1. A prescription for a Healthy Planet
This presentation serves to inform consumers of the public-private partnership campaign geared to disposing of your medications in an environmentally friendly manner, and to provide you with the steps you can take to protect the environment, your pets, and loved ones.
A prescription for a Healthy Planet
SMARxT DISPOSALTM public awareness campaign is a unique public-private partnership between the U.S. Fish and Wildlife Service, the American Pharmacists Association, and the Pharmaceutical Research and Manufacturers of America

2. Campaign Goals Raise awareness about proper medication disposal
Encourage consumers not to use the outdated advice of “flush unused medications or pour them down the sink”*
Provide consumers with environmentally friendly alternatives
How much do you know about how medication disposal affects the environment? There are three main goals this campaign desires to get across to consumers. These involve bringing the issue to the public, discouraging medication flushing, and providing guidance on the proper disposal alternatives.
*Unless on the list of medications the FDA advises to be flushed

3. Organizations Involved
American Pharmacists Association (APhA)
Founded in 1852 representing more than 63,000 practicing pharmacists, pharmaceutical scientists, students, technicians and others advancing our profession
U.S. Fish and Wildlife Service (USFWS)
Works with others to conserve, protect, and enhance fish, wildlife, and their habitats for the benefit of Americans
Pharmaceutical Research and Manufacturers of America (PhRMA)
Represents the country’s leading pharmaceutical research and biotechnology companies devoted to inventing medicines to allow patients to live longer, healthier, more productive lives
Three organizations have collaborated for the SMARxTdisposal project. Each has various focuses, but together they have partnered on this program to promote the well-being of our environment. The partners in the program represent complimentary roles, constituencies, and interests.

4. Potential Environmental Issues
Current scientific data shows no short-term effect of pharmaceuticals on aquatic life
The potential for long-term effects is currently being evaluated
The research that exists has had difficulty in proving short term effects of pharmaceuticals on aquatic life. However, long term effects are currently being evaluated and several studies have concluded medications do have effects on aquatic species, especially hormone byproducts of pharmaceuticals.
Improving the environment for fish will improve the environment for people as well.
Isabelle Robinson & Guillaume Junqua & Raymond Van Coillie & Olivier Thomas. Trends in the detection of pharmaceutical products, and their impact and mitigation in water and wastewater in North America Anal Bioanal Chem (2007) 387:1143–1151

5. Recent Water News
Officials in Philadelphia said testing there discovered 17 pharmaceuticals or byproducts in treated drinking water, including medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness and heart problems. Thirty-two pharmaceuticals or byproducts were found in the city's watersheds.
The drinking water for Washington, D.C., and surrounding areas tested positive for 6 pharmaceuticals.
Most products found in water are byproducts from human metabolism of the medications. This means that the majority of the medication byproducts found in drinking water come from what people excrete from their bodies and not dumping of unused medications. More advanced water filtration systems are being explored. People wishing to make their contribution to protecting the environment and community can ensure that unused medications are disposed of properly. As you can see, a variety of medications have been found in various city’s drinking waters, but as we will discuss in the next slide, no human impacts have been found.
From: Drugs in Tap Water.

6. Recent Water News
It is unlikely for any of these amounts of products to have an effect on humans
Study from 20 water treatment facilities showed medications in the parts-per-trillion range; too small to have human effects
One part per trillion is equal to 1 second in 32,000 years or 1 penny for 10 billion dollars.
Do all of these findings affect humans? Most studies show that is doubtful at this point, since the medications found are in the parts-per-trillion range. It has been said that the equivalent of 3 Olympic sized pools would be needed to have enough chemical to make one tablet.
Halford, Bethany. Side Effects. Chemical and Engineering News. 86;8: 13-17(Feb 2008)

7. Pharmaceuticals in the Water
Even though the USE of medications is the primary pathway for pharmaceuticals to reach the environment (excreted from human body), it remains essential for consumers to know how to dispose of their unused medications.
Again, it is important to reiterate that most of the byproducts of medications found in water are due to the use of medications; something we currently cannot change. However, if left unchecked, the effect of the unused waste of pharmaceuticals will complicate environment issues further.

8. Schematic Demonstrating how Medications Leaked into Environment
Various methods exist that allow contaminants to reach water supply, but it is important to point out the impact from residential homes
Not flushing will prevent part of the waste from residential areas

9. Pharmacists’ Role
Medications play a vital role in our health care system
It is important that all medications are taken as directed.
Pharmacists have the most direct contact with consumers concerning medications.
Pharmacists’ play an important role in
SMARxT Disposal TM:
Inform consumers of environmentally friendly disposal technique
Inform consumers of medications for which Food and Drug Administration (FDA) advises flushing
Because medications play such a vital role in our society, consumers need to be educated concerning their appropriate disposal and the effect inappropriate disposal may have on the environment. Pharmacists are available to help you. Do not hesitate to ask a pharmacist storage or disposal instructions of medications.

10. “Do not flush, place in trash”
Consumers who do not use all of their over the counter and prescribed medications should take the following steps…

11. Procedure for Disposal of Medications
DO NOT FLUSH unused medications*
DO NOT POUR them down a sink or drain*
Dispose of Unused Medication in Household Trash
*except for FDA identified exceptions
Heading straight to the toilet or sink is not the correct method to dispose of your medications. Your household trash is a much more environmentally friendly alternative. However, don’t just throw medications without altering them into the trash; pets and children are in danger if they come into contact with any unused medication, as well as the environment.

12. Protect children, pets, and the environment by…
Pour medication into
sealable plastic bag.
Now, when you are disposing of unused medications because they have expired, you started a new medication, etc. please follow these simple steps.
If medication is a solid, add water to dissolve.

13. Protect children, pets, and the environment by…
Adding kitty litter, sawdust, coffee grounds (anything to make medication less appealing to eat) to the plastic bag.

14. Protect children, pets, and the environment by…
Sealing the plastic bag completely and disposing in the trash.

15. Protect children, pets, and the environment by…
Removing and destroying ALL personal identification information (i.e., prescription label )from the medication container
Destroy personal information
Recycle plastic container

16. Procedure for Disposal of Medications
Check for approved state and local collection programs
Certain pharmacies may take unused medications and dispose of them for consumers.
Consult your pharmacist with any questions
Your pharmacist will be a great resource for these questions.

17. The FDA advises that the following medicines be flushed:
Actiq (fentanyl citrate)
Daytrana Transdermal Patch (methylphenidate)
Duragesic Transdermal System (fentanyl)
OxyContin Tablets (oxycodone)
Avinza Capsules (morphine sulfate)
Baraclude Tablets (entecavir)
Reyataz Capsules (atazanavir sulfate)
Zerit for Oral Solution (stavudine)
Meperidine HCl Tablets
Percocet (Oxycodone and Acetaminophen)
Xyrem (Sodium Oxybate)
Fentora (fentanyl buccal tablet)
The Food and Drug Administration (FDA) has identified these medications as products to be flushed and not thrown into trash or crushed due to their potential for abuse.
All other medications (prescription and non-prescription) can be disposed of according to the procedure previously outlined . Please make sure that powder generated from crushing stays in the plastic bag and is not inhaled during the crushing process.
*Each medication label advises flushing due to abuse potential

18. Proper Disposal of Unused Medicine Could Decrease Abuse
Young people ages abuse prescription drugs more than all other illicit drugs except marijuana
Majority of teens get these drugs easily or for free from friends or relatives
Teens are abusing prescription drugs because they believe they will receive a “safe high” and they are easily available
More than three in five teens say prescription pain relievers are easy to get from parents’ medicine cabinets
APhA is working with, PhRMA, the White House Office of National Drug Control Policy, and other partners on decreasing teenage prescription drug abuse. The numbers that abuse prescription drugs are alarmingly high, and teenagers state they easily get these from their relatives and friends. Unfortunately, they believe these medications are safe compared to illicit drugs, which is why they choose to abuse them. Prescription pain killers are second—only behind marijuana—as the Nation's most prevalent illegal drug problem.
Teens can ‘steal’ them from you and you may not realize how easy it is for them to get your prescription medications (called teen “pharming”).
Source: APhA and PhRMA are co-partners in this program.

19. Drug Use Among Teens
This graph shows that prescription pain relievers are abused just as much as marijuana. Consider how much easier it is to obtain these medications if they are left unused around the house. It is important to point out the ages for this graph are 12 and older, which are children who likely live and spend a lot of time in the house.
Available from:

20. Secure your medicines and dispose of unused medications properly
Prescription pain killers
Anti-anxiety medications
Medications for sleep
You play a big role in keeping these powerful medicines out of the hands of those who shouldn’t have them
Does anyone in your home have these prescription drugs? If so, lock them up and dispose of them properly when no longer needed.
Store medications where children cannot see or reach them—for example, in a locked box or cabinet. Teach children that medications can be dangerous if misused.

21. What to DO… AT HOME Keep medications in original containers
Never take someone else’s medication
Read the label every time you take a dose
Keep a current list of your medications
Store medication in a safe location
Dispose of unused medications properly
READ THE LABEL AND FOLLOW DIRECTIONS
Read the label each time you buy an OTC medicine or fill your prescription and don’t share medication
Using too much of any active ingredient may increase your chance of unwanted side effects.
It helps to give a written list of all your medicines and treatments to all your doctors, pharmacists and other team members. Keep a copy of the list for yourself and give a copy to a loved one. Include any allergies on your list.

22. Resources-Website www.smarxtdisposal.net
There are resources available regarding the SMARxT Disposal Campaign that can be found at This site contains the following resources and is being updated with other information:

23. Additional Resources Fact Sheet Bookmark Magnet
This is a fact sheet found on the website with a quick overview of the program for consumers and all health care providers.
Magnet

24. Together we can achieve a Healthy Planet
Questions?