Transcript Slide 1

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Secure Medicine Return:
PH:ARM Pilot in Washington State
Shirley Reitz, Pharm.D., BCPS
Associate Director, Pharmacy Clinical Services
Group Health Cooperative
Seattle, WA
206-901-4334
[email protected]
November 2008
Patient Demand
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• 2006 WCRC survey of 400 King County households revealed
– 39% have 10 or more medicine containers in their homes
– Only 33% report that they are currently using or plan to use these
meds
– 74% stated they would be willing to dispose of the meds in a
convenient location
• “We are cleaning out my Grandfather’s house and I have a
suitcase full of drugs that we need to get rid of. Can we bring them
into your disposal site?”
• “Our neighborhood association (over 400 homes) would like to
provide some education to the families in our neighborhood about
drugs in their homes – can we tell them to bring their meds to you
for disposal?”
• “Please dispose of this medication.
Enclosed is a donation….”
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Pharmaceuticals in Landfills
Leachate
pumped to sewer
treatment plants
possible escape
to groundwater
studies find drugs
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PH:ARM Team
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Pharmaceuticals from Households: A Return Mechanism
•HEALTH CARE PROVIDERS
– Group Health
Cooperative
•BUSINESSES
– Bartell Drugs
– Boarding/assisted living homes
•NON-PROFIT AGENCIES
•STATE & LOCAL GOVERNMENT
– King County Dept. of Natural
Resources & Parks
– Local Hazardous Waste
Management Program in King
County
– Public Health - Seattle and King
County
– Snohomish County Solid Waste
Management Division
– WA Department of Ecology
– Interagency Resource for
Achieving Cooperation (IRAC)
– Northwest Product Stewardship
•ADVISORS
Council
– WA State Board of Pharmacy
– Pacific NW Pollution Prevention
– WA State Dept. of Social and Health
Resource Center (PPRC)
Services - Aging and Disability
– WA Citizens for Resource
Services Administration
Conservation (WCRC)
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Group Health’s Goal
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• Work with community partners to develop a
medication disposal system that is:
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–
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Secure
Affordable
Reproducible
Sustainable
Meets all regulatory requirements
Easy for our patients to use
• Remove from the home medications posing risk
of unintentional poisoning, overdose, or abuse
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Group Health Pilot Bin Signs
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Group Health Pilot
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Pilot Project
• 25 Group Health clinic pharmacies statewide
•12 Bartell Drugstores around Puget Sound
• 3 boarding /assisted living homes in Seattle
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Group Health’s Experience
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Group Health Collected Meds
Percent by Weight
1,238 pounds total
16,460 drug containers
Over 14,000 lbs
of unwanted
medications
collected and
incinerated from
GHC locations
over 2 year pilot
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Interesting Findings
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Snapshots of collected materials
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14 Doses
of Enbrel
$5,600
Migranal Nasal
Spray
$120
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What we’ve learned:
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• Security is Critical!
– Secure drop boxes
– Complete tracking of
secure containers
– DEA utilization
• Staff Satisfaction
– “Makes my job easier”
• Regulatory issues
remain
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Next Steps
• Cost Considerations
– Need affordable solutions
– Pilot ending this year
– Looking for interim
Manufacturer funding
• Pilot project final report
– Report expected Jan ’09
– www.medicinereturn.com
• Legislative efforts in
2009
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Secure Medicine Return Legislation:
A Producer Responsibility Approach
Cheri Grasso
Local Hazardous Waste Management Program
in King County
[email protected]
206-263-3089
November 2008
Next Steps
• Regulatory Change
• Moving Beyond Grants
• Washington State Producer Responsibility
Legislation
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Regulatory Change
• Department of Transportation
– Medicines must be in original package
• Requires sorting
• Loose pills shipped in smaller container
• Limits weight of container
• Product Stewardship Institute
– Dialogue on regulations Dec 2 - 3
– www.productstewardship.us
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Beyond Grants
• PH:ARM successful in obtaining grants
• Search for Sustainable Funding
– Local Governments cannot pay for statewide
– Pharmacies have very small profit margin
– Producers most logical choice
• Voluntary approach?
– Creates unfair level for producers
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Secure Medicine Return Bill
• Producer paid statewide
medicine return program
• Passed out of
Environmental Health
Committee
• Unanimous, bi-partisan vote
• Big bill, short session
• Set stage for success in ‘09
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2008 Endorsers
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Business
Governments
Bartell Drugs
Group Health
Washington Food Industry
WA State Pharmacy
Association
Coalition for Clean Water
Civic & Environmental
Organizations
Children’s Alliance
Environment Washington
League of Women Voters of
WA
People for Puget Sound
Senior Citizens’ Lobby
Sierra Club Cascade Chapter
WA Citizens for Resource
Conservation
WA Organic Recycling
Council
WashPIRG
King County
Local Hazardous Waste Mgmt
Program in King County
Thurston County
WA Association of Sheriffs and Police
Chiefs
Yakima County
Health Organizations
Assoc of Advanced Practice
Psychiatric Nurses
Breast Cancer Fund
School Nurse Organization of WA
WA State Assoc of Occupational
Health Nurses
WA State Hospice and Palliative Care
Org.
WA State Nurses Assoc.
Policy:
Medicine Return Legislation
• Drug producers design & pay for program
– In every county statewide
– In all cities with populations > 10,000
• Covers
– Over-the-counter drugs
– Prescription drugs (including controlled substances)
• From
– Households
– Residential sources (hospice services,
nursing homes, schools, etc.)
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Medicine Return Legislation:
What does the program look like?
• Producers determine how best to securely and
conveniently collect the medicines
– Mail back
– Pharmacy
– Hybrid
– Other????
• If they choose a pharmacy model
– Pharmacies participate voluntarily
– Expect many pharmacies to do so
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Medicine Return Legislation:
• Hazardous Waste
Disposal
• Alternative Technology
• Outreach
• Board of Pharmacy
– Oversight
– Enforcement
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Medicine Return Legislation:
Shared Responsibility
Pharmaceutical brand owners
pay for program
Pharmacies give out information
on take back and may provide
take-back locations
Consumers return their
unwanted medications to
takeback location
Government provides oversight
and education
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Next Steps
• Seeking endorsements
• Talking with legislators
• Talking with pharmaceutical
manufacturers
• Successful passage in ’09!
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