[Pharmwaste] Non-adherence

[gressitt at uninets.net]

Worse, there is no feedback loop for the prescriber to know that an rx was
unfilled. Perhaps one of the state of the art systems for tat is the va
pharmacy system or the http://moxxi.mcgill.ca/ system. Stevan Gressitt,
M.D.

>
> I didn't realize that non-filled or non-refilled scripts were counted
> toward non-adherrance.  How would that be tracked if a person never
> presented a script to a pharmacy?  Do I need to actively cancel the
> scripts I thought were a waste of paper to prescribe, or that didn't
> work so I didn't refill them?
>
> -----Original Message-----
> From: pharmwaste-bounces at lists.dep.state.fl.us
> [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
> gressitt at uninets.net
> Sent: Monday, January 29, 2007 8:27 AM
> To: Gilliam, Allen
> Cc: pharmwaste at lists.dep.state.fl.us
> Subject: Re: [Pharmwaste] Non-adherence
>
>
> Allen, the Registry site is at www.communityofcompetence.com  Howeveer
> it will measure what is returned rather than actual compliance. That
> would be a deriviative conclusion that Matthew Mirelles has attempted
> and with some interesting results. What is necessary for his work to
> continnue howeveer is more actual reporting from as broad an array of
> sites as possible. The best information I have seen on actual compliance
> comes from within the Pharmaceutical Industry but is "proprietary."
> Stevan Gressitt, M.D. 207-441-0291
>
>> I was reminded that non-adherence also includes those scripts that are
>
>> not refilled.  I've been using 50% kind of as a national overall
>> average in my presentations since the numerous reports I've perused
>> range from 20% to 80% (for psychotrophics).  Regardless of which study
>
>> and what %, our nations' waters are in deep doo.  The boulder/denver
>> study REALLY opened some eyes over here.
>>
>> Slap me if I'm wrong but, didn't Dr. Gressitt (or somebody "out
>> there") start a national registry to try and get some handle on this
>> non-adherence rate? If so, what's that website again please? The only
>> questionnaire I've got doesn't address "not refilled".
>>
>> Allen Gilliam
>> ADEQ state pretreatment coordinator
>>
>> -----Original Message-----
>> From: pharmwaste-bounces at lists.dep.state.fl.us
>> [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Matthew
>
>> Mireles
>> Sent: Saturday, January 27, 2007 8:30 AM
>> To: 'Jackson, Jennifer'; pharmwaste at lists.dep.state.fl.us
>> Subject: RE: [Pharmwaste] RE: question on wastewater
>> characterizationofpharmaceuticals
>>
>>
>> Jen, thanks so much for your thoughtful and informative reply.  I
>> agree that prevention has to be the key.  Do you have an idea on what
>> drugs are most frequently showing up at your site?  If we can address
>> the issues of over-prescription, non-adherence of medications, and
>> proper disposal (this is the most challenging), then everyone should
>> be happy. Thanks for the reference.
>>
>> Matthew Mireles
>>
>> -----Original Message-----
>> From: pharmwaste-bounces at lists.dep.state.fl.us
>> [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
>> Jackson, Jennifer
>> Sent: Friday, January 26, 2007 5:01 PM
>> To: pharmwaste at lists.dep.state.fl.us
>> Subject: [Pharmwaste] RE: question on wastewater characterization
>> ofpharmaceuticals
>>
>> Hi Matthew,
>>
>> Your observation is a good one and there is a plethora of studies done
>
>> on what pharmaceuticals are entering waterways through wastewater
>> effluent. Check out the USGS 2002 Reconnaissance on Pharmaceuticals
>> and Personal Care Products. Boulder Creek, Potomac and San Francisco
>> Bay have some studies as well. Google Scholar will give you lots of
>> hits. To begin, look at:
>> http://toxics.usgs.gov/highlights/DM_top100.html as well as the
>> archives of this listserv.
>>
>> Lots of pharmaceuticals are coming to our treatment plants, and yes,
>> many wastewater agencies are concerned. Some pharms are broken down,
>> some adsorb to biosolids and some come out the end pipe. Every
>> treatment plant is different, with various kinds of technology.
>> Reverse osmosis, UV, ozonation, carbon filtration and now ultrasound
>> are all possible treatments that may break down or remove the
>> pharmaceuticals. Unfortunately, some pharms respond better to certain
>> treatments than others, meaning that a mix of treatments would be
>> necessary to get 'em all. Also unfortunately, the burden of bringing
>> this technology to our plants falls on our ratepayers -- real people,
>> rather than the true
>> culprits: over-prescription, formulations that don't break down and a
>> lack of EPA and FDA collaboration in ensuring pharmaceuticals are
> tested
>> for their environmental impacts.
>>
>> So pollution prevention is key for the portion of pharmaceuticals that
>
>> are unused by hospitals, hospice, or residents, because that's much
>> less expensive than, say reverse osmosis. Some people on this list are
>
>> working toward a solution for disposal that will comply with DEA
>> regulations as well as state and other federal law. The red tape is
>> unbelievable.
>>
>> For pharms that we take and pass through our bodies, I believe some
>> folks are looking at whether reformulation may be possible.
>>
>> Best,
>> Jen Jackson
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