unused medications where are we now? prepared for: u.s. drug enforcement administration by: dr....
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Unused MedicationsWhere are we now?
Prepared for: U.S. Drug Enforcement
Administration
By: Dr. Jeanie Jaramillo and Dr. Stevan Gressitt
July 19, 2011
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Disclosures
• Poison Center Incentive Grant funded by HRSA
• No other potential conflicts of interest
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Context
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Acknowledgement
This presentation includes information collected and compiled by the
Pharmaceutical Collection Monitoring Group
through use of thePharmaceutical Collection
Monitoring System™
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Purpose for Visit
• There’s an elephant in the room– Not that unused medications are a problem
• Now common knowledge:– Meds as a source of poisonings– Source of abuse (and diversion)– Source of misuse– Source of environmental contamination
• Finding a solution– Band aid approach is no longer enough
• Take back events are a band aid approach
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Root Cause Analysis is Needed
1. Define the problem factually2. Gather data and evidence3. Ask “why” and identify causes4. Identify corrective actions that will prevent
recurrence5. Implement actions6. Observe effect
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Purpose for Visit
• We’ve hit a brick wall at step #2 (gather data and evidence)
• We need the help of the DEA• Outline
– Discuss successful collection events– Data utility– Share results– Request support
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Data Collection
• Numerous take backs across country• Several high-quality data sets
– Gressitt– Mireles– Gottlieb– Jaramillo
• All data sets collected different data points– No consistency– Merging of data difficult if not impossible
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Pharmaceutical Collection Monitoring System™ (PCMS)
• Web-based recording and reporting tool• Provides for collection of consistent data
across multiple sites• Accessible by users anywhere that internet
service is available
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A Case Report: Car #188
• Amarillo, Texas • Population: ~180,000• Community Medication Take Back Event• Drive through• Collaborative effort with Amarillo Police
Department
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Car #188
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Car #188
• 2 large boxes• Medications from deceased parents
and cat• Speculatively parents both suffered
from chronic, terminal diseases• Reporting today only the controlled
substances from this vehicle
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Controlled Substances from Car #188
Drug Name Strength # ContainersQty
Collected AWPLow-High End
Street Value
diazepam 5 mg 18 2,320 $167 $2,320 - $46,400hydrocodone/ APAP 10/325 mg 4 520 $363 $1,040 - $10,400
Lorcet® 5/500 mg 2 2 $3 $6 - $18
Lyrica® 75 mg 6 84 $227 $420 - $1,680
morphine sulfate 30 mg 61 10,080 $5,352 $80,640 - $302,400
MS Contin® 30 mg 3 6 $17 $90 - $300
oxycodone/APAP 5/500 mg 15 802 $95 $802 - $4,010
temazepam 30 mg 2 180 $32 $180 - $3,600
111 13,994 $6,256 $85,498 - $368,808
Values obtained from NDIC reports. Indicate estimates.
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Car #188
• Rare occurrence or more common than we think?
• No data • Of what use would the data be? Would it
really help anything?
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What data do we have?
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April 30th DEA Take Back Day
• Eight organizations• 11 sites• Conducted events and logged data• Goal: data from at least first 50 participants• Result: data from items of 411 participants
was collected• 3,800 line items logged
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April 30th DEA Take Back Day
6%
60%
33%
Percentage Collected by Classification - All Sites Combined
Controlled Substances
Non-Controlled Substances
Over-the-counters
Unknown/unidentified
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Most Commonly Collected Controls
Acetaminophen with hydrocodone 22.7%
Acetaminophen with propoxyphene 21.3%
Benzodiazepines11.3%
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By Schedule
See handout report• C II• C III• C IV• C V
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Medication Utilization/ Wastage
• Controlled substances collected/documented– On average, 67% of dispensed controls were
brought to take back events for disposal– 67% = wasted
• Overprescribed?• Over-marketed?
60% 20%
18%
10%
*total >100% as some participants selected >1 answer
Percentages indicate what event participants would do with meds if event was unavailable.
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Why come to the DEA
• Data has utility; greatly needed• Lost participation of sites due to lack of DEA
support• Current directives
– No questions– No counts– No handling of meds
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Why come to the DEA?
• Need DEA to be part of the solution– Funding? – Letter of support?– Letter of understanding?
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Academia
PCMS
Community Partners.
Local Law Enforcement
.
DEA