1. Mission for Meds Improvement in Pharmaceutical Waste Management at the
US Army Community of Caserme Ederle in Vicenza, Italy
Presented by Edith Lang
for Walden University
I am Edith Lang, RN, graduate student in the Walden University Public Health program and the Patient Safety Officer for the US Army Health Center, Vicenza. This initiative is for dual purpose, to impact the environment and to impact patient safety.

2. Mission for Meds OBJECTIVES
Increase the knowledge of adult Caserme Ederle community members regarding the risks of accumulation of medications in the personal environment.
Discuss appropriate reasons for medication waste management in conjunction with current pharmacy take-back program.
Increase the return rate of unused medications to the US Army Health Center, Vicenza pharmacy for proper disposal.
Mission for Meds objectives are 1. increasing your personal knowledge, 2. waste management and pharmacy take-back, and 3. making both of these things happen.
So, what are medications?

3. What is a Medication? (Meds)
Medications include:
any prescription drug (Army or Host Nation)
store bought or over-the-counter drug
herbal supplement
diet supplements including body building agents
Vitamins
medications for pets should also be considered
It is important to note that any of these substances should be left in their original containers in order to identify the contents for the user or other household members.
Original containers will include any prescribing information on how to take the medication, as well as, dosing and warning labels. Expiration dates are also required on most packages in these category of medications.

4. History of Risks 51% of Worldwide Sales to the US
Residuals of medications found in the environment
Direct disposal (sewage or trash)
Bodily waste
Water treatment systems
Not all can be removed
Federal Policies
The US Geological Survey reports the presents of one or more personal care product or medication chemical in 80% of the 139 streams of 30 states sampled between 1999 to 2000 (Buxton & Kolpin, 2002).
Estimates from 2002 note that 51% of the worlds pharmaceutical sales were in the United States and Canada (Xia, Bhandari, Das & Pillar, 2005).
Why does this matter? Where do these meds go?
Some people throw meds into the trash or flush them way in the toilet or sink. Medications found in the trash by children or foraging animals may be ingested and harm the individual.
Medications and byproducts are excreted into the waste system and if meds are flushed into the system in addition to this, waste treatment systems may not have the capability to filter all the chemicals from entering our drinking water system (Snyder, Westerhoff, Yoon, & Sedlak, 2003).
The human or animal effects of such chemicals into the water system is not yet fully known; But we can do our part to assure personal medications are wasted in the most appropriate channels.
Federal Policies which are supported by the Department of Defense include:
DEA classifies controlled substances into five categories (schedules I through V)
􀂙Schedule I drugs have a high potential for abuse, other schedules have less potential
For more information: DEA’swebsite, CFR, Section 1308 –Schedules of Controlled Substances at
EPA – manufacuring, monitoring, and guidance
ChemAlliance . Org – give information to the following programs
Toxic Substances Control Act (TSCA)
Chemical Facility Anti-Terrorism Standards (CFATS)
Environmental Management System (EMS)
Leak Detection and Repair (LDAR)
Pollution Prevention Act (PPA)
Clean Water Act (CWA)
Federal Insecticide, Fungicide and Rodenticide Act (FIFRA)
Resource Conservation and Recovery Act (RCRA)

5. What is the Risk?
Risks of accumulation of such products in your home include:
Accidental ingestion by children or pets
Expired products may have alternative effects or ineffective results when used
Disposal into the water sources through the sink or toilet
Disposal into regular waste receptacles
Accidental overdoses and poisonings are a risk for older adults, children, teenagers, and pets (Seebusen & Edwards, 2006).
Multiple doses of the same medication can be confusing and patients have been known to take exponential doses of a medication in error.
Excess drugs are also tempting for illegal use through theft (Ruhoy & Daughton, 2007).
The disposal of medications into the water sources has been identified as an environmental risk due to residual elements which lead to exposure of humans, animals, and plant life (EPA, 2008).
Medications which are tossed into receptacles for waste are likely to expose animals which forage or children at play (Daughton, 2003).

6. Cycle of Exposure
High use of Meds in North America
Medications in the Home
Waste in Trash
Exposure to humans and animals
Waste in Sewage
Environmental and life form exposure
Disposal to Pharmacy
Regulated management
Here is a diagram of the exposures to the environment through disposal.
Proper disposal to the Department of Defense Pharmacy can divert accidental overdose in the home, adverse reactions to expired medications, exposure to the community in the trash or water system.

7. Hazardous Waste Collection & Federal Programs
The US Army Health Center in Vicenza is supported by the Department of Defense to assist in safe and fiscal management of unused pharmaceuticals. This program is managed by the US Army Materiel Management Center in Europe. Once meds are collected from the pharmacy location, they are placed in the proper receptacle and brought here until removed for incineration.
The EPA promotes a guaranteed return program for addressing reverse medication distribution and regulatory environmental issues (EPA, 2008).

8. Mission for Meds: Do the Right Thing
USAMMCE:
United States Army Materiel Management Center, Europe
Since 1995
Goals
No Charge
Benefits
The program supported by USAMMCE has been in place since 1995.
One of the goals for this program is to earn credit by returning medications which have expired. Our suppliers have agreements with the government in this case and money can be saved by earning credit through this program.
The USAMMCE does not charge to support this service.
Other benefits include environmental management and proper handling of medications in our personal possession.
(US Army Materiel Management Center, Europe, 2009)

9. What should I do? Assess your home for: Take-’em-Back
Unused medications
Expired medications
Unwanted medications
Take-’em-Back
Keep medications in their original container
TAKE any unused, expired, or unwanted medication BACK to the Pharmacy at the US Army Health Center, Vicenza.
Unused medication which you will no longer need or have an excess supply of including wrong dose of current prescriptions.
Expired medications – if no date is present, then bring to pharmacy for assessment.
Unwanted medications – drugs that you are not taking but you were prescribed. This is important to communicate to your provider because other treatment options may be available to you if you do not want to take a medication.
Labels may become illegible which can lead to dosing errors.
Always secure your medication in a place which is out of reach to children and animals.

10. US Army Health Center, Vicenza – bldg 113

11. Take-Back Pharmacy
The pharmacy on Caserme Ederle is located in the health center building 113
Hours of operation are from 0800 to 1700 Monday through Friday
Saturday from 0900 to 1300 hrs

12. Hours of Operation
Although the doors are locked at 1630, if you are in the building – the pharmacy is available until 1700.

13. Other assistance regarding medication safety
Also consider contacting (DSN numbers)
Army Community Service (ACS)
Family Advocacy Program (FAP)
Community Health Nurse
Child and Youth Services (CYS)
Patient Safety Officer
Your medical provider

14. References
Buxton, T., & Kolpin, D. (2002, June). USGS Fact Sheet FS : Pharmaceuticals, Hormones, and Other Organic Wastewater Contaminants in U.S. Streams. Retrieved April 14, 2009, from
Daughton, Christian G. (2003, May). Cradle-to-cradle stewardship of drugs for minimizing their environmental disposition while promoting human health. II. Drug disposal, waste reduction, and future directions. Environmental Health Perspectives, 111(5). Retrieved April 1, 2009, from
EPA. (2009). Pharmaceuticals and personal care products in water. Retrieved April 13, 2009, from
EPA. (2008, February). Drug disposal: ramifications for the environment and human health. Retrieved April 13, 2009, from
Still working on notes to the slides. Potential references included.

15. References Continued
Mackridge, A., & Marriott, J. (2007). Returned medicines: waste or a wasted opportunity? Journal of Public Health, 29(3), Retrieved April 1, 2009, from Ruhoy, I., & Daughton, C. (2007). Types and quantities of leftover drugs entering the environment via disposal to sewage - revealed by coroner records. Science of the Total Environment, 388(1-3), Retrieved April 13, 2009, from Seebusen, D., & Edwards, J. (2006). Patient practices and beliefs concerning disposal of medications. Journal of the American Board of Family Medicine, 19(6), ). Retrieved April 1, 2009, from Snyder, S., Westerhoff, P., Yoon, Y., & Sedlak, D. (2003). Pharmaceuticals, personal care products, and endocrine disruptors in water: implications for the water industry. Environmental Engineering Science, 20(5), Retrieved April 14, 2009, from US Army Materiel Management Center, Europe,. (2009). Drug returns program. Secured website reviewed on April 20, Xia, K., Bhandari, A., Das, K., & Pillar, G. (2005). Occurrence and fate of pharmaceuticals and personal care products (PPCPs) in biosolids. Journal of Environmental Quality, 34, Retrieved April 14, 2009, from

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