[Pharmwaste] Not sure how to get rid of extra opioids or antibiotics? The pharmacy may not know, either

Thu Jan 2 11:17:39 EST 2020

If they read the FDA guidance, flushing is what they still recommend for opioids. So, that part is not surprising. I do know we’ve addressed the availability of collection in a couple of the newsletters that the Board of Pharmacy sends to pharmacies, and we’ve also done a webinar for them. But, I just ran into a pharmacist that didn’t know about our extensive collection network. At this point, a pharmacist almost has to be hiding under a rock to not be aware of collection, especially given that so many chains now collect, and that disposal question seems to be a common one from households. It doesn’t surprise me though that they don’t follow state’s recommendations and still defer to FDA’s “guidance”.

I was curious to see the difference in opioids and antibiotics. It could be that the author doesn’t understand that most jurisdictions that have invested in capturing opioids through collection do not, in fact, recommend flushing.

Last time I checked in with FDA, they said they might change their guidance when collection infrastructure is more developed. So, that decision is entirely subjective. If they could at least refer people to states and to follow their recommendations, that would help.

Disappointing article pushing flushing.

From: Pharmwaste <pharmwaste-bounces at lists.dep.state.fl.us> On Behalf Of Deborah DeBiasi
Sent: Wednesday, January 01, 2020 7:28 AM
To: Pharmwaste list <pharmwaste at lists.dep.state.fl.us>
Subject: [Pharmwaste] Not sure how to get rid of extra opioids or antibiotics? The pharmacy may not know, either

It’s surprising, and concerning that pharmacies are still giving out incorrect information.  We still have work to do.

Not sure how to get rid of extra opioids or antibiotics? The pharmacy may not know, either
By Shelby Lin Erdman, CNN
Updated 6:35 PM ET, Tue December 31, 2019
 (CNN)When it comes to getting rid of prescription drugs, fewer than half of the pharmacies surveyed for a new study gave accurate guidance that met US Food and Drug Administration standards for disposing of unused opioids and antibiotics.
Researchers from the University of California at San Francisco <https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ucsf.edu%2Fnews&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218258757&sdata=E9Yq%2FqusBcwzK0HgvFLPKwQwKK0dkhmaEj1HwSlKcD0%3D&reserved=0> surveyed nearly 900 California pharmacies by phone over a two-month period in 2018 during the week and on weekends. For the study, published Monday in the journal Annals of Internal Medicine<https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fannals.org%2Faim&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218268744&sdata=tyf5K4O800O2c2gz9PGhYqtIxWNKLaC0kzt4fz8W9L8%3D&reserved=0>, researchers posed as parents with leftover opioids and antibiotics from a child's surgery.
They were looking for correct drug disposal instructions based on US Food and Drug Administration guidelines<https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fconsumers%2Fconsumer-updates%2Fwhere-and-how-dispose-unused-medicines&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218268744&sdata=tDjvXf16X3Yw0z3OL9B3W0%2Fg0fN9exERTcRONj3l3GA%3D&reserved=0>.
The agency recommends taking unused medications to drug disposal or takeback programs as the best way of getting rid of unused or unwanted drugs. If a disposal program is not available, the agency suggests mixing antibiotics with coffee grinds or kitty litter, sealing the mixture in a container and throwing it in the garbage. It recommends flushing opioids.

Researchers found only 47% of pharmacies gave correct instructions on how to dispose of antibiotics and 34% provided correct information about opioid disposal. On weekends, only 15% correctly directed customers about safe antibiotic disposal and 7% gave the correct information about disposing of opioids.

When asked about takeback programs at the 898 pharmacies, 91 said they had a program for antibiotic disposal and 82 said they had a program for opioid disposal.

"This clearly points to the need for better dissemination of information on proper medication disposal," Hillary Copp, senior study author and associate professor of urology at UCSF, said in a statement.

"The FDA has specific instructions<https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fdrugs%2Fsafe-disposal-medicines%2Fdisposal-unused-medicines-what-you-should-know&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218278739&sdata=FiBUp4ZPxLKigR80vYg1tZNL4jRn7C5%2Fz%2FoXZv7RJxc%3D&reserved=0> on how to dispose of these medications, and the American Pharmacists Association has adopted this as their standard. Yet it's not being given to the consumer correctly the majority of the time," Copp said.
The improper disposal of medication can result in antibiotic resistance, pollution, child and pet poisonings and drug misuse.

Deborah L. DeBiasi
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