Med disposal: Impact on Pharmacy Practice

1. Med disposal: Impact on Pharmacy Practice Jackie Campbell, B.Sc. Pharm., LLB Saxe Law Office October 7, 2010

2. Outline • What’s the problem? • What’s being done? • Impact on pharmacy practice • Challenges & opportunities Jackie Campbell

3. What’s the problem? Pharma waste • What is it? • How much is there? Nobody knows • Ontario’s MHSW Program Plan said approx 10% of pharmaceuticals not consumed; Estimate 659 tonnes avail for collection • How does it get into the environment? • Through use/excretion • Inappropriate disposal • Appropriate disposal - Incineration • What does it do? Jackie Campbell

4. What’s the problem? Effects of drugs in the environment • Medications • Individual vs class • Interactions? • Cocktail? • No known adverse effect • What concentration is trigger for concern? • No adverse effect to whom? Jackie Campbell

5. What’s the problem? • Overuse of drugs • Antimicrobials: resistance? • Antibiotics/antifungals/antivirals • Allergies • Endocrine concerns • Effects of chronic, low-level exposure • Biomagnification in food chain? Jackie Campbell

6. How do we get rid of unused drugs? • Flush/Pour/Fling • Consumers • Health professionals? • Disposal service • Licensed? • Do they know what they’re doing? Jackie Campbell

7. Who’s got pharma waste? Consumers - targetted Pharmacists Physicians Veterinarians Pharma companies Jackie Campbell

8. Outline • What’s the problem? • What’s being done? • Impact on pharmacy practice • Challenges & Opportunities Jackie Campbell

9. What’s being done? • Some provinces regulate • BC, Ontario • Manitoba • Voluntary programs • Most other provinces Jackie Campbell

10. Some figures… • What’s being collected? • BC • 51.3 tonnes (2009); up from 35.7 tonnes (2008) • Ontario • 42 tonnes collected by municipalities (2007) • 250 tonnes via other channels - e.g., pharmacies (2008) Jackie Campbell

11. Outline • What’s the problem? • What’s being done? • Impact on pharmacy practice • Challenges & Opportunities Jackie Campbell

12. Pharmacist Standards of Practice Pharmacist must ensure Safe, legal, environmentally sound disposal of meds outdated, recalled, spoiled Appropriate removal/disposal of outdated inventory The “how” left to discretion of pharmacist Jackie Campbell

13. Responsible enviro practice Benefits of “responsible environmental practice” ↓ drug abuse opportunity ↓ accidental poisonings ↓ inadvertent use of expired drugs ↓ harm to environment Better monitoring of patient medication therapy - will ultimately ↓ waste, so more cost-effective system Jackie Campbell

14. Benefits to pharmacy practice Cradle to grave service re meds Counselling programs Use information from med returns (ask patient first!) Patient compliance? Educate patients Decrease med wastage Dispense small amounts of new Rx drugs Differentiate service provided Re-look at processes - go greener Provide environmental labelling/information Jackie Campbell

15. Special issues Safety To staff - e.g., remove meds from containers -- Dust? Splash? Off-gas? Watch for diversion - some drugs may be “of interest” Confidentiality Confidential patient info on package labels, containers Patients may be sensitive about what they’re bringing back Place in disposal container as received Vials, bottles included Ask patients to bring meds in plastic bags  costs? Jackie Campbell

16. Special issues Narcotics and controlled drugs Recommended to record name/quantity Render unusable A second person should sign that they witnessed destruction Labelling - conflicting info e.g., fentanyl patches Put used patches in childproof container, return to pharmacy (College of Pharmacists of BC) Flush (manufacturers) Produce monographs could be an enviro tool! Jackie Campbell

17. Special issues Physician samples Volume not known, but… How DO doctors dispose of samples? Conflicting codes? Veterinary drugs Huge volumes used Veterinary medicine Farming Aquaculture Vet College provides detailed suggestions for disposal of expired drugs Jackie Campbell

18. Outline • What’s the problem? • What’s being done? • Impact on pharmacy practice • Challenges & Opportunities Jackie Campbell

19. Challenges • Laws - Different definitions of “pharmaceuticals” • What’s collected and what’s not - don’t confuse patients • Practical significance? Not clear • Targets need to expand past “household quantities” to • Farms • Long term care facilities • Veterinary drugs • Doctors’ offices Jackie Campbell

20. Challenges • It’s a secret … Awareness • By consumers • By health professionals • Of service • Of need • It’s all about…convenience • …And necessity • Work towards by-laws like Vancouver’s • Cost Jackie Campbell

21. Tips from other jurisdictions • Sweden • Environmental labelling classification system • Examines enviro impact of medication • Low, medium or high risk to aquatic environment • …Select meds according to enviro impact • European Medicines Agency (EMEA) • Recommends that package inserts include “Medicines no longer required should not be disposed of via wastewater or the municipal sewage system” Jackie Campbell

22. Opportunities • Health professionals • Wiser prescribing practices • Keep inventory at a minimum • Talk to suppliers, manufacturers • Engage consumers • Ask them why they have outdated meds at home • Responsible med disposal • Demand NO excessive packaging • Government funding mechanisms • Formulary analysis should include enviro impact Jackie Campbell

23. Avoid “enviro surprise” • Environmental surprise… where ultimate hazards differ from those that were anticipated Jackie Campbell

24. SAXE LAW OFFICE email: jackie@envirolaw.com Blog: envirolaw.com Jackie Campbell