GUEST BLOG: What Happens to Leftover Medicine?

Written by:

Jeanie Jaramillo

Managing Director, Texas Panhandle Poison Center

Director, Medication Cleanout

Assistant Professor, Texas Tech University Health Sciences Center School of Pharmacy

What Happens to Leftover Medicine?

Most any of us could walk through our homes and find unused, leftover medicines somewhere – the bathroom medicine cabinet, a kitchen cupboard or drawer, perhaps a bedside table.  So, what happens to these medicines?  There was a time when we wouldn’t think much about disposing of leftover medicines by either flushing them or placing them in the trash.  However, as the message about environmental contamination with these agents has reached each of us through the media, we’ve become a society that no longer throws.  What do we do with them?  Unfortunately, we’re not provided with an easy answer and, as a result, many of us simply hold on these medications; storing them indefinitely in our homes.  In fact, in a survey conducted by our poison center through our medication take back program, we have found that ~75% of participants state they would simply keep old medications if they could not have brought them to us for disposal.

Is Leftover Medicine Really a Problem?

Leftover medicine is a big problem that is only getting bigger.  Many poisonings that occur in children are the result of children accessing the medicines on their own.  This occurs when we leave medicines in unsecure places, or when we have them out for our use and fail to return them to a secure location.  Small children like to explore, and they also mimic adults; so, if they see mom or dad taking medicine – they want to do the same.  Most childhood poisonings that require emergency room visits are due to medicines rather than other products around the home.

An even bigger problem occurs when teens decide to experiment with medicines in an attempt to get “high”.  They’ve learned enough to understand that illegal drugs like cocaine and heroin are dangerous.  But they feel that prescription medicines are safe.  If mom and dad keep these agents in the home, they must be safe, right?  And, they were prescribed by a physician.  Teens do not understand the danger of harm and even death that can occur from the inappropriate use of medicines.  Although prescription medicines present a greater risk of harm, even over the counter medications can be harmful when used inappropriately.

And, according to the Centers for Disease Control and Prevention, the abuse of prescription medications is the fastest growing drug problem in the U.S.  Additionally, every 14 minutes, someone loses their life as the result of an unintentional drug overdose.  We, as a society, cannot continue to leave medicines around our homes to serve as a potential source for poisonings and abuse.

What Can I do About it?

As someone who has worked in poison control for many years, the number one recommendation that I give is to get any medicines that are no longer needed out of the house.  I feel that the best method for med disposal at this time is to take any unused medicines to a community medicine take back program.  If a program is not available, another option is mail-back.  Many pharmacies sell envelopes in which medicines can be placed and then mailed for disposal. There are some medicines that should not be mailed, so instructions in the envelopes should be reviewed carefully.  If neither of those are an option, my next best recommendation is to use the kitty litter/coffee grounds method.  Pour the meds into a sealable zipper bag, add kitty litter or coffee grounds and a some water, seal the bag, place it in a disposable container (like a butter tub), and then place it in the trash (preferably directly into an alley or curbside disposal bin).  Although this method still may result in environmental impact, it is preferable over the harm that could occur to family members, friends, acquaintances, or even pets.

Our poison center started a medicine disposal program in 2009 and has conducted 29 events to date.  As a result, we have collected over 15,000 pounds of unused medicines for proper disposal.  These are meds that are no longer available to serve as a source for poisoning or abuse.

What Do Take-Back Programs Do With the Medicine?

Medication take back programs are likely to vary across the U.S. as each state has different environmental and pharmaceutical regulations.  With our program, medicines that are classified as “controlled”, like many pain medicines, are turned over to law enforcement as required by law.  This amounts to about 10% of our collected meds.  All other medicines are sent for incineration at a pharmaceutical-approved facility by a waste management company.  These facilities must meet strict environmental requirements that minimize environmental impact.

How Can People Find Take Back Programs in Their Area?

The U.S. Drug Enforcement Administration (DEA), in coordination with local law enforcement agencies, has been holding National Medicine Take Back days twice a year.  While it is unclear at this time how long the DEA will continue these, they do have a date set for this spring (April 26, 2014.)  Individuals can visit the DEA website at: http://www.deadiversion.usdoj.gov/drug_disposal/takeback/ to determine if an event will be held in their communities.

Many take back programs exist across the country and are supported by various organizations.  In fact, there are too many to list here and I am unaware of a single site for referencing all of these.  I would recommend a general internet search for “medication take back program” as a good starting point.  Also, many local police and/or sheriffs’ departments now have drop boxes available, so a call to an individual’s local police or sheriff department is an option.

Poison Centers in Action: The West Virginia Chemical Spill

As West Virginian residents begin to return to normalcy, after the last water ban was lifted following a chemical spill that threatened major water sources, the West Virginia Poison Center continues its efforts to address the health concerns of the community.

In a recent press conference, Governor Earl Ray Tomblin said, “We’ve been in this thing for 11 days. It’s a very complicated issue. I’m not a scientist, you know. I have to rely on the best information that I have.” Tomblin did not guarantee that the drinking water is safe but rather left it up to the individuals. “It’s your decision…if you do not feel comfortable drinking or cooking with this water then use bottled water.”

While the chemical spill itself created its own concerns and complications, investigation into the toxicity of the chemical itself created the most confusion. Few answers could be found on the chemical in question and its potential adverse effects in people.

Though the lack of definitive information on about 7,500 gallons of 4-methylcyclohexane methanol that leaked into the river may create its own limitations, Dr. Elizabeth Scharman, director of the West Virginia Poison Center, was confident that the available information, along with the expertise of a team of health care professionals and chemists, allowed for sufficient guidelines for the handling of immediate medical response to the chemical spill.

“When you don’t have specific information about a chemical’s toxicity, you can look at its structure and make some predictions about what could be expected.” said Scharman. “When you don’t have definitive information, you do what is best for public health and that is why the Governor put out a ‘do not use the water’ (except for flushing) order on the evening of January 9th.”

The West Virginia Poison Center collaborated with West Virginia’s state health department, the Centers for Disease Control (CDC), the Department of Environmental Protection (DEP), chemists, and others to ensure that the best interests for public health were being served.  .

While the unique experience of facing an incident involving a large number of individuals exposed to a large quantity of an unknown compound entering the water system, created its own obstacles, Dr. Scharman and her team of Poison Specialists, like many health care professionals dealing with the chemical spill’s aftermath, were faced with the increased challenge of managing an influx of new cases, maintaining regular daily Poison Center call volume, and effectively determining if those experiencing symptoms were effected by the chemical spill or some other illness – a lofty task during the onset of flu season.

“What the Poison Specialists were doing was to take individual assessments to determine whether the caller or their family member were exposed to the water and if so how (e.g., drank it, bathed in it, brushed their teeth with it), and if they were having symptoms.  If symptoms were not felt to be related to a pre-existing condition or other acute medical illness (in which case, a separate triage plan was followed), management recommendations and other information was provided specific to this water contamination incident.  “Poison Centers are in an ideal position to play this role as they are staffed by health care professionals,” said Dr. Scharman.

A handful of callers were referred to an emergency department by the West Virginia Poison Center. The number referred were a very small percentage of the number of individuals who called the center. Dr. Scharman cautioned that, for those individuals who were admitted to a hospital with a concern for contaminated water exposure, the fact that they were admitted did not mean that their symptoms were determined to be related to the spill.

Dr. Scharman also stated that the substance itself, though somewhat illusive in toxicology reference sources, was not highly toxic.

“We were not expecting that we would have people with severe or harmful effects and this is consistent with the types of calls we evaluated,” she said.

The most common symptoms reported were nausea, diarrhea, or rashes.

Although the water ban has now been lifted, the West Virginia Poison Center continues to answer calls related to the chemical spill.

As a part of that brain trust, the West Virginia Poison Center was front and center when news of the chemical spill broke. Before calls came in regarding specific cases, the poison center had received a call from a reporter on the afternoon of January 9^thasking about the chemical after individuals had called the media asking about smelling licorice in the air.  While there hadn’t been any calls from the public at that time, the Poison Center began to research the chemical reported to have been involved in order to prepare itself should calls be received.

“That is part of what poison centers do. We do active surveillance in our communities in real time,” said Dr. Scharman.

When human exposure related calls began pouring in, 2,423 during the main phase of the incident, the poison center was ready.

Poison Specialist Jamie Cook, BSN, MSN, CSPI, who was answering the phones said, “I’ve been here for about three and a half years. This has definitely been the biggest [emergency situation]…We’ve really had to work together as a team. We’ve had to call in Poison Specialists, even those who were out for vacation.”

Cook said that perhaps one of the more challenging aspects of this particular situation was that the public had limited access to water which meant a decline in the ability to use soap and water for cleaning and the potential for some reported symptoms to be more a result of germs than the chemical spill as the duration of the “do not use” order became longer.

Despite the continued challenges of the chemical spill and the subsequent water ban, Cook is confident that the poison center played a crucial role in the health of the community and that the community is now more aware of the center’s role in their safety.

“I think there are people who were not aware that we were here or what we do, that are now,” she said.

As for the public, they’re strong she said, “West Virginians are very tough and very resilient and they’re always helping each other out.”

Meet Warren Patitz – Poison Expert at the Indiana Poison Center

When you call the Poison Help line, a poison expert is on the other end of line to help you. While many of these experts are physicians, nurses and pharmacists, they’re also parents, grandparents, sisters, brothers and friends just like you.

The AAPCC is proud to showcase the dedicated professionals at America’s poison centers. Meet this week’s Poison Center Spotlight, Warren Patitz , poison expert at the Indiana Poison Center.

MEET JOANN CHAMBERS-EMERSON, POISON EXPERT AT THE FLORIDA POISON INFORMATION CENTER – TAMPA!

When you call the Poison Help line, a poison expert is on the other end of line to help you. While many of these experts are physicians, nurses and pharmacists, they’re also parents, grandparents, sisters, brothers and friends just like you.

The AAPCC is proud to showcase the dedicated professionals at America’s poison centers. Meet this week’s Poison Center Spotlight, JOANN CHAMBERS-EMERSON, poison expert at the FLORIDA POISON INFORMATION CENTER – TAMPA.

Twitter Party – What Parents Need to Know About Tweens and Over-the-Counter Medication #OTCed

For more information visit: http://www.5minutesformom.com/84357/scholastic-otc-twitter-party/