Transcript Document

Unused Medications
Where are we now?
Prepared for: U.S. Drug Enforcement Administration
By: Dr. Jeanie Jaramillo and Dr. Stevan Gressitt
July 19, 2011
Disclosures
• Poison Center Incentive Grant funded by
HRSA
• No other potential conflicts of interest
Context
Acknowledgement
This presentation includes information
collected and compiled by the
Pharmaceutical Collection Monitoring Group
through use of the
Pharmaceutical Collection
Monitoring System™
Purpose for Visit
• There’s an elephant in the room
– Not that unused medications are a problem
• Now common knowledge:
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Meds as a source of poisonings
Source of abuse (and diversion)
Source of misuse
Source of environmental contamination
• Finding a solution
– Band aid approach is no longer enough
• Take back events are a band aid approach
Root Cause Analysis is Needed
1.
2.
3.
4.
Define the problem factually
Gather data and evidence
Ask “why” and identify causes
Identify corrective actions that will prevent
recurrence
5. Implement actions
6. Observe effect
Purpose for Visit
• We’ve hit a brick wall at step #2 (gather data
and evidence)
• We need the help of the DEA
• Outline
– Discuss successful collection events
– Data utility
– Share results
– Request support
Data Collection
• Numerous take backs across country
• Several high-quality data sets
– Gressitt
– Mireles
– Gottlieb
– Jaramillo
• All data sets collected different data points
– No consistency
– Merging of data difficult if not impossible
Pharmaceutical Collection
Monitoring System™ (PCMS)
• Web-based recording and reporting tool
• Provides for collection of consistent data
across multiple sites
• Accessible by users anywhere that internet
service is available
A Case Report: Car #188
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Amarillo, Texas
Population: ~180,000
Community Medication Take Back Event
Drive through
Collaborative effort with Amarillo Police
Department
Car #188
Car #188
• 2 large boxes
• Medications from deceased parents and
cat
• Speculatively parents both suffered from
chronic, terminal diseases
• Reporting today only the controlled
substances from this vehicle
Controlled Substances from Car #188
Drug Name
Strength # Containers
Qty
Collected
AWP
Low-High End
Street Value
diazepam
hydrocodone/
APAP
5 mg
18
2,320
$167
$2,320 - $46,400
10/325 mg
4
520
$363
$1,040 - $10,400
Lorcet®
5/500 mg
2
2
$3
$6 - $18
Lyrica®
75 mg
6
84
$227
$420 - $1,680
morphine sulfate
30 mg
61
10,080
$5,352
$80,640 - $302,400
MS Contin®
30 mg
3
6
$17
$90 - $300
oxycodone/APAP 5/500 mg
15
802
$95
$802 - $4,010
temazepam
2
180
$32
$180 - $3,600
111
13,994
$6,256
$85,498 - $368,808
30 mg
Values obtained from NDIC reports. Indicate estimates.
Car #188
• Rare occurrence or more common than we
think?
• No data
• Of what use would the data be? Would it
really help anything?
What data do we have?
April 30th DEA Take Back Day
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Eight organizations
11 sites
Conducted events and logged data
Goal: data from at least first 50 participants
Result: data from items of 411 participants
was collected
• 3,800 line items logged
April 30th DEA Take Back Day
Percentage Collected by Classification - All Sites
Combined
6%
Controlled Substances
33%
Non-Controlled Substances
Over-the-counters
60%
Unknown/unidentified
Most Commonly Collected Controls
Acetaminophen with hydrocodone
22.7%
Acetaminophen with propoxyphene
21.3%
Benzodiazepines
11.3%
By Schedule
See handout report
• C II
• C III
• C IV
• CV
Medication Utilization/ Wastage
• Controlled substances collected/documented
– On average, 67% of dispensed controls were
brought to take back events for disposal
– 67% = wasted
60%
• Overprescribed?
• Over-marketed?
20%
10%
18%
Percentages indicate what event participants would do with meds if event was unavailable.
*total >100% as
some participants
selected >1 answer
Why come to the DEA
• Data has utility; greatly needed
• Lost participation of sites due to lack of DEA
support
• Current directives
– No questions
– No counts
– No handling of meds
Why come to the DEA?
• Need DEA to be part of the solution
– Funding?
– Letter of support?
– Letter of understanding?
DEA
PCMS
Academia
Local Law
Enforcement.
Community
Partners.
Contact Information
Jeanie Jaramillo
[email protected]
(806) 354-1611
Stevan Gressitt
[email protected]
(207)441-0291