1. Dr. Amy Tiemeier, Pharm.D., BCPS St. Louis College of Pharmacy Regional eXcess MEdication Disposal Service Partnership

4. St. Louis: Missouri & Mississippi Rivers converge MO and IL 5 counties

6. Objectives:  Identify 25 regional supermarkets that will serve as collection centers.  Establish an environment friendly methodology to dispose of unwanted medications.  Plan and present a major regional workshop for seniors through our senior services partners.  Provide educational programs to 10-20 regional schools on drug safety, etc.  Conduct relevant research on the topic. Such as: o Demographics of patrons o What types of medications are being turned in o Previous disposal methods Measurement Methodology:  Surveys at point of collection  Data collected at point of collection  Feedback from involved parties  Attendance at Regional Senior Workshop(s)  Pre/post senior survey on knowledge gained  # of school programs conducted  # of students in the programs  Pre/post student survey on knowledge gained Outcomes: Immediate  Public awareness of an issue that affects the region but until now has not been addressed on a major scale. Intermediate  Removal of medications that harm the environment and pose a health hazard. Long Term  An attitudinal change of the general public that currently accepted and promoted means of medication disposal are not correct.  A shift in the advertising by major pharmaceutical companies towards an improved disposal method for unused medications.

8. Publications have had a circulation of 704,300 in metropolitian area. – Belleville News Democrat – Schnucks Advertising Circulars – Metropolitan Sewer District Bill Inserts Community outreach activities of the partners included over 20 community based programs that contacted an additional 2,136 area residents. – Mideast Area Agency on Aging (MEAAA) – OASIS – AARP School based programs were offered in 15 different class settings and reached 387 students and 15 teachers.

9. Educating at AARP Health Fair

11. Area Resources for Community and Human Services (ARCHS) Area Resources for Community and Human Services (ARCHS) Schnuck Markets, Inc. Cintas Corporation St. Louis College of Pharmacy Missouri AARP Mid-East Area Agency on Aging St. Louis OASIS Senior Services Plus

12. WK Health Stericycle St. Louis City Agency on Aging Metropolitan Sewer District STL County Waste Management Program MO Environmental Water Association Living Lands and Waters American Water Company PhRMA Saint Louis University

14. 6 months of planning set-up: Controls, policies and procedures, marketing, scheduling 12 months of take-back programs: provide the service and educate the public Determine feasibility of on-going take-back programs Phase 1 Phase 2 Phase 3

15. √ US EPA √ US EPA Human Subjects Review & St. Louis University IRB Board √ Hazardous Materials Information Center (US Dept of Transportation) √ MO Bureau of Narcotics and Dangerous Drugs (BNDD) √ US DEA, MO & IL √ MO Board of Pharmacy √ MO and IL EPA

16. EPA and federal DEA approved plan of separate bins, multiple person check off, and officer picks up immediately following the drop off period. – Specifically for this grant MO State BNDD would not agree Therefore, we did not accept control medications

17. 20 locations, 3 hour drop off time once a month Document controls but do not accept Accept non-controlled unwanted medications Inform patrons what to do with non-returnable materials Only collect medications during collection times

18. Greeter Tech Student Extern Pharmacist Show location Manage flow Market Ready materials Assist with workflow Document Determine drug Discuss drug related problems Check drug documentation Feedback Liability/reliability of information

19. Greet and explain purpose Background Facts & Comparisons 4.0 drug database on students laptop for quick tablet identification Clinical Pharmacology used for identifying potential controls Educational materials offered

22. 1 st contracted company did not have enough manpower on Fridays although we were assured by management that this could happen Little to no response from company when issues brought to their attention Company was not invested in project Contract was cancelled Did not cost grant as there was a breech in contract

23. Box 2 Plastic bags (one for backup in case of leakage, you can double bag the meds) Tape roll (use every month) Bill of Lading (“manifest”) via email Tie for plastic bag (not pictured) Preprinted shipping label

27. Through September 2008 – 1,949 lbs. – Does not include box or container

28. Completed: 547 surveys Demographics – Average Age: 57 – Ethnicity Caucasian: 80% – Gender: 71% female 72% did not bring back any medications 70% preferred to bring back to pharmacy

29. Overall Participation: > 900 patients Store Participation: four patients per store per event Average # of Meds Returned: 9 Average age: 63.5 Gender: 75% female Ethnicity: 96% Caucasian

30. “How did you dispose of your medications previously?” – Kept: 20% – Flushed: 44% – Trash: 20% – Saved for future use: 1% – Gave to friend: 1% – Collection Program: 4% – Other: 10%

31. 8,800 individual prescriptions, OTC and herbals collected – ½ were tablet or capsules non-control prescription items – Controlled substances: 500 tablets and capsules attempted – OTC: 1,700 tablets and capsules – Herbal: 24 tablets and capsules

32. Tablets and Capsules – > 190,000 Liquids – Over 800 bottles Inhalers – 110 (MDI or DPI)

33. RxMEDS Community Partners  ARCHS (www.stlarchs.org)www.stlarchs.org  Schnuck Markets, Inc. (www.schnucks.com/pharmacy/rxreturns.asp)www.schnucks.com/pharmacy/rxreturns.asp  St. Louis College of Pharmacy (www.stlcop.edu)www.stlcop.edu  Cintas (www.cintas.com)  AARP Missouri Chapter, Senior Services Plus  OASIS & Mid-East Area Agency on Aging