[Pharmwaste] rate of drug wastage

Thu, 27 Jan 2005 22:37:32 -0500

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Alice, Thanks for reminding me of that article. The ASCP was at our
conference in October and is interested in the issue of returns from
long-term care facilities and I am in fairly close contact with Tom Clark on
other matters as well, but who is quite knowledgeable about some of the
regulatory aspects around nursing homes. I'd like to suggest another set of
references, at www.mainesenate.org/expiredmeds There is a gray block on the
right side of the page and the one from Sudbury Ontario is the most
sophisticated analysis of consumer returns I have been able to find. It
wasn't a flashy peer-reviewed paper, but rather a serious local effort with
the National Association of Boards of Pharmacy's in Canada. Specifically it
focused on Sudbury and then extrapolated province wide and then Canada wide.

     What I would appreciate is if anyone knows of any papers similar to
that Sudbury paper, I would be quite appreciative of any passed my way. I am
not sure how they have reported out the returns is the best, but it is a
start. Rates of controlled drugs match what we have collected pretty closely
so far. But there is something not quite clear enough about some of their
tables ( or I just don't see the point.) 

One of the complications in the long-term care area is that there is also a
drug-recycling movement, but the Pharmacoeconomics of this are quite tight.
Security remains a serious issue as well.

Stevan

  _____  

From: pharmwaste-admin@lists.dep.state.fl.us
[mailto:pharmwaste-admin@lists.dep.state.fl.us] On Behalf Of Chapman, Alice
Sent: Thursday, January 27, 2005 4:35 PM
To: Stevan Gressitt; 'Proffitt, Leah'; 'Johnson, Emma (ECY)';
pharmwaste@lists.dep.state.fl.us
Subject: RE: [Pharmwaste] rate of drug wastage

Hello,

The article by Paone et al, Medication Destruction and Waste Measurement and
Management in Long-term Care Facilities  accessible at:
http://www.ascp.com/public/pubs/tcp/1996/jan/  provides some insight into
the possible amounts generated.  I'm not aware of any survey information
directly addressing waste generation rates in the general residential
population.  

The focus of the paper was the cost of drug wastage, and also the rate or
percentage of drug waste in Long Term Care Facilities. The percentage of
drug waste was 6.7% of the cost of medications dispensed.

The paper also has some ideas for reducing drug waste, with expected cost
savings documented, so any of you out there working with nursing homes, etc.
could deliver this pollution prevention message.  

Alice Chapman, PE

Local Hazardous Waste Management Program in King County

130 Nickerson St, #100

Seattle, WA  98109

http://www.govlink.org/hazwaste/

206-263-3058 phone

206-263-3070 fax

  _____  

From: Stevan Gressitt [mailto:gressitt@uninets.net] 
Sent: Sunday, January 23, 2005 2:49 PM
To: 'Proffitt, Leah'; 'Johnson, Emma (ECY)';
pharmwaste@lists.dep.state.fl.us
Subject: RE: [Pharmwaste] Pharmaceutical Waste

Thanks for that article. I do suspect that the amount of waste
pharmaceuticals however from the consumer side is far higher than the rates
in the article. For instance we know patient compliance is between 20-80%
with averages talked about at 50%. Considering the higher rate of
polypharmacy among the elderly, accounting for left-overs at death, and
rates of non-use due to allergic reactions and unacceptable side effects, it
still seems the rate would be magnitudes over the 3-7% numbers. I understand
that there might be proprietary survey information held by some companies
that have assessed this but I have not seen it and wonder if anyone here
knows of open source assessments that have been published? Stevan Gressitt,
M.D.

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<div class=3DSection1>

<st1:City w:st=3D"on"><st1:place w:st=3D"on">Alice</st1:place></st1:City>, Thanks for reminding me of that article. The ASCP was at =
our
conference in October and is interested in the issue of returns from =
long-term
care facilities and I am in fairly close contact with Tom Clark on other
matters as well, but who is quite knowledgeable about some of the =
regulatory
aspects around nursing homes. I&#8217;d like to suggest another set of
references, at <a =
href=3D"http://www.mainesenate.org/expiredmeds">www.mainesenate.org/expir=
edmeds</a>
There is a gray block on the right side of the page and the one from =
<st1:place
w:st=3D"on"><st1:City w:st=3D"on">Sudbury</st1:City> <st1:State =
w:st=3D"on">Ontario</st1:State></st1:place>
is the most sophisticated analysis of consumer returns I have been able =
to
find. It wasn&#8217;t a flashy peer-reviewed paper, but rather a serious =
local
effort with the National Association of Boards of Pharmacy&#8217;s in =
<st1:country-region
w:st=3D"on"><st1:place =
w:st=3D"on">Canada</st1:place></st1:country-region>. Specifically
it focused on <st1:City w:st=3D"on">Sudbury</st1:City> and then =
extrapolated
province wide and then <st1:country-region w:st=3D"on"><st1:place =
w:st=3D"on">Canada</st1:place></st1:country-region>
wide.<o:p></o:p>

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;What =
I would
appreciate is if anyone knows of any papers similar to that <st1:City =
w:st=3D"on"><st1:place
 w:st=3D"on">Sudbury</st1:place></st1:City> paper, I would be quite =
appreciative
of any passed my way. I am not sure how they have reported out the =
returns is
the best, but it is a start. Rates of controlled drugs match what we =
have
collected pretty closely so far. But there is something not quite clear =
enough
about some of their tables ( or I just don&#8217;t see the point.) =
<o:p></o:p>

One of the complications in the =
long-term
care area is that there is also a drug-recycling movement, but the =
Pharmacoeconomics
of this are quite tight. Security remains a serious issue as =
well.<o:p></o:p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'>Stevan<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>

<div>

<div class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><font =
size=3D3
face=3D"Times New Roman"><span style=3D'font-size:12.0pt'>

<hr size=3D2 width=3D"100%" align=3Dcenter tabindex=3D-1>

</span></font></div>

<p class=3DMsoNormal><b><font size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'>
pharmwaste-admin@lists.dep.state.fl.us
[mailto:pharmwaste-admin@lists.dep.state.fl.us] <b><span =
style=3D'font-weight:
bold'>On Behalf Of </span></b>Chapman, Alice<br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> Thursday, January =
27, 2005
4:35 PM<br>
<b><span style=3D'font-weight:bold'>To:</span></b> Stevan Gressitt; =
'Proffitt,
Leah'; 'Johnson, Emma (ECY)'; pharmwaste@lists.dep.state.fl.us<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> RE: [Pharmwaste] =
rate of
drug wastage</span></font><o:p></o:p></p>

</div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'>Hello,</span></font><o:p></o:p></p>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'>&nbsp;<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'>The article by Paone et al, =
<em><i><font
face=3DArial><span style=3D'font-family:Arial'>Medication Destruction =
and Waste
Measurement and Management in Long-term Care Facilities&nbsp; =
</span></font></i></em>accessible
at:&nbsp; <a =
href=3D"http://www.ascp.com/public/pubs/tcp/1996/jan/">http://www.ascp.co=
m/public/pubs/tcp/1996/jan/</a>&nbsp;
provides some insight into the possible amounts generated.&nbsp; I'm not =
aware
of any survey information directly addressing waste generation rates in =
the
general residential population.&nbsp; </span></font><o:p></o:p></p>

<div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'>The focus of the paper was the cost =
of
drug wastage, and also the rate or percentage of drug waste in Long Term =
Care
Facilities.&nbsp;The percentage of drug waste was 6.7% of the cost of
medications dispensed.</span></font><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

The paper&nbsp;also has some ideas =
for
reducing drug waste, with expected cost savings documented, so any of =
you out
there working with nursing homes, etc. could deliver this pollution =
prevention
message.&nbsp; <o:p></o:p>

</div>

<div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'>Alice Chapman, =
PE<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'>Local Hazardous Waste Management =
Program
in <st1:place w:st=3D"on"><st1:PlaceName =
w:st=3D"on">King</st1:PlaceName> <st1:PlaceType
 =
w:st=3D"on">County</st1:PlaceType></st1:place><o:p></o:p></span></font></=
p>

<p class=3DMsoNormal><st1:Street w:st=3D"on"><st1:address =
w:st=3D"on"><font size=3D2
  color=3Dblue face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
  color:blue'>130 Nickerson St, =
#100</span></font></st1:address></st1:Street><font
size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
color:blue'><o:p></o:p></span></font></p>

<p class=3DMsoNormal><st1:place w:st=3D"on"><st1:City w:st=3D"on"><font =
size=3D2
  color=3Dblue face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
  color:blue'>Seattle</span></font></st1:City><font size=3D2 =
color=3Dblue
 face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;color:blue'>, <st1:State
 w:st=3D"on">WA</st1:State>&nbsp; <st1:PostalCode =
w:st=3D"on">98109</st1:PostalCode></span></font></st1:place><font
size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:10.0pt;font-family:Arial;
color:blue'><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'><a =
href=3D"http://www.govlink.org/hazwaste/">http://www.govlink.org/hazwaste=
/</a><o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'>&nbsp;<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'>206-263-3058 =
phone<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dblue face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:blue'>206-263-3070 =
fax<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'><o:p>&nbsp;</o:p></span></font></p>

</div>

<div class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><font =
size=3D3
face=3D"Times New Roman"><span style=3D'font-size:12.0pt'>

<hr size=3D2 width=3D"100%" align=3Dcenter tabIndex=3D-1>

</span></font></div>

<p class=3DMsoNormal style=3D'margin-bottom:12.0pt'><b><font size=3D2 =
face=3DTahoma><span
style=3D'font-size:10.0pt;font-family:Tahoma;font-weight:bold'>From:</spa=
n></font></b><font
size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;font-family:Tahoma'> Stevan
Gressitt [mailto:gressitt@uninets.net] <br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> Sunday, January 23, =
2005
2:49 PM<br>
<b><span style=3D'font-weight:bold'>To:</span></b> 'Proffitt, Leah'; =
'Johnson,
Emma (ECY)'; pharmwaste@lists.dep.state.fl.us<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> RE: [Pharmwaste]
Pharmaceutical Waste</span></font><o:p></o:p></p>

Thanks for that article. I do =
suspect that
the amount of waste pharmaceuticals however from the consumer side is =
far
higher than the rates in the article. For instance we know patient =
compliance
is between 20-80% with averages talked about at 50%. Considering the =
higher
rate of polypharmacy among the elderly, accounting for left-overs at =
death, and
rates of non-use due to allergic reactions and unacceptable side =
effects, it
still seems the rate would be magnitudes over the 3-7% numbers. I =
understand
that there might be proprietary survey information held by some =
companies that
have assessed this but I have not seen it and wonder if anyone here =
knows of
open source assessments that have been published? Stevan Gressitt, =
M.D.<o:p></o:p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>

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