[Pharmwaste] Sampling of med take back items

Fri Jan 22 10:54:32 EST 2010

We can all work together.  I certainly am not trying to mandate that all collections must be inventoried.  In fact, in the presentations I provide, I advocate that there need to be several models.  If you have a police dept that is willing to take everything collected and incinerate it all, simply weighing the collections is great for an outcome measure.  This is a viable model for programs that have limited sources and from a poison control and abuse prevention perspective, this is just as effective as any inventoried program.

Our events are conducted legally with law enforcement participation.  We do collect non-identifiable patient information through a survey (i.e. why are you disposing of these meds? Change in dose, change of drug, death of patient, etc.; What would you have done with these if this event had not occurred?)  However, to be able to do this, we did go through our Institutional Review Board.  The purpose of the IRB is to assure the protection of the safety, rights, and welfare of people.  This is not in violation of privacy laws.  Other specific details could be collected with the use of consent forms that would also require approval through an Institutional Review Board.

We are trying to get unwanted meds out of households and properly disposed of while also researching why the meds are leftover, so we can begin to approach the root cause.  Yes, this is rudimentary at this point, but we must start somewhere.

What have we learned?  We’ve only had one event thus far, but what appears to be evident is that many over-the-counter products do not need to be marketed in quantities greater than 10.  Nebulizer solutions do not always need to be provided in boxes of 100.  More than half of the participants would have simply kept (at home) the meds that they turned in if the event had not been available.  Although the kitty litter/coffee grounds method from household disposal is advocated, many people still believe this is an environmentally poor practice.

I certainly did not mean to imply that what you are saying is wrong.  This forum is simply for the sharing of information and both of our perspectives are helpful.  I have gained much valuable information from the list and it has facilitated many networking opportunities for which I am appreciative.

Jeanie Jaramillo, PharmD
Managing Director, Texas Panhandle Poison Center
Assistant Professor, Texas Tech UHSC School of Pharmacy
1501 S. Coulter St.
Amarillo, TX 79106
P: (806) 354-1611
C: (806) 672-0833
F: (806) 354-1667
Cisco IP: 30412

From: Dennis Lucia [mailto:djlucia at gw.dec.state.ny.us]
Sent: Friday, January 22, 2010 7:52 AM
To: pharmwaste at lists.dep.state.fl.us; Stevan Gressitt; Jaramillo, Jeanie
Cc: Allan Geisendorfer; Rod Larson; Jennifer_Crittenden at umit.maine.edu; Len Kaye; John Schloss
Subject: RE: [Pharmwaste] Sampling of med take back items

Before you attempt to mandate that you need drug statistics for all collections.  What have you learned from the collections that have been held, where data on the types of drugs and quantity has been recorded?

Doing an analysis of every 1/10 or 1/20 or 1/100 will not tell you much and requires that at each collection you have a trained pharmacist.  By the way, you do know that having anyone other than law enforcement handle the unwanted controlled substances at a collection event is illegal.

Are you planning to collect additional information in violation of privacy laws.
Like:
Diagnosis; length of treatment;
Did the patient have health insurance, type of health insurance;
1st prescription or multiple times that it has been prescribed
Male/female, age.
Why did patient stop taking drug? Reaction, type of reaction? Got better? Died?
You will also need info on the location where the collection takes place and demographic on the patient, regarding their life style, and medical history.

There are many variables that make the analysis complicated...

Are you trying to get unwanted drugs out of households and properly disposed of or are you trying to do a research study to analyze why patients don't take the medications prescribed to them and why drugs are being over prescribed?

Let's simplify the drug collections and work on the other issues in other ways!!!

Dennis J. Lucia, P.E.
Pollution Prevention Unit
Division of Environmental Permits
New York State Department of Environmental Conservation
625 Broadway  4th Fl.- SW
Albany, NY 12233-1750
(518) 402-9469
Fax (518) 402-9168

>>> "Gressitt, Stevan" <Stevan.Gressitt at maine.gov> 1/22/2010 7:37 AM >>>
Your internal consistency idea looks good. I am not the mathematician or statistician, but I suspect there is enough horsepower on this list to advise. It might also be interesting to see the difference in consistency at 1/10 1/20 1/100 depending on sixze as we all who are trying to sample will probably do best if we adopt a “best practice”

Stevan Gressitt, M.D., Medical Director
Office of Adult Mental Health Services
Department of Health and Human Services
Marquardt Building, 2nd Floor
11 State House Station
32 Blossom Lane
Augusta, ME  04333-0011
Ph: (207)287-4273
Fax: (207)287-1022
Cell Phone: (207) 441-0291
E-Mail : stevan.gressitt at maine.gov<mailto:stevan.gressitt at maine.gov>
http://www.maine.gov/dhhs/mh/

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________________________________
From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Jaramillo, Jeanie
Sent: Wednesday, January 20, 2010 2:29 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] Sampling of med take back items

I had no luck with having our epidemiologist help with a sampling protocol.  He’s already being pulled in many different directions.  I did want to mention that our next event (3/27) will likely be the last one in which we conduct a full inventory.  We will be collating the items collected by participant (i.e. these 20 items all came from car #1), which will be a little more work this time around.  I believe this will allow us to validate sampling techniques that we could use for future events.  For instance, we could pull out the data from every Xth participant, summarize it, and extrapolate it to the total number of participants and then compare that to the full inventory.  I’m sure there’s some statistical method to do that.

Jeanie Jaramillo, PharmD
Managing Director, Texas Panhandle Poison Center
Assistant Professor, Texas Tech UHSC School of Pharmacy
1501 S. Coulter St.
Amarillo, TX 79106
P: (806) 354-1611
C: (806) 672-0833
F: (806) 354-1667
Cisco IP: 30412

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