1. Pharmacists’ Perspective on Unwanted/Waste Pharmaceuticals PSI: Pharmaceuticals National Dialogue Sacramento, CA June 19, 2008 Shirley Reitz, Pharm.D., BCPS Associate Director, Pharmacy Clinical Services Group Health Cooperative Seattle, WA

2. Pharmacists’ Perspective Is there a problem? If there is an issue, what are the primary challenges for Pharmacy in helping to solve this issue? What is needed to move this issue forward?

3. Is there a problem? Patient Demand  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….”

4. Is there a problem? Patient Demand  Over 10,000 lbs of unwanted medications collected and incinerated  Implemented in all 25 Group Health pharmacy locations  Regional pharmacy chain implementing in 10 additional pilot sites Collected Drugs, Percent by Weight

5. Is there a problem?  The majority of teens (57%), who use these products, say they get prescription drugs for free from a relative or friend (47%), or take them from a relative or friend (10%), without asking; and  Adolescents are more likely than young adults to become dependent on prescription medication. New abusers of prescription drugs have caught up with new users of marijuana; Pain relievers, such as OxyContin and Vicodin, are the most commonly abused prescription drugs by teens; One third of all new abusers of prescription drugs in 2005 were 12-17-year olds; Prescription drugs are the drug of choice among 12- and 13-year olds; Patient Safety - “Teens and Prescription Drugs” 2007 White House ONDCP report:

6. Is there a problem?

7. What are the challenges for Pharmacy? Regulatory  Controlled Substance Act  Drug Enforcement Agency  State Boards of Pharmacy Cost  Need affordable solutions  Pharmacies/Patients should not be required to fund solutions Lack of Educational Outreach  Education of patients and healthcare professionals Lack of guidance at the national level  National pharmacy associations

8. What do we need to move forward? Models that demonstrate a safe, secure, convenient, affordable disposal system  Pilot program in 25 Group Health Pharmacy locations in Washington state  Design and develop secure disposal bin  Tracking system from consumer deposit to incineration Regulatory responsiveness  Allow secure collection of controlled substances from public in convenient locations (pharmacies)  Reduce administrative burden Cost  Ensure that burden of disposal cost does not fall to patients or to the pharmacies

9. What do we need to move forward? Educating consumers to take action  Media campaign  Training for care providers to educate patients  Web site development (such as www.medicinereturn.com)

10. What do we need to move forward? Health Care Providers  Group Health Businesses  Bartell Drug Company Non-profit agencies  Interagency Resource for Achieving Cooperation (IRAC)  Northwest Product Stewardship Council  WA Citizens for Resource Conservation  Pacific NW Pollution Prevention Resource Center State and local government  King County Local Hazardous Waste Management Program  Snohomish County Solid Waste Management Division  Public Health – Seattle and King County  WA Department of Ecology Advisors  WA State Board of Pharmacy  WA Department of Social and Health Services Pharmaceutical Manufacturers National Dialogue and Development of Partnerships

11. Pharmacists’ Perspective Contact Information Shirley Reitz, Pharm.D., BCPS Associate Director, Pharmacy Clinical Services Group Health Cooperative Seattle, WA 98168 206-901-4334 Reitz.sj@ghc.org