Dr. Amy Tiemeier, Pharm.D., BCPS

St. Louis College of Pharmacy

RRegional egional eeXXcess cess MEMEdication dication DDisposal isposal SServiceervicePartnershipPartnership

St. Louis: Missouri &

Mississippi Rivers converge

• MO and IL • 5 counties

Objectives: Identify 25 regional

supermarkets that will serve as collection centers.

Establish an environment friendly methodology to dispose of unwanted medications.

Plan and present a major regional workshop for seniors through our senior services partners.

Provide educational programs to 10-20 regional schools on drug safety, etc.

Conduct relevant research on the topic. Such as:

o Demographics of patronso What types of medications

are being turned in o Previous disposal methods

MeasurementMethodology: Surveys at point of

collection Data collected at

point of collection Feedback from

involved parties Attendance at

Regional Senior Workshop(s)

Pre/post senior survey on knowledge gained

# of school programs conducted

# of students in the programs

Pre/post student survey on knowledge gained

Outcomes: Immediate Public awareness of an issue

that affects the region but until now has not been addressed on a major scale.

Intermediate Removal of medications that

harm the environment and pose a health hazard.

Long Term An attitudinal change of the

general public that currently accepted and promoted means of medication disposal are not correct.

A shift in the advertising by major pharmaceutical companies towards an improved disposal method for unused medications.

• Publications have had a circulation of 704,300 in metropolitian area.– Belleville News Democrat– Schnucks Advertising Circulars– Metropolitan Sewer District Bill Inserts

• Community outreach activities of the partners included over 20 community based programs that contacted an additional 2,136 area residents. – Mideast Area Agency on Aging (MEAAA)– OASIS– AARP

• School based programs were offered in 15 different class settings and reached 387 students and 15 teachers.

Educating atAARP Health

Fair

Educating atAARP Health

Fair

Area Resources for Community and Human Services (ARCHS)

Area Resources for Community and Human Services (ARCHS)

Schnuck Markets, Inc. Schnuck Markets, Inc. Cintas Corporation Cintas Corporation

St. Louis College of Pharmacy St. Louis College of Pharmacy

Missouri AARP Missouri AARP

Mid-East Area Agency on Aging Mid-East Area Agency on Aging

St. Louis OASISSt. Louis OASIS

Senior Services Plus Senior Services Plus

WK Health WK Health

Stericycle Stericycle

St. Louis City Agency on Aging St. Louis City Agency on Aging

Metropolitan Sewer District Metropolitan Sewer District

STL County Waste Management Program STL County Waste Management Program

MO Environmental Water Association MO Environmental Water Association

Living Lands and Waters Living Lands and Waters

American Water Company American Water Company

PhRMA PhRMA

Saint Louis University Saint Louis University

Phase 1Phase 1

Phase 2Phase 2

Phase 3Phase 3

√US EPA√US EPA Human Subjects Review & St. Louis University

IRB Board√Hazardous Materials Information Center (US Dept of Transportation) √MO Bureau of Narcotics and Dangerous Drugs

(BNDD) √US DEA, MO & IL √MO Board of Pharmacy √MO and IL EPA

• EPA and federal DEA approved plan of separate bins, multiple person check off, and officer picks up immediately following the drop off period. – Specifically for this grant

• MO State BNDD would not agree• Therefore, we did not accept control medications

• 20 locations, 3 hour drop off time once a month • Document controls but do not accept • Accept non-controlled unwanted medications• Inform patrons what to do with non-returnable

materials • Only collect medications during collection times

Greeter TechStudent Extern Pharmacist

•Show location•Manage flow

•Market •Ready materials• Assist with workflow

•Document •Determine drug •Discuss drug related problems

•Check drug documentation •Feedback

Liability/reliability of information Liability/reliability of information

• Greet and explain purpose • Background • Facts & Comparisons 4.0 drug database on

students laptop for quick tablet identification• Clinical Pharmacology used for identifying potential controls • Educational materials offered

• 1st contracted company did not have enough manpower on Fridays although we were assured by management that this could happen

• Little to no response from company when issues brought to their attention

• Company was not invested in project• Contract was cancelled• Did not cost grant as there was a

breech in contract

Box

2 Plastic bags (one for backup in case of leakage, you can double bag the meds)

Tape roll (use every month)

Bill of Lading (“manifest”) via email

Tie for plastic bag (not pictured)

Preprinted shipping label

• Through September 2008– 1,949 lbs.– Does not include box or

container

• Completed: 547 surveys• Demographics

– Average Age: 57– Ethnicity

• Caucasian: 80%

– Gender: 71% female

• 72% did not bring back any medications

• 70% preferred to bring back to pharmacy

• Overall Participation: > 900 patients• Store Participation: four patients per store

per event• Average # of Meds Returned: 9• Average age: 63.5• Gender: 75% female• Ethnicity: 96% Caucasian

“How did you dispose of your medications previously?”– Kept: 20%– Flushed: 44%– Trash: 20%– Saved for future use: 1%– Gave to friend: 1%– Collection Program: 4%– Other: 10%

• 8,800 individual prescriptions, OTC and herbals collected– ½ were tablet or capsules non-control

prescription items– Controlled substances: 500 tablets

and capsules attempted – OTC: 1,700 tablets and capsules– Herbal: 24 tablets and capsules

• Tablets and Capsules– > 190,000

• Liquids– Over 800 bottles

• Inhalers– 110 (MDI or DPI)

RxMEDSCommunity Partners ARCHS (www.stlarchs.org)

Schnuck Markets, Inc. (www.schnucks.com/pharmacy/rxreturns.asp)

St. Louis College of Pharmacy (www.stlcop.edu)

Cintas (www.cintas.com)

AARP Missouri Chapter, Senior Services Plus

OASIS & Mid-East Area Agency on Aging