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SAFE MEDICINE DISPOSAL FOR ME *** A way for Maine’s citizens to safely and properly get rid of unused or expired medicine Funded by the U.S. EPA (Grant #CH-83336001-0) and an allocation from a Fund for Healthy Maine administered by the Maine Drug Enforcement Agency. Disclosure.

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A way for Maine’s citizens to safely and properly get rid of unused or expired medicine

Funded by the U.S. EPA (Grant #CH-83336001-0) and an allocation from a Fund for Healthy Maine administered by the Maine Drug Enforcement Agency

  • The content of this presentation does not relate to any product of a commercial interest. Therefore, there are no relevant financial relationships to disclose.
why maine the state s prescription drug problem
Why Maine?: The State’s Prescription Drug Problem
  • In 2007, nearly 90% of Maine drug deaths were caused by prescription drugs
  • Maine Drug Enforcement Agency arrests for prescription drug misuse or diversion has increased dramatically to 23% of all arrests
  • In terms of the relationship of pharmaceuticals to violent crime and property crime, Maine ranks number one in the country
  • Maine ranks second in terms of the availability of pharmaceuticals for abuse
Large rural regions

38th in population density; < 10 residents per square mile in over half of state

Distribution/collection and financial challenges

Chronic illness and related drug use higher in rural areas

Oldest state

Median age 41.2 years (United States Census, 2005)

Americans 65+ account for over 1/3 of prescriptions dispensed, but only 13% of the national population

Why Maine? The Challenges of a Rural and Aging State

methods of disposal
Methods of Disposal
  • Flushing
    • Water pollution
  • Trash
    • Ends up in water stream
    • Potential for diversion of drugs
    • Overdose by children and pets
  • Collection Programs and Events
    • Often require law enforcement involvement
    • Sustainability challenges
coalition building
Coalition Building
  • Began with Maine Benzodiazepine Study Group and Maine Drug Enforcement Agency
  • Convened a group stakeholders from children’s advocacy, environmental organizations, medical associations, and others to create legislative solution
Public Law 2003, Chapter 679

Maine Unused Pharmaceutical Disposal Program

Program administration – Maine Drug Enforcement Agency

Maine Drug Return Implementation Group

LD 411 “An Act To Establish a Pilot Program for Return of Unused Prescription Drugs by Mail” (Sponsored by Representative Anne Perry) (Signed 6/27/07)

Historic State Legislation

program overview
Program Overview
  • Unique opportunity to test and refine state-wide field model
  • Phased mail-in return program
  • Funded by the U.S. Environmental Protection Agency (EPA) and an allocation from the Fund for a Healthy Maine
  • Phases I and II established a working prototype for state and beyond
Postage-paid medicine return envelopes are distributed to selected pharmacies and organizations across the state at no cost

Staff members then give the envelopes and an instruction packet to interested participants

Program Model

program model
Program Model

Program Participants

Secure delivery to Maine Drug Enforcement Agency

Envelopes received, logged, catalogued and destroyed under MDEA custody

program goals
Program Goals
  • Remove unneeded prescription drugs from circulation
  • Disposal in compliance with applicable state and federal laws and sound environmental practices
phased implementation
Allows for monitoring of the program and piloting of protocols

Phase I: Four-county model (1,800 envelopes)

Pharmacies as the point of distribution for program envelopes

Limited press/marketing

No public education effort

Selected sites within the designated area

Only for people 65 and older and caregivers

Phased Implementation
7,600 mailers available through statewide network of participating pharmacies and partnering sites (over 100 sites)

Refinements based on Phase I experience:

Expansion of program to target to all age groups

Expansion of distribution sites beyond pharmacies

Community education

Phase II

20,000 mailers available through statewide network of participating pharmacies and partnering sites (approx. 150 sites)

Funding in place through 2011

Current Operations

It curtails childhood overdoses

It restricts household drug theft

It limits accumulation of drugs by the elderly and other high users

It protects our physical environment

It restrains improper drug donations

It eliminates waste in the health care system

Drug Collection Benefits

The toll-free helpline phone number is 1-866-637-9743.

Participants can call any time and leave a message.

Phone calls are returned by Center on Aging staff.

Pharmacies or other organizations can also inquire about the program through the helpline.

Program Helpline

The website address is

Information about the project is available on the website.

Pharmacists and project participants can also e-mail questions to the Center on Aging project staff at [email protected]

Program Website

elder involvement
Elder Involvement

Community Advisory Board created with older adults and RSVP volunteers from each county

Membership reflects state’s diversity

Collaboration among 5 RSVP programs statewide

Community members served as Distribution Site Educators in Phase I

Deliver mailers and materials to distribution sites

Educate site pharmacists and staff on the process

Phase II: Educators promote the benefits of returning unwanted medications

lasting impact community education
Lasting Impact: Community Education

 Community volunteers educating others about safe medication management and disposal

Participants in community outreach and education presentations range in age from 20 to over 80 years old.

94% of participants had never participated in a community drug disposal event prior to attending an education session.

lasting impact community education1
Lasting Impact: Community Education

The average exam score on post-presentation evaluations was 95/100 indicating that the training has a high level of impact on knowledge.

Geographic and demographic patterns of prescription drug accumulation

Pharmacoeconomic assessments


Implications for prescribing, insurance reimbursement, and dispensing policies

Data Collection Strategy

Survey is completed and placed into the envelope with their medicine.

2,074 surveys returned during pilot

Consumer Survey

drug inventory
Drug Inventory
  • Cataloging of returned drugs by project pharmacists
pilot phases drug returns data
Pilot Phases Drug Returns Data
  • 3,926 envelopes collected
  • 42% return rate
  • 2,123 pounds of non-controlled drugs
  • 250 pounds of controlled drugs
  • Over 380,000 pills collected
  • 86% of returns are prescription drugs, 12% over the counter
  • 31% of returns included mail order drugs
observations from the initial drug returns analysis phase 1
Observations from the Initial Drug Returns Analysis (Phase 1)

Interesting/anecdotal findings:

  • Many of the mailers contained full bottles of unused drugs from mail-order pharmacies or VA pharmacy services
  • Received full bottles of very costly antiretroviral drugs (HIV/AIDS drugs)-Wasted healthcare $$
  • Older meds not uncommon-some of the returns were noted to be as old as 30 years old
  • Estimated that one envelope contained enough unused narcotics to net $7,000 if sold on the street
observations from the initial drug returns analysis phase 1 cont
Observations from the Initial Drug Returns Analysis (Phase 1) (cont.)

Interesting/anecdotal findings:

  • A mix of local and mail order pharmacies is not uncommon among those who use the program-but who has the entire medication record for these patients?
    • This includes patients who are receiving the same medication via a local pharmacy and a mail-order pharmacy
consumer profile
Consumer Profile
  • Average age of mailback program users: 59 years of age
  • Age range of users/those returning medicine through the mailback:

4 years – 95 years of age

  • Avg. age has dropped considerably from Phase I (avg. age = 70) to Phase II (avg. age = 59).

*Percentages add up to more than 100 as respondents are allowed to check off multiple options for this question.

survey data cont
Survey Data (cont.)
  • 41% were returning medicine for themselves
  • 35% were returning medicine for a relative
  • Nearly 20% were returning medicine for a deceased friend or loved one
  • The decision about what to dispose of can be complex as indicated by the fact that 16% of our respondents did not know what kind of medicine they were returning.

*Percentages add up to more than 100 as respondents are allowed to check off multiple options for this question.

  • “Thank you for this program-great as is”
  • “Make envelopes more available/have more sites”
  • “Advertise more”
  • “Bigger envelopes”
  • “This is such a waste of medicine. This could be used for the uninsured elderly/homeless/those in need, etc”
comments cont d
Comments Cont’d
  • “This is a fantastic program. The meds of a deceased love one are an emotional reminder of that person. Thank you for offering a private method of disposal. You saved me many tears.”
comments cont d1
Comments Cont’d
  •  ”My brother and I have tried to find a safe and responsible way to dispose of these meds for 18 months! We have not found any other way after several attempts with local police, hazardous waste, pharmacy, hospice, etc.”
program partners and national advisory board
Program Partners and National Advisory Board

Maine-Based Organizations

Center on Aging, University of Maine

Maine Association of Psychiatric Physicians

Safe Medicine for Maine

Maine Council for Child & Adolescent Psychiatry

Maine Department of Health and Human Services

Maine Department of Environmental Protection

Maine Drug Enforcement Agency

University of New England

Maine Office of Adult Mental Health Services

Husson University

Maine Center for Disease Control and Prevention

Maine Office of the Attorney General

Maine Office of Elder Services

Maine Pharmacy Association

Maine Independent Pharmacies

Maine RSVP Programs

Maine Office of Adult Mental Health

Maine Medical Association

Margaret Chase Smith Center Policy Center, University of Maine

Northern New England Poison Center

Federal & National Organizations

American Pharmacists Association

Community Medical Foundation for Patient Safety

National Council on Patient Information and Education

Office of the U.S. Attorney General

Rite Aid Corporation

U.S. Drug Enforcement Administration

U.S. Environmental Protection Agency

U.S. Postal Service

Villanova University Center for the Environment

Daily operations:

Jennifer Crittenden, M.S.W.

Project Director

UMaine Center on Aging

[email protected]

Project administration:

Lenard Kaye, D.S.W./Ph.D.

Principal Investigator

UMaine Center on Aging

[email protected]

General Project Information:

Phone:  1-866-ME-RX-RID (1-866-637-9743)

Email: [email protected]