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Shirley Reitz, Pharm.D., BCPS Associate Director, Pharmacy Clinical Services Group Health Cooperative Seattle, WA 206-901-4334 November 2008. Secure Medicine Return: PH:ARM Pilot in Washington State. Patient Demand. 2006 WCRC survey of 400 King County households revealed

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Secure medicine return ph arm pilot in washington state

Shirley Reitz, Pharm.D., BCPS

Associate Director, Pharmacy Clinical Services

Group Health Cooperative

Seattle, WA


November 2008

Secure Medicine Return:PH:ARM Pilot in Washington State

Patient demand
Patient Demand

2006 WCRC survey of 400 King County households revealed

39% have 10 or more medicine containers in their homes

Only 33% report that they are currently using or plan to use these meds

74% stated they would be willing to dispose of the meds in a convenient location

“We are cleaning out my Grandfather’s house and I have a suitcase full of drugs that we need to get rid of. Can we bring them into your disposal site?”

“Our neighborhood association (over 400 homes) would like to provide some education to the families in our neighborhood about drugs in their homes – can we tell them to bring their meds to you for disposal?”

“Please dispose of this medication. Enclosed is a donation….”


Pharmaceuticals in landfills
Pharmaceuticals in Landfills


pumped to sewer treatment plants

possible escape

to groundwater

studies find drugs

Ph arm team pharmaceuticals from households a return mechanism
PH:ARM TeamPharmaceuticals from Households: A Return Mechanism


Group Health



Bartell Drugs

Boarding/assisted living homes


Interagency Resource for Achieving Cooperation (IRAC)

Northwest Product Stewardship Council

Pacific NW Pollution Prevention Resource Center (PPRC)

WA Citizens for Resource Conservation (WCRC)


King County Dept. of Natural Resources & Parks

Local Hazardous Waste Management Program in King County

Public Health - Seattle and King County

Snohomish County Solid Waste Management Division

WA Department of Ecology


WA State Board of Pharmacy

WA State Dept. of Social and Health Services - Aging and Disability Services Administration


Group health s goal
Group Health’s Goal

Work with community partners to develop a medication disposal system that is:





Meets all regulatory requirements

Easy for our patients to use

Remove from the home medications posing risk of unintentional poisoning, overdose, or abuse


Pilot project
Pilot Project

  • 25 Group Health clinic pharmacies statewide

  • 12 Bartell Drugstores around Puget Sound

  • 3 boarding /assisted living homes in Seattle


Group health s experience
Group Health’s Experience

Over 14,000 lbs of unwanted medications collected and incinerated from GHC locations over 2 year pilot

Group Health Collected Meds

Percent by Weight

1,238 pounds total

16,460 drug containers


Snapshots of collected materials
Snapshots of collected materials

14 Doses of Enbrel


Migranal Nasal Spray



What we ve learned
What we’ve learned:

Security is Critical!

Secure drop boxes

Complete tracking of secure containers

DEA utilization

Staff Satisfaction

“Makes my job easier”

Regulatory issues remain


Next steps
Next Steps

  • Cost Considerations

    • Need affordable solutions

    • Pilot ending this year

    • Looking for interim Manufacturer funding

  • Pilot project final report

    • Report expected Jan ’09


  • Legislative efforts in 2009

Secure medicine return ph arm pilot in washington state

Cheri Grasso

Local Hazardous Waste Management Program in King County


November 2008

Secure Medicine Return Legislation:A Producer Responsibility Approach

Next steps1
Next Steps

  • Regulatory Change

  • Moving Beyond Grants

  • Washington State Producer Responsibility Legislation

Regulatory change
Regulatory Change

  • Department of Transportation

    • Medicines must be in original package

      • Requires sorting

      • Loose pills shipped in smaller container

      • Limits weight of container

  • Product Stewardship Institute

    • Dialogue on regulations Dec 2 - 3


Beyond grants
Beyond Grants

  • PH:ARM successful in obtaining grants

  • Search for Sustainable Funding

    • Local Governments cannot pay for statewide

    • Pharmacies have very small profit margin

    • Producers most logical choice

  • Voluntary approach?

    • Creates unfair level for producers

Secure medicine return bill
Secure Medicine Return Bill

Producer paid statewide medicine return program

Passed out of Environmental Health Committee

Unanimous, bi-partisan vote

Big bill, short session

Set stage for success in ‘09

2008 endorsers
2008 Endorsers


Bartell Drugs

Group Health

Washington Food Industry

WA State Pharmacy Association

Civic & Environmental Organizations

Children’s Alliance

Environment Washington

League of Women Voters of WA

People for Puget Sound

Senior Citizens’ Lobby

Sierra Club Cascade Chapter

WA Citizens for Resource Conservation

WA Organic Recycling Council



Coalition for Clean Water

King County

Local Hazardous Waste Mgmt Program in King County

Thurston County

WA Association of Sheriffs and Police Chiefs

Yakima County

Health Organizations

Assoc of Advanced Practice Psychiatric Nurses

Breast Cancer Fund

School Nurse Organization of WA

WA State Assoc of Occupational Health Nurses

WA State Hospice and Palliative Care Org.

WA State Nurses Assoc.

Policy medicine return legislation
Policy:Medicine Return Legislation

  • Drug producers design & pay for program

    • In every county statewide

    • In all cities with populations > 10,000

  • Covers

    • Over-the-counter drugs

    • Prescription drugs (including controlled substances)

  • From

    • Households

    • Residential sources (hospice services, nursing homes, schools, etc.)

Medicine return legislation what does the program look like
Medicine Return Legislation:What does the program look like?

  • Producers determine how best to securely and conveniently collect the medicines

    • Mail back

    • Pharmacy

    • Hybrid

    • Other????

  • If they choose a pharmacy model

    • Pharmacies participate voluntarily

    • Expect many pharmacies to do so

Medicine return legislation
Medicine Return Legislation:

  • Hazardous Waste Disposal

  • Alternative Technology

  • Outreach

  • Board of Pharmacy

    • Oversight

    • Enforcement

Medicine return legislation shared responsibility
Medicine Return Legislation:Shared Responsibility

Pharmaceutical brand owners pay for program

Pharmacies give out information on take back and may provide take-back locations

Consumers return their unwanted medications to takeback location

Government provides oversight and education

Next steps2
Next Steps

  • Seeking endorsements

  • Talking with legislators

  • Talking with pharmaceutical manufacturers

  • Successful passage in ’09!