UMaine Center on AgingMaine Benzodiazepine Study Group

Camden Hall 25 Texas Avenue

Bangor, Maine 04401207-262-7920

www.mainecenteronaging.org

IMPLEMENTING A STATEWIDE MAIL BACK PROGRAM FOR

EXPIRED AND UNUSED PRESCRIPTION DRUGS

IMPLEMENTING A STATEWIDE MAIL BACK PROGRAM FOR

EXPIRED AND UNUSED PRESCRIPTION DRUGSImproving Patient Safety through Informed Medication

Prescribing and Disposal PracticesOctober 31, 2007

Historic State LegislationHistoric State LegislationHistoric State LegislationHistoric State Legislation

• Public Law 2003, Chapter 679 – Maine Unused Pharmaceutical Disposal Program– Program administration – Maine Drug

Enforcement Agency– Maine Drug Return Implementation Group

• LD 411 “An Act To Establish a Pilot Program for Return of Unused Prescription Drugs by Mail” (Sponsored by Representative Anne Perry) (Signed 6/27/07)

Maine’s Prescription Maine’s Prescription Drug ProblemDrug Problem

Maine’s Prescription Maine’s Prescription Drug ProblemDrug Problem

• In 2002, nearly 90% of Maine drug deaths were caused by prescription drugs (Maine Department of Health and Human Services, Office of Substance Abuse, 2005)

• Maine Drug Enforcement Agency arrests for prescription drug misuse or diversion has increased dramatically to 16% of all arrests (Maine Department of Health and Human Services, Office of Substance Abuse, 2005)

• In terms of greatest drug threat and the relationship of pharmaceuticals to violent crime and property crime, Maine ranks number one in the country (National Drug Intelligence Center, 2006)

• Maine ranks second in terms of the availability of pharmaceuticals for abuse (National Drug Intelligence Center, 2006)

Project OverviewProject OverviewProject OverviewProject Overview

• Unique opportunity to test and refine state-wide field model

• Phased mail-in return program• Funded by the U.S. Environmental Protection

Agency (EPA)• Working prototype for state and beyond• Future full scale establishment of Maine

Unused Pharmaceutical Disposal Program

Project GoalsProject GoalsProject GoalsProject Goals

• Remove unneeded prescription drugs from circulation

• Disposal in compliance with applicable state and federal laws and sound environmental practices

Project ObjectivesProject ObjectivesProject ObjectivesProject Objectives

• Quantification by weight, type and hazardous characteristics by actual pill count and classification

• Cost feasibility of rollout

• Education campaign concerning proper disposal

Phased Phased ImplementationImplementation

Phased Phased ImplementationImplementation

• Two-phase, 18-24 month project1. 1,800 mailers available to consumers

through distribution by a pharmacy

2. Refine process; 7,200 mailers available

Number of mailers distributed in both phases has increased by 50% to 9,000 pieces

Phase IPhase IPhase IPhase I

• 1,800 mailers available through distribution centers at approximately 7 pharmacies

• Aroostook, Cumberland, Kennebec, and Penobscot counties

• No formal campaign to drive individuals into pharmacies to return medications

Phase IIPhase IIPhase IIPhase II

• 7,200 mailers available through statewide network of participating pharmacies

• Statewide rollout – 16 counties• Refinements based on Phase I

experience• Public communications to drive

individuals into the distribution centers

Key ComponentsKey ComponentsKey ComponentsKey Components

• Secure and manage network of distribution points (pharmacies) where individuals pick up mailers to return medication

• Create and issue to distribution centers informational materials for pharmacists, staff, and individuals acquiring mailers

Key ComponentsKey ComponentsKey ComponentsKey Components

• Create and distribute to distribution centers 9,000 mailers and accompanying surveys for those returning medications

• Collect, inventory and destroy returns in compliance with applicable state and federal laws and sound environmental practices

• Conduct activities in a four-county region in Phase I and statewide in Phase II

Key ComponentsKey ComponentsKey ComponentsKey Components

• Generate, analyze and report on survey and inventory data in manner that allows physicians, pharmacists, insurance companies, patients and others to modify behaviors to minimize unused medications

• Disseminate related educational information through statewide network of community health promotion organizations and municipal health officers

Project Collaborations and Project Collaborations and AdvisementAdvisement

Project Collaborations and Project Collaborations and AdvisementAdvisement

Maine-Based Organizations

• Maine Benzodiazepine Study Group (MBSG) & Drug Disposal Group

• Maine Department of Environmental Protection

• Maine Drug Enforcement Agency• Maine Office of Substance Abuse• Maine Department of Health• Maine Office of the Attorney General• Maine Office of Elder Services• Maine Pharmacy Association• Maine Independent Pharmacies• Maine RSVP Programs

• Margaret Chase Smith Center Policy Center

• Northern New England Poison Center

Federal & National Organizations

• U.S. Drug Enforcement Administration• U.S. Postal Service• Community Medical Foundation for

Patient Safety• National Council on Patient Information

and Education• Office of the U.S. Attorney General• Rite Aid Corporation• American Pharmacists Association

The Benefits of a Maine The Benefits of a Maine ProjectProject

The Benefits of a Maine The Benefits of a Maine ProjectProject

• Large rural regions and urban centers• 38th in population density; < 10 residents per

square mile in over half of state– Distribution/collection and financial challenges– Chronic illness and related drug use higher in rural

areas

• Oldest state– Median age 41.2 years (United States Census, 2005)

– Americans 65+ account for over 1/3 of prescriptions dispensed, but only 13% of the national population

Drug Collection BenefitsDrug Collection BenefitsDrug Collection BenefitsDrug Collection Benefits

• Prevent environmental exposure– aquatic ecosystem

• Minimize accidental overdoses and poisonings

– people, pets and wildlife

• Limit “pharming” and drug-related theft• Provide alternative to drug stockpiling• Preclude bad drug donations• Reduce inefficiency in the health care

system

Project Data CollectionProject Data CollectionProject Data CollectionProject Data Collection

• Geographic and demographic patterns of prescription drug accumulation

• Pharmacoeconomic assessments – Waste – Implications for prescribing, insurance

reimbursement, and dispensing policies

The MailersThe MailersThe MailersThe Mailers

• Full compliance for mailing– USPS/State/Federal requirements

• Postage-paid mailers accommodate a range of contents

• Padded mailers nondescript and not easily identifiable to a criminal element

Drug Inventory & DisposalDrug Inventory & DisposalDrug Inventory & DisposalDrug Inventory & Disposal

• Compliance with Maine Drug Enforcement Agency, Department of Environmental Protection– 2 law enforcement officers (double

verification)– Secure consolidation facility at an MDEA

location– Repeat count of number of packages

received– Proper disposal of all drugs collected

Insuring Insuring Elder InvolvementElder Involvement

Insuring Insuring Elder InvolvementElder Involvement

• Community Advisory Board created with older adults from each county– Membership reflects state’s diversity

• Community members will serve as Distribution Site Educators– Deliver mailers and materials to distribution sites– Educate site pharmacists and staff on the process– Refer pharmacists and staff to toll-free project

number and web site• Educators will promote the benefits of

returning unwanted medications

Projected OutcomesProjected OutcomesProjected OutcomesProjected Outcomes

• Understanding practicality and costs associated with mail back medication return program

• Information on best methods to educate older adults concerning hazards of unused medications and improper disposal

• Reduction in medications available for improper disposal, diversion or poisoning

• Heightened awareness by public-at-large and older adults that could lead to reduction in accidental deaths, human and animal poisonings, and suicides caused by unused medications

Projected OutcomesProjected OutcomesProjected OutcomesProjected Outcomes

• Hundreds, if not thousands, of pounds of unwanted medications collected from households in Maine and disposed of in prudent fashion

Want to Know More Want to Know More About the Project?About the Project?

Want to Know More Want to Know More About the Project?About the Project?

Please contact:

Daily operations:

jennifer.crittenden@umit.maine.edu

Project administration:

len.kaye@umit.maine.edu

Technical issues:

gressitt@uninets.net