[Pharmwaste] Drug Take-back Not Free & Childhood Poisoning by Medication on the Rise

Matthew C. Mireles mirelesmc at earthlink.net
Sun Sep 18 12:54:59 EDT 2011


Margaret, you are absolutely correct about my "all programs are free" comments.  Our research intern who compiled data from our Annual Survey of drug take-back programs reminded me that all but one program is open to the public; most of the programs do not charge individuals for returning UEMs.  However, as you pointed out, there are enormous costs associated with organizing and implementing a program.

Grants and sponsorships won't cover all the expenses.  Illinois passed a bill to add an extra charge for drug offenses, that would be used to support drug take-back. Others are pursuing product stewardship legislation.  Maine at one time proposed a 25 cent charge on each prescription to convey the message that UEMs are everyone's problem and responsibility, including patients and consumers.

Our group actually specializes in the study of patient safety. Our National UEM Project is just one of many research projects we have ongoing.  We are interested in learning more about the root causes of overprescription, overconsumption, non-adherence, stockpiling and improper disposal of UEMs.  Our work emphasizes greatly on the patient and consumer as the center of our healthcare system. Therefore, my comment was focusing mostly on the perspective of the patients and consumers who are dealing with UEMs.  

Right now, we have been impressed with the all the responses and feedback to our Annual Survey and the publication of the National Directory of Drug Take-Back and Disposal Programs.  I believe it may be the only, most comprehensive listing of 492 programs.  Several more are out there; some refused to complete the survey for whatever reason.

Your organization Take Back Your Meds Coalition in WA State is one of the most well-organized and -operated programs in the country!  

Thank you for your comments and reminder that funding for drug take-back in the US will remain a fiscal challenge for many.  sustainability of the program over time is one of the measures we are recording, BTW.  We wish all of you the best in your endeavor.  But according to our recent discussion with the GAO, the challenge may be hinged more on the political leadership of which agency should guide or direct drug take-back systems for consumers.  We have our own theory, and you probably do too.

Matthew Mireles
Community Medical Foundation for Patient Safety




-----Original Message-----
>From: "Shield, Margaret" <Margaret.Shield at kingcounty.gov>
>Sent: Sep 17, 2011 4:14 PM
>To: "Matthew C. Mireles" <mirelesmc at earthlink.net>, "Walters,Scott (DEP)" <scwalters at pa.gov>, "DeBiasi,Deborah (DEQ)" <Deborah.DeBiasi at deq.virginia.gov>, "pharmwaste at lists.dep.state.fl.us" <pharmwaste at lists.dep.state.fl.us>
>Cc: "djlefeber at comofcom.com" <djlefeber at comofcom.com>, "Elizabeth A. Smith
> PhD" <easmith at comofcom.com>
>Subject: RE: [Pharmwaste] Drug Take-back Not Free & Childhood Poisoning by Medication on the Rise
>
>Thanks for all your great work Matthew and this latest study adds more evidence to the magnitude of the crisis of accidental poisonings from medicines in the home.
>I have to respond to the "all programs are free" statement though.  Nothing is free.  Somebody is paying the bill.  Finding adequate financing for community drug take-back programs is a very real problem.  It's so concerning that I don't want to let that statement fly by, even though I'm sure it wasn't intended to imply that take-back programs are without costs.
>
>In Washington State, we have successful, secure medicine take-back programs that are collecting large amount of medicines even without much promotion, but they're struggling to maintain funding, and most communities cannot afford a program at all.  These "no-cost to consumer" drug take-back programs are mostly being paid for by law enforcement, by public health departments, by cities and counties.  Those funds come from taxes and rates on local residents and on businesses from every sector.  A few take-back programs have some grant dollars from various sources, also often taxpayer funded.  And the sporadic, temporary DEA coordinated take-back days are pulling funds from DEA's budget from federal taxes.
>
>Local and state governments are facing the biggest crisis of funding I've seen in my lifetime - essential services are being cut beyond the bone. Local governments already have to shoulder costs of the human health impacts from poisonings, addiction, and overdoses from these medications.  Now we're expected to pay for drug take-back programs too?!?
>
>It's not a core function of government to clean up the mess from the products sold by the multi-billion dollar pharmaceutical industry.
>Our estimate for the cost of a statewide medicine take-back program for WA State is well under $2.5 million per year, even with anticipation of large amounts of medicines collected.  Comparing that cost to the total sales of prescription and over-the-counter medicines in our state, which is > $4 billion annually, works out to 1 penny for take-back for every $16 in drug sales. So the cost of a statewide, comprehensive, well-promoted drug take-back program would be only about 2 pennies per the cost of an average prescription.  Pharmaceutical companies can incorporate this relatively small cost into the cost of their product to provide sustainable and adequate funding for take-back programs. Sheriffs can't do that, local governments can't do that.
>
>The Take Back Your Meds Coalition in WA State is working to create effective medicine take-back programs for all communities in the state.  Everyone is doing their share in this effort except the drug companies who are making the product.  We would like to see the pharmaceutical industry stop saying "NO" to providing support for drug take-back programs and start saying "YES" to helping our communities solve this big problem.
>
>See more info at www.TakeBackYourMeds.org
>
>Thanks for reading to the end of this long message!
>Margret
>
>Margaret Shield PhD
>Policy Liaison
>Local Hazardous Waste Management Program in King County
>130 Nickerson Street, Suite 100, Seattle, WA 98109-1658
>(w) 206-263-3059
>(c) 206-265-9732
>
>Protect Our Kids, Families, and Environment - www.TakeBackYourMeds.org
>________________________________________
>From: pharmwaste-bounces at lists.dep.state.fl.us [pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Matthew C. Mireles [mirelesmc at earthlink.net]
>Sent: Friday, September 16, 2011 1:01 PM
>To: Walters,Scott (DEP); DeBiasi,Deborah (DEQ); pharmwaste at lists.dep.state.fl.us
>Cc: djlefeber at comofcom.com; Elizabeth A. Smith PhD
>Subject: RE: [Pharmwaste] Childhood Poisoning by Medication on the Rise
>
>>From the homes that we have seen, medicines are often left open for easy access in original containers on counters, dining and kitchen tables.  If you get tired of chatting with the ER folks, visit your local vets.  Pets are also frequent victims of accidental poisoning from prescription meds.  Find your nearest drug take-back site.  Practically, all programs are free!
>
>
>-----Original Message-----
>>From: "Walters, Scott (DEP)" <scwalters at pa.gov>
>>Sent: Sep 16, 2011 2:56 PM
>>To: "Matthew C. Mireles" <mirelesmc at earthlink.net>, "DeBiasi,Deborah (DEQ)" <Deborah.DeBiasi at deq.virginia.gov>, "pharmwaste at lists.dep.state.fl.us" <pharmwaste at lists.dep.state.fl.us>
>>Cc: "djlefeber at comofcom.com" <djlefeber at comofcom.com>, "Elizabeth A. Smith
>> PhD" <easmith at comofcom.com>
>>Subject: RE: [Pharmwaste] Childhood Poisoning by Medication on the Rise
>>
>>It does make sense that a large amount of this would be from grandparents' medications.  As you age, not only do you tend to use more medications, arthritis makes the child-proof caps very difficult to open.  Many seniors replace these caps with easier to open ones.
>>
>>-----Original Message-----
>>From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Matthew C. Mireles
>>Sent: Friday, September 16, 2011 3:39 PM
>>To: DeBiasi,Deborah (DEQ); pharmwaste at lists.dep.state.fl.us
>>Cc: djlefeber at comofcom.com; Elizabeth A. Smith PhD
>>Subject: Re: [Pharmwaste] Childhood Poisoning by Medication on the Rise
>>
>>this is absolutely shocking, when the deaths and morbidities are totally preventable!  As a matter of fact, almost 40% of accidental poisoning among children happen at grandparents' homes according to the MN poison center.
>>
>>BTW, we are working with more community-based groups that are trying to prevent or reduce substance abuse among teens and adults.  Since 2008, our group has been surveying drug take-back programs around the country.  We publish the National Directory of Drug Take-Back and Disposal Programs every few years to help communities and local organizations set up and run safe and legal collection of unused and expired meds.  Most communities use this Directory to locate the nearest drug take-back sites.  The second edition is now available.  If you like a copy, let me know.
>>
>>We are trying to measure the effectiveness and impact of drug take-back programs in the communities. This was a question posed to us by the GAO looking at drug take back in the US.  If you are doing research in this area, please let us know.
>>
>>
>>Matthew C. Mireles
>>PI: The National Unused & Expired Medicines Project Community Medical Foundation for Patient Safety
>>832-778-7777
>>
>>
>>
>>
>>
>>
>>-----Original Message-----
>>>From: "DeBiasi, Deborah (DEQ)" <Deborah.DeBiasi at deq.virginia.gov>
>>>Sent: Sep 16, 2011 1:39 PM
>>>To: pharmwaste at lists.dep.state.fl.us
>>>Subject: [Pharmwaste] Childhood Poisoning by Medication on the Rise
>>>
>>>http://www.webmd.com/parenting/news/20110915/childhood-poisoning-by-med
>>>ication-on-the-rise
>>>
>>>
>>>
>>>Childhood Poisoning by Medication on the Rise
>>>
>>>Study Shows Increase in ER Visits Due to Poisoning From Medicines in
>>>Kids Age 5 and Under
>>>
>>>By Kathleen Doheny
>>>
>>>WebMD Health NewsReviewed by Laura J. Martin, MD Sept. 16, 2011 -- Childhood poisonings by medication are up dramatically, despite repeated messages to adults to keep prescription and over-the-counter medicines out of reach and locked up.
>>>
>>>"Overall, the visits to the emergency department for poisoning by medicines [in children age 5 and younger] were up 30%," says G. Randall Bond, MD. Bond is an emergency physician at Cincinnati Children's Hospital Medical Center and medical director of the Cincinnati Drug and Poison Information Center.
>>>
>>>The increase occurred over an eight-year period, from 2001 to 2008. During that same time, the number of children age 5 years and under in the U.S. went up only 8%, Bond says.
>>>
>>>The majority of the accidents involved a child getting into medicines, not a parent or other caretaker giving a child an incorrect dose, Bond tells WebMD.
>>>
>>>The study is published in The Journal of Pediatrics.
>>>
>>>Tracking Childhood Poisonings
>>>
>>>The researchers evaluated patient records from the National Poison Data System of the American Association of Poison Control Centers. They looked at the years 2001 to 2008 and focused on children age 5 years and younger.
>>>
>>>All the children were evaluated at a health care facility after being unintentionally exposed to over-the-counter or prescription medication. The researchers categorized the doses as those the child took by mistake or an error made by an adult giving the child medicine.
>>>
>>>The researchers looked at visits to emergency departments, hospital admissions, injuries, and trends.
>>>
>>>They evaluated a total of 453,559 records. In 95% of cases, the child got into the medicine. Most problems occurred after children got into prescription medicines.
>>>
>>>Children getting into prescription medicines accounted for more than 248,000 emergency department visits, nearly 42,000 hospital admissions, and more than 18,000 injuries.
>>>
>>>Most often, the drug ingestions that caused the most serious illnesses involved opioid painkillers, sedatives, and heart medicines.
>>>
>>>Over the eight years, 66 deaths occurred, Bond says. More often, he says, ''the injuries were transient, as in they had a coma and recovered, or they had low blood sugar and recovered."
>>>
>>>For most, the poisonings had no long-term ill effects, he says.
>>>
>>>Explaining the Increase in Childhood Poisonings
>>>
>>>The increase in childhood poisonings by medication are easily explained, Bond says. "More medicines are out there for kids to get in to," he says.
>>>
>>>For instance, 50% of adults reported taking at least one prescription medicine in a 1998 survey, and 7% five or more, Bond says, citing other research. By 2006, the same researcher found 55% took at least one prescription medicine, and 11% took five or more.
>>>
>>>"These are preventable injuries," Bond says. Parents need to be reminded that medications need to be ''out of sight and locked up."
>>>
>>>That means immediately after taking them or giving them to children, he says Bond cites cases of children being poisoned after a parent gave them a proper dose, but then left the medication out within reach for a few minutes.
>>>
>>>Parents should treat all medicines the same way when it comes to keeping them locked away, Bond says. "Sometimes parents think cold medications are in a different class and are safer," he says. Not true, he tells them.
>>>
>>>Soon, more help may be coming from prescription drug manufacturers, Bond says.
>>>
>>>He works with the PROTECT Initiative, a collaboration of government agencies such as the CDC, nonprofit organizations, and industry to promote medication safety.
>>>
>>>Initially, the project targeted non-prescription medicines. It sponsored a campaign encouraging adults to put medicines up, away, and out of sight.
>>>
>>>Next, Bond says, the project will start discussions with pharmaceutical companies about how to help reduce poisonings. Strategies include, for instance, adding a ''flow dispenser'' to liquid medicines. That way, children can't take off the top and drink it all.
>>>
>>>Advice for Parents
>>>
>>>Adults can keep handy the number of the American Association of Poison Control Centers, 800-222-1222.  All 57 U.S. centers can be reached by the same number. The organization's web site also offers information about an app for the iPhone.
>>>
>>>The increase of 30% in emergency department visits for childhood poisonings by medication is termed ''shocking'' by Michael Cohen, RPh, ScD, president of the Institute for Safe Medication Practices.
>>>
>>>He reviewed the findings for WebMD.
>>>
>>>The new study, he says, ''definitely shows we still have a big problem out there."
>>>Adults can take some simple steps to reduce risk, Cohen says.
>>>
>>>Be sure the child-resistant cap is closed correctly. Cohen finds they are often replaced incorrectly.
>>>
>>>Treat patches infused with medicines (such as painkillers or nitroglycerin) the same as other medicines. He cites cases of children digging patches out of the trash and applying them. To dispose of them safely, he suggests folding them and putting them in a childproof container. Another option, depending on the manufacturer's instructions, is to flush them, he says.
>>>Be aware of the ''granny syndrome."  When grandparents visit, they may store medicines in a suitcase left on the floor or in their pocketbooks, he says. Parents can remind them to put up and lock up the medicines.
>>>
>>>Store medicines in a cabinet above the children's eye level. Avoid the bathroom, as there is too much moisture. If the cabinet does not have a lock, buy an inexpensive plastic lock at a home supply store.
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>Deborah L. DeBiasi
>>>Email:   Deborah.DeBiasi at deq.virginia.gov WEB site address:
>>>www.deq.virginia.gov Virginia Department of Environmental Quality
>>>Office of Water Permit and Compliance Assistance Programs Industrial
>>>Pretreatment/Whole Effluent Toxicity (WET) Program PPCPs, EDCs, and
>>>Microconstituents www.deq.virginia.gov/vpdes/microconstituents.html
>>>Mail:          P.O. Box 1105, Richmond, VA  23218
>>>Location:  629 E. Main Street, Richmond, VA  23219
>>>PH:         804-698-4028      FAX:      804-698-4032
>>>
>>>---
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