1. Heather Stewart Doctor of Pharmacy Candidate, 2014 Generation Rx Co-Chair, APhA-ASP Stevan Gressitt, M.D. Founding Director, International Institute for Pharmaceutical Safety 2011 International Symposium on Safe Medicine October 4, 2011 1

2.  The content from Heather Stewart does not relate to any product of a commercial interest. Therefore, there are no relevant financial relationships to disclose.  Safe Medicine Disposal for ME was funded by the U.S. Environmental Protection Agency Grant # CH-83336001-0. ▪Lenard Kaye, Principal Investigator and Director ▪Jennifer Crittenden, Program Manager and Research Associate, University of Maine Center on Aging, Bangor, ME ▪Stevan Gressitt, Co-Principal Investigator, and former Medical Director Maine Office of Adult Mental Health Services, Maine Department of Health and Human Services, Augusta, ME 2

3.  To summarize the Maine data collected from the "National Medication Take Back" event on April 30, 2011.  To raise awareness of the growing need for successful medication disposal programs.  To compare and contrast results from the "Safe Medicine Disposal for ME" program and the "National Medication Take Back" event. 3 Data Collected Independent of DEA

4. CountyCounty PopulationLbs Collected Sagadahoc35293766.2 Aroostook718701470.8 Androscoggin1077021503.3 Piscataquis17535180.1 Cumberland2816742537.2 Hancock54418474.9 Kennebec1221511054.6 Lincoln34457261.6 Knox39736297.9 Franklin30768228.1 York1971311427.3 Waldo38786271.7 Penobscot153923938 Washington32856153.6 Oxford57833234.8 Somerset52228119.9 Maine Total Collection: 11920 lbs (Source US DEA Maine Office) 4

5.  Portland ▪55 Participants ▪Logged 797 individual medications ▪Collected 43,278 Units* ▪73.7% Waste  Belfast ▪13 Participants ▪Logged 97 individual medications ▪Collected 3,166 Units* ▪68.5% Waste  Long Term Care Facility ▪3 Participants ▪Logged 75 individual medications ▪Collected 2,761 Units* ▪65.1% Waste * pills, milliliters, patches, or grams 5

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8. * Classification as a controlled substance is defined by the Controlled Substance Act of 1974 8

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10. Therapeutic ClassOriginal AmountReturned AmountWaste (%) Cardiovascular12350934475.7 Hormone & Hormone Replacement4201260161.9 Diuretic2537170367.1 Anticonvulsant1983168484.9 Antibiotic1797148782.7 Antidepressant1692128075.7 Antineoplastic1966114458.2 Anticoagulant1567111671.2 Gastrointestinal106996890.6 NSAID96257259.5 10

11. 11 ** Excludes Barbiturates * Classification as a controlled substance is defined by the Controlled Substance Act of 1974

12. ****** Group 1 includes all others except the top 10 *pills, milliliters, patches, or grams 12 ** Includes hormone replacement

13.  Enabled through state legislation  Public Law 2003, Chapter 679 “An Act to Encourage the Proper Disposal of Unused Pharmaceuticals” ▪Sponsored by Senator Lynn Bromley ▪http://www.maine.gov/legis/opla/drugrpt.pdf  P rototype model (statewide and national replication) for the disposal of unused household medications (controlled and non- controlled)  Anonymous, free way to dispose of unused medications safely and properly  High heat incineration, according to Maine’s law enforcement drug seizures procedure  Utilizes U.S. Postal Service to solve Maine challenges  Maine has a high degree of rurality  Oldest state in the nation ▪Maine median age 42.7 years old versus U.S. 37.2 years old (2010 U.S. Census Bureau) 13

14.  A physician told the patient to stop taking the medication or gave the patient a new prescription. (27.3%)  Medicine belonged to a deceased family member. (19.6%)  The person felt better or no longer needed the medicine. (18%)  The person had a negative reaction or allergy to the medicine. (11.9%) 14

15. 15 Marketing Status of Returned Medication UNKNOWN marketing status was predominantly associated with missing or insufficient data (e.g. no match for drug name).

16. 16 Medication Returns by Federal Controlled Substance Category* *Classification as a controlled substance is defined by the Controlled Substance Act of 1974

17. 17 Estimated Proportion of Waste (Percentage) By Pill Count

18. * Environmental risk refers to the risk of acute toxicity to the aquatic environment. 18

19.  Need for data while ensuring the highest level of security  Justification for policy  Improved pharmacy practice ▪Health care professionals need to collaborate to avoid prescription abuse, misuse, and diversion  Patient Safety ▪Primary Concern  Immediate need for education on all fronts  Pharmacists, prescribers, patients, and government officials  Need to utilize student pharmacists for greatest impact  Need to take affirmative position 19

20. Heather Stewart Doctor of Pharmacy Candidate, 2014 Generation Rx Co-Chair University of New England 716 Stevens Avenue Portland, Maine 04103 hstewart@une.edu Cell: 207-710-7047 20 Stevan Gressitt, M.D. Faculty Associate, University of Maine Center on Aging Academic Member, Athens Institute for Education and Research Athens, Greece Founding Director, International Institute for Pharmaceutical Safety University of New England, College of Pharmacy, Department of Pharmaceutical Sciences Associate Professor of Clinical Psychiatry, University of New England, College of Osteopathic Medicine 716 Stevens Avenue Portland, Maine 04103 gressitt@gmail.com Cell: 207-441-0291 www.benzos.une.edu www.safemeddisposal.com