[Pharmwaste] Percentage of waste drugs from unwanted consumer meds
cunha.bruce at marshfieldclinic.org
cunha.bruce at marshfieldclinic.org
Thu Nov 17 20:22:49 EST 2005
Good job to all.
This is the kind of information that we need to make sure our representatives know about. I just heard another article on the news today blaming healthcare facilites for what is being found in the streams.
I also wonder if a study has ever been done on the level of these products that would show up in porta-potties. A study like this would give a beter idea on how much of these chemicals are actually coming out of the users of these medications VS what is coming from disposal.
Controlling the issue needs to be multifacited and not just "lets jump on the most obvious without actually knowing about the topic"
Bruce E. Cunha RN MS COHN-S
Manager, Employee Health and Safety
Marshfield Clinic
Marshfield WI
cunha.bruce at marshfieldclinic.org
715-387-5586
------Original Message------
From: "Stevan Gressitt" <gressitt at uninets.net>
Date: Wed Nov 16, 2005 -- 09:36:15 PM
To: "'Gilliam, Allen'" <GILLIAM at adeq.state.ar.us>, "'Galvin, Dave'" <Dave.Galvin at METROKC.GOV>, "'Charlotte A. Smith'" <csmith at pharmecology.com>, <pharmwaste at lists.dep.state.fl.us>, <cunha.bruce at marshfieldclinic.org>
Subject: RE: [Pharmwaste] Percentage of waste drugs from unwanted consumer meds
Further contribution to the compliance issue:
http://www.fda.gov/womens/taketimetocare/usemeds.html
http://akmhcweb.org/ncarticles/Medication%20Nonadherence.htm
And from the above last reference:
One study showed that 77% of patients demonstrated degrees of compliance
with their medication regimen when the treatment was designed to cure a
disease and only 63% of patients complied when treatment was aimed at
prevention. However, when medication was to be taken over a long period,
compliance rates dropped dramatically to approximately 50% for either
prevention or cure.[3]
Studies show that 20% to 80% of patients make errors in taking medication
and that 20% to 60% stop taking medications before being instructed to do
so.[1,3] With older populations, the literature concerning adherence reports
that compliance rates range roughly from 38% to 57%, with an average rate of
less than 45%.[3,4]
The table at the below link for instance should give pause to just how
serious a problem adherence is and how many efforts have gone into "fixing
it." The variety of ingenious efforts is impressing and the results
appalling if the efficacy is considered (see the Roter 125 row which is
about line 2)
http://www.bhiva.org/guidelines/2004/adherence/table.html
Of course we can all point out that feedback fro unused medication rates
might have altered prescribing practice or other intervention..but none of
us were there to address it back then.
To end this quick overview, enjoy the conclusions at the end of the
following abstract. We may with public awareness help with this. It won't be
easy or prone to resolution with a one shot program. But awareness might
help patients think a bit more about taking their medication as prescribed.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u
ids=12472329&dopt=Abstract> &db=PubMed&list_uids=12472329&dopt=Abstract
Stevan Gressitt, M.D.
_____
From: Gilliam, Allen [mailto:GILLIAM at adeq.state.ar.us]
Sent: Wednesday, November 16, 2005 8:42 AM
To: Stevan Gressitt; Galvin, Dave; Charlotte A. Smith;
pharmwaste at lists.dep.state.fl.us; cunha.bruce at marshfieldclinic.org
Subject: RE: [Pharmwaste] Percentage of waste drugs from unwanted consumer
meds
thanx Stevan and Dave,
don't know if all the below reached Bruce's (cc'd above) screen since he's
on the h2e listserve but hope this raises his eyebrows. there apparently is
ALOT of unused meds from the private/residential sector being unused and
tossed. although, compared to other healthcare related clinics/long term
care homes, there doesn't seem to be enough info available yet to supply any
numbers.
Charlotte? is any of this getting to your contact with the u.s. house of
reps' science committee? and THANX for agreeing to come up for one more
"show" on the national H2E program in n.w. arkansas! see ya in january!
allen gilliam
adeq state pretreatment coordinator
501.682.0625
-----Original Message-----
From: Stevan Gressitt [mailto:gressitt at uninets.net]
Sent: Tuesday, November 15, 2005 8:16 PM
To: 'Galvin, Dave'; 'Charlotte A. Smith'; pharmwaste at lists.dep.state.fl.us
Cc: Gilliam, Allen
Subject: RE: [Pharmwaste] Percentage of waste drugs from unwanted consumer
meds
Apologies for the delay. Just briefly here is an introduction to the issue
of adherence..I',m puzzled they don't refer to Robin Clark's article, so
I'll do some digging around. I've seen the Kuspis article but that may have
gone the way of the last computer crash. Charlotte, did you get the email I
sent you yesterday ever? Stevan Gressitt
>From Medscape Pharmacists <http://www.medscape.com/pharmacistshome>
Expert
<http://www.medscape.com/px/viewindex/more?Bucket=columns&SectionId=2587>
Column
Medication Adherence: A Literature Review
Posted 10/12/2005
Charlotte A. Kenreigh, PharmD, and Linda Timm Wagner, PharmD
Introduction
Medication adherence is defined by the World Health Organization as "the
degree to which the person's behavior corresponds with the agreed
recommendations from a health care provider."[1] Poor adherence to
prescribed regimens can result in serious health consequences. For instance,
a recent study found that the risk of hospitalization was more than double
in patients with diabetes mellitus, hypercholesterolemia, hypertension, or
congestive heart failure who were nonadherent to prescribed therapies
compared with the general population.[2]
Rates of nonadherence vary widely in the literature and can be very high,
even in the tightly controlled environment of a clinical trial. Multiple
factors contribute to nonadherence. For instance, patients with chronic
conditions are less likely to follow prescription orders than those with
acute conditions.[3]
A patient's ability and willingness to follow a prescribed regimen directly
influences the effectiveness of that therapy. One factor is the patient's
ability to read and understand medication instructions. Patients with low
literacy may have difficulty understanding instructions; this ultimately
results in decreased adherence and poor medication management.[4] Issues of
low literacy must be recognized and strategies designed with this limitation
in mind.[4]
Current practices, such as the increased use of mail service pharmacies and
reduced time available for the pharmacist to provide patient counseling,
present challenges for pharmacists to effectively assess and detect
medication adherence issues. However, pharmacists have a unique role in the
medication management system that places them in a position to positively
affect medication adherence. This requires the continued review of new
information so that new concepts and ideas can be incorporated into patient
counseling and intervention programs. This paper reviews some of the new
trials reported in 2005 on medication adherence, with particular emphasis on
how pharmacists might incorporate this knowledge into their practices.
1. Dobbels F, Van Damme-Lombaert R, Vanhaecke J, De Geest S. Growing
pains: Non-adherence with the immunosuppressive regimen in adolescent
transplant recipients. Pediatr Transplantation. 2005;9:381-390.
2. Anon. Poor medication adherence increases healthcare costs.
PharmacoEconomics and Outcomes News. 2005;480:5.
3. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med.
2005;353:487-497.
4. Praska JL, Kripalani S, Seright AL, Jacobsen TA. Identifying and
assisting low-literacy patients with medication use: a survey of community
pharmacies. Ann Pharmacother. 2005;39:1441-1445.
5. Rubin RR. Adherence to pharmacologic therapy in patients with type 2
diabetes mellitus. Am J Med. 2005;118:27S-34S.
6. Hill-Briggs F, Gary TL, Bone LR, Hill MN, Levine DM, Bancati FL.
Medication adherence and diabetes control in urban African Americans with
type 2 diabetes. Health Psychol. 2005;24:349-357.
7. MacLaughlin EJ, Raehl CL, Treadway AK, Sterling TL, Zoller DP, Bond
CA. Assessing medication adherence in the elderly: Which tools to use in
clinical practice? Drugs Aging. 2005;22:231-255.
8. van der Wal MH, Jaarsma T, van Velhuisen DJ. Non-compliance in
patients with heart failure; how can we manage it? Eur J Heart Failure.
2005;7:5-17.
9. Bova CA, Fennie KP, Knafl GJ, Dieckhaus KD, Watrous E, Williams AB.
Use of electronic monitoring devices to measure antiretroviral adherence:
practical considerations. AIDS Behav. 2005;9:103-110.
10. Grant RW, Singer DE, Meigs JB. Medication adherence before an
increase in antihypertensive therapy: a cohort study using pharmacy claims
data. Clin Ther. 2005;27:773-781.
11. Diaz E, Woods SW, Rosenheck RA. Effects of ethnicity on psychotropic
medications adherence. Community Med Health J. 2005;41:521-537.
_____
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Galvin, Dave
Sent: Friday, November 11, 2005 1:59 PM
To: 'Charlotte A. Smith'; pharmwaste at lists.dep.state.fl.us
Cc: Stevan Gressitt; Gilliam, Allen
Subject: RE: [Pharmwaste] Percentage of waste drugs from unwanted consumer
meds
Charlotte et al. -- This is one of the key unanswered questions of the
moment. I am aware of only two published studies that try to assess what
people do with old/unused medications, both via surveys. Neither directly
answers the question, but both at least give a glimmer of what avenue people
use for disposal, and the more recent study also attempts to proportion out
use vs. disposal avenues.
A ten-year-old study from Pittsburg (I have only seen references to it, have
not tracked down the original article), appears to be the only American data
published: Kuspis, D.A., and E.P. Krenzelok. 1996. "What happens to
expired medications? A survey of community medication disposal." Vet.
Human Toxicol. 38: 48-49. The survey found that 54 percent of people
dispose of unused medications in the solid waste, 35 percent via the sink or
toilet, and only 1 percent by returning them to pharmacies (as summarized in
the following source).
In the December, 2005, issue of Environmental Health Perspectives (available
on-line earlier), a new British study gives us the most useful look at this
issue: Bound, J.P., and N. Voulvoulis. 2005. "Household disposal of
pharmaceuticals as a pathway for aquatic contamination in the United
Kingdom." Environmental Health Perspectives 113 (12): 1705-1711
(accessible at: http://ehp.niehs.nih.gov/members/2005/8315/8315.pdf ). This
survey of residents in southeast England found that, on average, half do not
finish prescription medications and thus end up with waste medications to
dispose. While 80 percent of pain meds are typically used up, only 18
percent of antibiotics are used as prescribed, leaving 82 percent as waste.
Roughly half of beta-blockers and anti-depressants go unused. Overall,
British residents dispose of 63 percent of used meds in the solid waste, 11
percent in the toilet, and bring 22 percent back to pharmacies. The authors
present a very useful conceptual model for quantifying the pathways of
pharmaceuticals from domestic use into the environment. They conclude,
"...disposal of unused pharmaceuticals either by household waste or via the
sink or toilet may be a prominent route that requires greater attention."
If we could get some up-to-date surveys of this kind here in the states,
they would be very useful to enlighten us all and help fill in the blanks in
the Bound and Voulvoulis model. Maybe together with the non-compliance rate
information that Dr. Gressitt has referred to, we could begin to get our
arms around a rough quantification of waste pharmaceuticals in this country.
I hope this helps.
-- Dave Galvin
Local Hazardous Waste Management Program in King County
Seattle, Washington
206-263-3085
Dave.Galvin at metrokc.gov
_____
From: Charlotte A. Smith [mailto:csmith at pharmecology.com]
Sent: Friday, November 11, 2005 6:01 AM
To: Gilliam, Allen; pharmwaste at lists.dep.state.fl.us
Cc: Stevan Gressitt
Subject: RE: [Pharmwaste] Percentage of waste drugs from unwanted consumer
meds
Thanks, Allen, and much success at your seminar. Will you be discussing drug
waste with folks? The more often the better!
Steve, if you have any hard data, that would be very helpful. I have given
your name to the Washington staffers, so they may be contacting you. Hope
you don't mind!
Charlotte A. Smith, R. Ph., M.S., HEM
President
PharmEcology Associates, LLC
200 S. Executive Drive, Suite 101
Brookfield, WI 53005
262-814-2635
Fax: 414-479-9941
csmith at pharmecology.com
www.pharmecology.com
H2E Champion for Change Award 2004
_____
From: Gilliam, Allen [mailto:GILLIAM at adeq.state.ar.us]
Sent: Friday, November 11, 2005 7:38 AM
To: Charlotte A. Smith; pharmwaste at lists.dep.state.fl.us
Cc: Stevan Gressitt
Subject: RE: [Pharmwaste] Percentage of waste drugs from unwanted consumer
meds
Charlotte (we're gonna miss ya at our next H2E seminar in n.w. arkansas in
january!),
i hope Stevan (cc'd above) will respond with more detailed info he had
provided (back in july?) regarding "non-compliance rates" (% of meds not
used by residential recipients). i believe he referred to another person
and report (by a pharmaceutical company?) that indicated 40 to 60 % of drugs
prescribed are "tossed". the med's final resting place (landfill or
toilet?) i don't believe was mentioned because of lack of data. i believe
he even estimated the monetary losses to states' healthcare programs to be
about $1 million for a state the size of arkansas (~2.5 million population)
because of this waste. considering today's economic woes and the rising
costs of healthcare, one would think state legislators' eyes would pop out
of their sockets if they had this type of info and try to mitigate.
Stevan? think you can dig up that source again?
Thanx in advance,
allen gilliam
adeq state pretreatment coordinator
501.682.0725
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Charlotte A.
Smith
Sent: Thursday, November 10, 2005 4:16 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] Percentage of waste drugs from unwanted consumer meds
Hello,
I just received a call from a staffer at the US House of Representatives
Science Committee inquiring as to what percentage of drugs entering the
environment, primarily through drain/sewer disposal, can be attributed to
consumers flushing unwanted medications. I do not know of any studies on
this or available data. Do any of you have information you can share that I
can refer back to this gentleman? It appears the House of Representatives is
starting to become interested in this issue so I think we should do all we
can to make the case for enabling legislation, especially with respect to
DEA and funding of programs. Thanks much!
Charlotte A. Smith, R. Ph., M.S., HEM
President
PharmEcology Associates, LLC
200 S. Executive Drive, Suite 101
Brookfield, WI 53005
262-814-2635
Fax: 414-479-9941
csmith at pharmecology.com
www.pharmecology.com
H2E Champion for Change Award 2004
--
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