the
toilet.
 Some
have
been
returned
to
the
pharmacy
for
credit
if
they
were
un‐opened.
We
used
to
flush
drugs
but
are
now
leaning
towards
alternatives.
The
issue
with
flushing
drugs
down
the
toilet
is
that
flushed
medications
do
not
go
to
“heaven”
but
get
incorporated
into
our
water
system.
You
could
also
try
to
return
untouched,
unopened
and
unexpired
medications
to
the
pharmacy.
5
Medications
and
drinking
water
 Pharmaceuticals
and
personal
care
products
(PPCPs)
are
a
source
of
water
pollution:







PPCPs
of
concern
include:
Prescription
and
over‐the
counter
therapeutic
drugs
Veterinary
drugs
Fragrances
Cosmetics
Sun‐screen
products
Diagnostic
agents
Nutraceuticals
(e.g.,
vitamins)
6
Medication
pollution
in
drinking
water
 “Officials
in
Philadelphia
said
testing
there
discovered
56
pharmaceuticals
or
byproducts
in
treated
drinking
water,
including
medicines
for
pain,
infection,
high
cholesterol,
asthma,
epilepsy,
mental
illness
and
heart
problems”
 “Anti‐epileptic
and
anti‐anxiety
medications
were
detected
in
a
portion
of
the
treated
drinking
water
for
18.5
million
people
in
Southern
California.”
 “Researchers
at
the
U.S.
Geological
Survey
analyzed
a
Passaic
Valley
Water
Commission
drinking
water
treatment
plant,
which
serves
850,000
people
in
Northern
New
Jersey,
and
found
a
metabolized
angina
medicine
and
the
mood‐stabilizing
carbamazepine
in
drinking
water.”
 “The
drinking
water
for
Washington,
D.C.,
and
surrounding
areas
tested
positive
for
six
pharmaceuticals.”
7
The
hazards
of
flushing……..
 Sewage
treatment
systems
are
not
equipped
to
remove
medications
from
water.
 There
is
no
routine
testing
for
medications
in
drinking
water
 Pharmaceuticals
have
been
found
in
streams,
rivers,
lakes
and
in
drinking
water
.
 The
effects
of
these
chemicals
and
mixtures
on
human
health
are
unknown.
Sewage
treatment
plants
are
not
equipped
for
screening
out
or
removing
pharmaceuticals
from
our
drinking
water.
Some
medications
also
get
into
the
water
system
after
having
been
used
by
humans
and
excreted
in
the
commode.
8
The
ideal
situation
for
medication
disposal
 Pharmaceutical
waste
take
back
programs
are
the
wave
of
the
future.
 In
the
meantime,
we
need
to
find
safer
ways
to
dispose
of
unused
medications
AND
 We
need
to
ensure
that
the
agencies
we
work
for
have
safe
pharmaceutical
disposal
policies
in
place
So
what
are
we
supposed
to
do?
There
are,
unfortunately,
no
straight
answers.
Take‐back
programs
are
beginning
to
be
introduced
into
legislation.
We
need
to
have
policies
in
place
to
make
sure
that
medications
are
being
thrown
away
to
the
right
place
at
the
right
time.
9
Strategies
for
unused,
non‐expired
medications
 Check
with
the
pharmacy
that
they
were
dispensed
by
to
see
if
they
will
take
them
back
for
credit
or
proper
disposal.
 You
may
be
able
to
take
advantage
of
community
drug
take‐back
programs
or
other
programs,
such
as
household
hazardous
waste
collection
events,
that
collect
drugs
at
a
central
location
for
proper
disposal
This
only
applies
to
non‐controlled
substances.
Opportunities
for
donating
medications
are
few
and
far
between.
10
When
disposal
is
the
only
answer
 If
the
medication
is
expired,
refused
or
contaminated
you
will
need
to
dispose
of
it.
 Do
NOT
flush
prescription
drugs
down
the
toilet
or
drain
unless
the
label
or
accompanying
patient
information
specifically
instructs
you
to
do
so.
11
Safe
medication
disposal
‐
non
controlled
substances
 Take
prescription
drugs
out
of
their
original
containers.
 Mix
drugs
with
an
undesirable
substance,
such
as
cat
litter
or
used
coffee
grounds.
 Put
the
mixture
into
a
disposable
container
with
a
lid,
such
as
an
empty
margarine
tub,
or
into
a
sealable
bag.
Unused
or
expired
medicines
that
do
not
have
flushing
directions
in
the
label
can
be
safely
disposed
in
the
household
trash
by
following
this
procedure.
The
procedure
is
recommended
by
national
guidelines.
12
Continued
 Conceal
or
remove
any
personal
information,
including
Rx
number,
on
the
empty
containers
by
covering
it
with
black
permanent
marker
or
duct
tape,
or
by
scratching
it
off.
 Place
the
sealed
container
with
the
mixture,
and
the
empty
drug
containers,
in
the
trash.
 http://www.smarxtdisposal.net/
13
Disposal
of
controlled
substances
 On
October
12,
2010,
President
Obama
signed
the
Secure
and
Responsible
Drug
Disposal
Act.
 This
bill
amends
the
Controlled
Substances
Act
to
allow
a
user
of
a
legal
pharmaceutical
to
deliver
the
drugs
to
another
person
for
disposal
as
long
as
the
disposal
is
handled
in
a
way
that
will
keep
the
drugs
from
being
diverted
to
another
user.
Controlled
substances
pose
a
hazard
because
they
have
a
high
potential
of
being
abused.
This
law
allows
states
and
private
entities
to
create
programs
to
collect
and
safely
dispose
of
unwanted
prescription
drugs.
Previously,
it
was
illegal
to
deliver
a
controlled
substance
to
someone
else
for
disposal.
Now
responsible
parties
can
take
back
controlled
substances.
14
Safe
medication
disposal
‐
controlled
substances
 Because
of
this
law
there
may
now
be
programs
that
take
back
and
dispose
of
controlled
substances.
 The
FDA
still
recommends
that
controlled
medications
be
disposed
of
by
flushing.
 Agencies
should
have
policies
to
deal
with
the
disposal
of
controlled
substances.
 Often
these
policies
involve
disposal
by
the
delegating
nurse.
The
first
national
take‐back
day
was
in
September
2010.
121
tons
of
pills
were
collected
from
3000
sites
that
day.
Go
to
nationaltakebackday.com
website,
put
in
your
zip
code
to
see
where
and
when
you
can
bring
back
your
excess
drugs.
Next
national
take
back
day
is
April
30th,
2011.
The
FDA
recommendation
about
flushing
medications
is
a
guideline
and
not
a
policy.
15
This
list
from
FDA
tells
you
what
unused
or
expired
medicines
you
should
flush
down
the
sink
or
toilet.
Actiq, oral transmucosal lozenge *
Avinza, capsules (extended release)
Daytrana, transdermal patch system
Demerol, tablets *
Demerol, oral solution *
Diastat/Diastat AcuDial, rectal gel
Dilaudid, tablets *
Dilaudid, oral liquid *
Dolophine Hydrochloride, tablets *
Duragesic, patch (extended release) *
Embeda, capsules (extended release)
Exalgo, tablets (extended release)
Fentora, tablets (buccal)
Kadian, capsules (extended release)
Methadone Hydrochloride, oral solution *
Methadose, tablets *
Morphine Sulfate, tablets (immediate release) *
Morphine Sulfate, oral solution *
MS Contin, tablets (extended release) *
Onsolis, soluble film (buccal)
Opana, tablets (immediate release)
Opana ER, tablets (extended release)
Oramorph SR, tablets (sustained release)
Oxycontin, tablets (extended release) *
Percocet, tablets *
Percodan, tablets *
Xyrem, oral solution
To
find
this
list,
search
for
“FDA
pharmaceutical
disposal”.
We
still
do
not
want
these
medications
in
the
water
system,
but
we
definitely
do
not
want
them
in
our
kids.
It
is
therefore
recommended
that
we
flush
them.
16
Compliance
with
Medication
Technician
Training
 When
we
are
writing
our
agencies
policies
we
need
to
make
sure
we
are
also
complying
with
the
medication
technician
training
curriculum
and
the
procedures
set
in
place
by
the
delegating
nurse
Procedures
and
clear
guidelines
are
needed.
17
Model
Programs
in
Maryland
 In
Calvert
County,
the
Calvert
Alliance
Against
Substance
Abuse
has
established
a
prescription
drug
disposal
programs
developed
through
a
local
public/private
partnership
have
ensured
the
proper
disposal
of
more
than
700
pounds
of
prescription
medications
in
just
the
first
year
of
operation.
 Participating
Calvert
County
pharmacies
collected
600
pounds
of
unused
prescription
drugs
in
2010
while
county
residents
dropped
off
more
than
146
pounds
of
medications
at
a
Calvert
County
Sheriff’s
Office
drop
box.
18
Take
back
partners
 Chesapeake
Pharmacy
of
Chesapeake
Beach
and
Calvert‐Arundel
Pharmacy
in
Owings,
are
part
of
Maryland’s
“Take‐Back”
Program
and
accept
the
return
of
non‐narcotic
prescriptions,
over‐the‐counter
drugs
and
supplements.
 The
Calvert
County
Sheriff’s
Office
maintains
a
“24/7”
pharmaceuticals
drop
box
at
its
headquarters
on
Church
Street
in
Prince
Frederick
that
can
be
utilized
at
any
time
with
no
questions
asked.
 County
residents
may
also
dispose
of
unused
pharmaceuticals
through
one
of
the
quarterly
household
hazardous
waste
disposal
events
sponsored
by
the
Calvert
County
Division
of
Solid
Waste.
These
one‐
day
events
give
residents
the
opportunity
to
safely
dispose
of
a
wide
variety
of
hazardous
chemicals
and
substances,
including
unused
medications.
19
Conclusions
and
Questions
 Flushing
medication
down
the
toilet
is
contributing
to
the
pollution
of
our
recreational
and
drinking
water
supply.
 Safer
medication
disposal
techniques
are
available
and
effective
.
 Watch
for
changes
in
your
county
as
take
back
programs
and
waste
management
programs
develop.
 Encourage
your
pharmacy
to
participate
in
efforts
to
reduce
the
unsafe
disposal
of
medications
‐
Flushing
is
not
the
answer
except
for
those
controlled
drugs.
Procedures
and
policies
for
disposal
of
controlled
drugs
are
needed.
‐
Trashbags
with
disposed
of
drugs
go
the
landfill
or
are
incinerated,
so
it
is
not
perfect.
‐
Large
facilities
can
have
the
pharmacies
to
take
back
unused
medication.
‐
Should
we
get
the
drug
manufacturers
to
be
involved
with
disposal
of
drugs?
20