Correction & More Info RE: [Pharmwaste] Pharmacy Receptacle Experience Update

Tue Oct 13 12:25:31 EDT 2015

All,

I need to correct one of the statements I made in the email I sent yesterday. I stated that the DEA  restricts liquids and inhalers from being deposited. Several of you sent me comments and you are right, this is NOT in the DEA regs! Sorry about that. I'm not sure where my mind carried that over from. Our unit does have a placard that states no liquids or inhalers or sharps. I'm going to check with our vendor and make sure that that is not a UPS/shipping restriction and see about removing the placard.

In the meantime, I don't want my misinformation to proliferate! This is what I love about the listserv....good feedback and sharing of information.

One thing I would like to see the vendors of receptacles offer is "on demand" inner liner/box provision. I believe that as of now, they all want us to prospectively select how many liners we need per month or per year. That's difficult to predict for a new service like this and it's something that's likely to change as more people learn of the receptacles and usage increases. It seems logical to always keep 1-2 on hand, then each time a full box is shipped for destruction, a new one would be sent. I understand that they need a commitment in order to not lose money on this service. Perhaps, they could set a required minimum that's near their break-even point or a minimally accepted profit and then allow for flexibility beyond that. If I recall correctly, one of the vendors allows for a one time change to the number of liners being requested. There's also a product Ronica shared with me called Big Belly Solar. It's a sensor that detects how full a bin is and provides that info to you.

I also wanted to mention that we do NOT plan to have the receptacle take the place of our take back events. We still have our events twice per year, once in the spring and once in the fall. In fact, in Amarillo, we had one on September 12th (we already had our dates set when DEA announced they were reinstating their event). 776 cars came through and 1900 pounds of meds were collected. The community loves the events. It brings attention to the issue and allows us to educate the public through media interviews and handout materials. At this point, I don't feel that a single solution (i.e. take back events, receptacles, etc.) is going to be sufficient. However, if disposal receptacles (without restrictions on items like liquids and inhalers) were to become universally available in pharmacies, take back programs may become unnecessary.

The down side of all of this is that we are still approaching this as a disposal problem. We've got to make changes on the prescribing, dispensing, and marketing ends (what I like to call the "front end") to address the true underlying issues. This is why we continue to collect data at our events. We are getting closer to submitting manuscripts for publication! Notable problem areas: overprescribing of pain meds following procedures (the CDC has new guidance for prescribers about this), ointments and creams are dispensed in quantities/sizes that are much greater than what consumers use, nebulizer solutions are dispensed in quantities that are much greater than what consumers use, there seems to be no "checks and balances" process in place for mail order/auto refill leading to HUGE quantities of wasted meds, vitamin and supplement products are marketed in much larger quantities than are used. If any of you are affiliated with pharmacy schools, these events are a win/win. Utilizing students to help collect data makes it affordable and provides them with a learning opportunity beyond anything that can be taught in the classroom. The students are always amazed at the amount of meds that are wasted. And, as university students, they've all had background checks. We haven't had as much success getting medical students involved, but we're working on it. We have a data collection system that we can share at no cost.

Here are a few pics from our last event. We've got another one this Saturday in Abilene and conducted one in Lubbock on October 3rd as well.

[Two officers are in this photo!][cid:image010.jpg at 01D105A9.DBA9DF50][cid:image011.jpg at 01D105A9.DBA9DF50][cid:image012.jpg at 01D105A9.DBA9DF50][cid:image013.jpg at 01D105A9.DBA9DF50]

Jeanie Jaramillo-Stametz, PharmD
Managing Director, Texas Panhandle Poison Center
Asst. Professor, Texas Tech UHSC School of Pharmacy
Director, Medication Cleanout
1300 S. Coulter St., Suite 105
Amarillo, TX 79106
(office): (806)414-9299
(mobile): (806)376-0039

From: Jaramillo, Jeanie [mailto:Jeanie.Jaramillo at ttuhsc.edu]
Sent: Monday, October 12, 2015 3:14 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] Pharmacy Receptacle Experience Update

Hello All,

As promised, here is my update on how our pharmacy-based medication disposal receptacle experience is going.

Recap: The Texas Panhandle Poison Center is part of Texas Tech's School of Pharmacy. The School of Pharmacy runs a retail pharmacy in the School of Medicine/Allied Health building next door (this building houses multiple practice clinics.) Our poison center has run a periodic, twice annually medication take back event as a poison prevention measure of one of our grants. We were recently awarded a community grant for the events, thus freeing up poison funding. We are using this funding to support a permanent pharmacy-based collection receptacle at the pharmacy next door.

The DEA authorized collector registration was simple. It took approximately 5 minutes and we had the printable PDF certificate in hand. For the disposal service, we are utilizing RxReturnBox (a division of RedBag service). With RxReturn, we are provided with boxes and inner liners per DEA specifications. The boxes are pre-paid for shipping when full, utilizing UPS. So, when a box is full, we take it out of the receptacle, secure the inner liner closed, seal the shipping box, place the pre-paid shipping label on it, notify UPS that it's ready, and place it in the University's secure outbound package pickup room.

We installed our first 40 gallon liner in the receptacle on 9/14. We removed it for shipping on 10/01. The process has been relatively smooth. We developed our own forms for keeping the DEA required documentation. (I'll attach to this email.) We have promoted the box very little at this point. The PIC at the pharmacy felt that the box would be inundated, so we are taking it slow in terms of getting the word out. Customers at the pharmacy are inquiring regarding what it is and seem to be eager to use it.

Challenges:

*         Since this is a relatively new process with UPS, they've made adjustments. The initial boxes/inner liners were "downsized." My guess is that they were too bulky and difficult to handle when full, as even the smaller boxes we have now are bulky and heavy when full.

*         We ordered the stainless still version of the receptacle rather than the powder-brushed white model. When we installed it, we realized how much space was available on the front and thought we'd order large magnets with our current desired message to place on the front. As it turns out, magnets don't stick to it! Thankfully, we tried it out before we ordered the magnets. So, now, we design our desired message in Word or PowerPoint, laminate it, and tape it to the front. Of note, the vendor does offer the capability for interchangeable messaging "windows" on the units.  Basically, a hard plastic sleeve where you can slide in your info and change it out as needed.

*         According to the DEA, no liquids or inhalers or sharps should be inserted in the receptacle. We've placed a sign on it to reflect this directive, but we really can't monitor what people are placing in there close enough to control this. When the pharmacy staff is standing at their counter, they can try to keep an eye on what is going in, but they are usually busy and I don't feel that it's appropriate to expect them to monitor this on top of their other duties.

*         Today the receptacle stank!!!! I could smell it when I was about 2 feet away from it. I think someone must of put shark oil or something in there! The unit is well-contained, but it doesn't block against odors.

Other notes:

*         We can't tell if the box is full without opening the unit. We need a peep hole or something. For now, we have made a log sheet for "visual checks". We note how full the box is to guide us as to when we need to check again. When we get it all settled, I think we'll have a better idea of how frequently to change it out and this won't really be an issue.

*         Since we hold the twice annual take back events, we often have stragglers come to the SOP thinking they can "drop off" their meds. This box now gives us somewhere close to send them. (See our map attached.)

Surprises:

*         Now that our pharmacy is an "authorized collector," we've had several LTCFs in the area ask about us setting up receptacles at their locations. This is not something we're doing just yet, but definitely something we're considering.

Next steps:

*         Begin active promotion of use of the receptacle.

[cid:image001.jpg at 01D105A0.55E4F6B0]

Jeanie Jaramillo-Stametz, PharmD
Managing Director, Texas Panhandle Poison Center
Asst. Professor, Texas Tech UHSC School of Pharmacy
Director, Medication Cleanout
1300 S. Coulter St., Suite 105
Amarillo, TX 79106
(office): (806)414-9299
(mobile): (806)376-0039

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