Transcript MEDICATION TAKE-BACK PILOT PROJECT

COLORADO DEPARTMENT OF PUBLIC
HEALTH AND ENVIRONMENT
Uniting Public Health Conference
October 2, 2009
A SECURE, CONVENIENT AND
ENVIRONMENTALLY SOUND
OPTION FOR THE DISPOSAL OF
UNUSED AND UNWANTED
HOUSEHOLD MEDICATIONS
With the Environment…
“How an aging population and our growing
addiction to pharmaceuticals may be
poisoning our rivers” NRDC – Fall 2006
“Fish sex change investigated - CU group
establishes treatment plant effluent as
culprit” Boulder Daily Camera – Dec. 2006
“Pharmaceuticals found in drinking water,
affecting wildlife and maybe humans”
AP – March 2008
“Man-made chemicals found in drinking
water at low levels” USGS – December 2008
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WHAT ARE THESE CONTAMINANTS?
• Broad range of compounds including
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Pesticides
Flame Retardants
Teflon® and Gortex®-Related Materials
Surfactants
Nanomaterials
Prions
Personal Care Products
Pharmaceuticals
The ability to detect is advancing faster than the
understanding of potential effects
However, we do know that many contaminants:
• Exhibit toxic characteristics
• May cause microbial antibiotic resistance
• Act as endocrine disruptors
• Sexual anomalies in fish have been observed
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Degrade into metabolites with potential effects
Can persist in the environment
• With varying degrees of mobility
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Where to Go for More Information
• USEPA PPCP’s in Water Home Page
http://www.epa.gov/waterscience/ppcp/
• USGS Emerging Contaminants in the Environment
http://toxics.usgs.gov/regional/emc/
• Consortium for Research and Education on
Emerging Contaminants (CREEC)
http://co.water.usgs.gov/CREEC/
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They are everywhere in modern society
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They are designed to have a biological effect
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They may be resistant to some forms of
degradation to retain their activity over time
Significant portions pass through the user
unchanged or as biologically active metabolites
They may be resistant to degradation or removal
through conventional water and wastewater
treatment techniques
Stoner, et al NYSDEC
With Drug Abuse…
“In 2008 three times as many people in
Colorado died from prescription drug abuse
(562) than from drunk-driving related
crashes” CDPHE, Health Statistics - 2009
“Nationally1 in 5 teens (19%) report abusing
prescription drugs that were not prescribed to
them” Partnership for a Drug Free America –
2005-2006
“With kids availability and ease of use are two
key factors when kids are using drugs”
Boston Globe – January 2006
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Challenges
• Majority of pharmaceuticals and their metabolites
found in the environment are excreted by humans
and animals
• Most pharmaceuticals do not have water quality
standards and are not routinely monitored
• Environmental assessments of new drugs may not
reveal chronic effects of low concentrations
• Alternative products or dosage reduction may not
be viable options in treatment of health conditions
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What Can We Do Now?
• Reduce those that enter the environment through
disposal to landfills and drains
• Pick the “low-hanging fruit” and engage the public
• Immediate pollution reduction
• Education and awareness
• “Chemical Footprint”
• Purchasing decisions
• Support of further actions:
• Product stewardship
• Product packaging
• Prescription dosages
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Available Medication Take-Back Strategies
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Take-Back Events
Pharmacy Store/Health Agency Collection Points
Police Station-Based Collection Points
Mail-In Programs
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King County, WA Survey Results
What Locations are Convenient?
If Convenient, Would You Use It?
PH:ARM Team
Washington State
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Important Considerations
• Controlled Substances Act
• DEA must approve collection of controlled substances
• Controlled substances must be “in control” of law
enforcement at all times through disposal
• Disposal Methods
• Controlled substances
• Limited to incineration with police evidence (contraband)
• Uncontrolled substances
• Hazardous waste incinerator affords greatest
environmental protection
• Project Design Components
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Convenience
Security
Controlled Substances Act Compliance
Environmental Protection
Contractor Qualifications
Partnerships
Promotion
Costs
Funding
Outcomes
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Chosen Collection Method for Pilot Project
• Pharmacy Store and Local Health Agency Medication
Collection Bins
• Convenient
• Secure
• Cost-Effective
• No controlled substances accepted
• No need to sort medications
• No law enforcement or pharmacist interaction
• Measureable Success
• Pounds of medication collected
• User and host surveys
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Secure collection boxes installed in:
• King Soopers/City Market
• 5 Front Range locations
• 2 Summit County locations*
• Tri-County Health Department
• Commerce City
• Englewood
• Denver Health Services
• Denver General Hospital
*tentative
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Collection boxes constructed with:
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Signage indicating “non-controlled medications”
Attached list of prohibited controlled substances
Heavy-gauge steel
Floor or wall bolts
One-way repository
Double-lock mechanism
Lighted view port
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Collection
• Bin unlocked by location representative and
contractor at same time
• Bag pulled from box without examination
• Contents immediately shredded in transport truck
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Disposal
• Hazardous waste incinerator
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What About Controlled Substances?
• Most difficult aspect of medication take-back event
or project planning
• Drug Enforcement Administration is considering public
comments on disposal options
• In the interim, guidance must be available directing
public to:
• Seek out local collection events that accept them, or
• Properly dispose of them in the trash if no alternative can
be found
USFWS, APA, PhRMA
www.smarxtdisposal.net
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Contractor Qualifications
• Employee screening program
• Registered hazardous waste transporter
• Commercial drivers licensing with hazardous
materials endorsements
• Colorado hazardous waste transfer facility
• Staffed call center to accept after-hours service
requests
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And the Contractor is…….
• Curbside Inc.
• Meets all project requirements
• Extensive household hazardous waste experience
• Similar project experience
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Garden Grove, CA
Laguna Woods, CA
Buena Park, CA
Costa Mesa, CA
Orange, CA
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Project Partners
King Soopers
Tri-County Health Department
Pollution Prevention Advisory Board (PPAB)
Peer Assistance Services
Pharmaceutical Research and Manufacturers of
America (PhRMA)
• Colorado Pharmacists Society
• Various cities, counties and utilities
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Promotion
• Avoid “over selling” a small-scale pilot project
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Press Release
Web Page
Talking Points
Posters
Fact Sheets
Partner Web Links
Partner Contact List
Coordinated Location Host Advertising
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Costs
• Collection Boxes
• ~ $1,700 per site for two year period
• Collection and Transport
• ~ $2,000 per site for two year period
• Disposal
• ~ $4,100 per site for two year period
• Total Two-Year Cost Per Site
• ~ $7,800
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Funding
• USEPA – Region 8
• Funding leases for 10 collection boxes
• CDPHE Internal Funds
• $15,000
• Supplemental Environmental Project (SEP) Dollars
• Pollution Prevention Advisory Board
• $12,000 pollution prevention grant
• Denver Water Contribution for Denver Locations
• Funding for collection, transport and disposal costs
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Outcomes
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Frequency of collection
Pounds of medications collected
Customer survey results
Host location survey results
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What Results Might We Expect?
• Similar Pilot Project – State of Washington
Two-year duration (October 2006 – October 2008)
Gradual expansion to 25 locations
Minimal advertising and promotion
More than 15,000 pounds collected of non-controlled
substances collected
• Estimated that state-wide program, if manufacturer
funded, would add $0.01 to $0.02 to cost of each
medication
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PH:ARM Team
Washington State
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Future Direction
• State-wide program?
• Pilot will provide data for evaluation
• Legislation may be necessary to secure funding
sources
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Washington – Pending
• Manufacturers must develop approved programs for
collection, transport and disposal
• Manufacturers responsible for program costs
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Maine - Pending
• Mail-in program
• Manufacturers responsible for program costs
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California – 2007
• Requires development and implementation of
model programs – Report to legislature Dec. 2010
Long-term care facilities are
flushing pharmaceutical wastes to sewer
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Shredding pharmaceutical waste which goes to
a landfill
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Nursing Homes
• 20-bed nursing home
• Up to 20 gallons per month of waste medications
• ~ 220 nursing homes in Colorado
• Estimated 4,400 gallons per month
• Flushed, trashed or improperly disposed
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Waste from nursing homes
(estimate 4,400 gallons per month)
+ Over 500 assisted living facilities
+ Elder home health care
+ others
= Total rough estimate ~16,000 gallons of
waste medication per month in Colorado
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Household Pharmaceutical Wastes
• Implement Medication Take-Back Pilot Project
• Monitor programs and legislation in other states
• Provide advice to local take-back event planners
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Long-Term Care and Medical Facility Wastes
• Identify opportunities for solid waste program
integration, training and guidance
• Monitor activities in other states
• Develop partnerships
• Gather data
• Pursue funding
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Contacts
• Greg Fabisiak
• Project Manager
• 303-692-2903
• Kathryn Stewart
• Generators Assistance Program
• 303-692-3415