Safe, convenient drug take-back law passed by Board of Health New program will provide a safe medicine disposal system for King County residents
On June 20, 2013, the King County Board of Health took a significant remaining step towards reducing preventable deaths from drug overdoses by passing a Rule & Regulation to create a drug take-back system for King County residents. The program promotes the safe disposal of unused prescription and over-the-counter medicines, and will be funded and operated by the drug manufacturers who produce the medications. Implementation of the program is expected to take up to 18 months based on the requirements specified in the Rule & Regulation.
What is the purpose of a medicine take-back program?
The goal of a take-back program is to protect public health and the environment by reducing the amount of medicines available for misuse and keeping waste medicines out of waterways and water supplies.
What is happening at the Board of Health on this issue?
Since July 2012, a subcommittee of the King County Board of Health has explored ways to protect human health by reducing the amount of unused medicines in people's homes by ensuring convenient and safe disposal options. Subcommittee members include Chair McDermott, Board Member Conlin, Board Member Baker, Board Member Nicola and Director and Health Officer of Public Health David Fleming.
First, the subcommittee heard from key stakeholders. Then the subcommittee undertook an in-depth policy discussion. A proposed Rule and Regulation was developed, outlining an industry-funded product stewardship model for drug take-back in King County.
Under the proposal before the Board:
Residents would be able to drop, free-of-charge, their leftover and expired medicines in secure boxes conveniently located in most retail pharmacies or law enforcement offices throughout King County;
Collected medicines would then be destroyed by incineration at properly permitted facilities;
Drug manufacturers selling medicines for residential use in King County would be required to run and pay for the program (similar to established product stewardship programs in our state for items like computers); and,
Public Health Seattle & King County would oversee the program to ensure its effectiveness and safety.
A public hearing on the proposed Secure Medicine Return Rule & Regulation was held on May 16, 2013 (click on video image below.) A hearing and potential action is scheduled for June 20, 2013.
Why is safe disposal of medicines a public health issue?
1. More people die from prescription medicines than from heroin and cocaine combined;
2. Most abusers of prescription drugs get the pills from a friend or relative's medicine cabinet;
3. Prescription medicines are the drug of choice among 12 and 13-year olds;
4. Preventable poisonings from medicines have also been rising rapidly, especially among kids and seniors; and
5. 32% of child poisoning deaths in Washington were caused by someone else's prescription medication and 26% were caused by over-the-counter (OTC) medications.
How will a drug take-back program reduce drug abuse and poisonings?
Medicine cabinets provide teens and others with easy access to drugs. Storing unwanted or expired medicines in our homes contributes to the epidemic of medicine abuse and accidental poisonings. Drug take-back programs offer the only secure and environmentally sound way to dispose of leftover medicines.
The White House Office of National Drug Control Policy recommended four “pillars” for the prevention of prescription drug abuse in its 2013 National Drug Control Strategy: (1) educate physicians about opiate painkiller prescribing; (2) expand prescription drug monitoring programs and promote links among state systems and to electronic health records; (3) increase prescription return/take-back and disposal programs; and (4) enforcement to address doctor shopping and pill mills.
Washington has led the nation in efforts to address the medicine misuse crisis. We require health care providers to be educated about prescribing opiate painkillers. A prescription monitoring program is up and running. Law enforcement continues to take action to curb illegal use. A convenient way to dispose of unneeded medicines is the missing piece in our efforts.
Why not flush leftover medicines or dispose of them in the household trash?
Flushing medicines releases drugs into waterways because wastewater treatment facilities do not effectively remove or degrade pharmaceutical compounds.
Throwing unused medicines away is not safe. Garbage cans are not secure, and our landfills and sewage treatment plants are not designed to sufficiently removed these complex chemicals.
The FDA (Food and Drug Administration) lists medicine take-back programs as their first choice for safe disposal of unused medicines, and only suggests putting medicines in the trash if there is no drug take-back program available. See Disposal of Unused Medicines: What You Should Know.
The DEA and the EPA, as well as WA State Department of Ecology, King County Solid Waste and Seattle Public Utilities, also recommend use of medicine take-back programs as the proper disposal method for leftover and expired medicines.
How much medicine is not consumed/left unused by patients?
About 30% of prescription and OTC medicines sold go unused. Expired or left-over medicines that accumulate in home medicine cabinets increase risks of poisonings and abuse.
Why are there so many leftover drugs?
There are many reasons why people have leftover prescription medicines. A doctor may change a patient's medicine to find one that's better for them. Large amounts of medicines are often leftover after a serious illness or after the death of a family member.
Over-the-counter (OTC) medicines also need to be properly handled and disposed of safely. Several OTC medicines (e.g., ibuprofen, Tylenol) are on the top ten poisoning list in Washington; twenty-six percent of child poisonings in Washington were caused by OTC medicines.
What are medicine take-back programs?
Take-back programs collect unused medicines from the public in a secure manner, and assure their destruction at proper incineration facilities. The FDA, DEA, Office of National Drug Control Policy, and the EPA all recommend the use of medicine take-back programs as the safest way to dispose of leftover medicines.
Are take-back programs currently operating in King County?
Currently, there are voluntary take-back programs at 24 pharmacies and 11 law enforcement offices in King County. These programs are collecting large amounts of medicines:
Voluntary law enforcement take-back programs, including the semi-annual DEA take-back days, have collected more than 20,000 pounds of medicines since 2010.
Voluntary pharmacy take-back programs at Group Health and some Bartell Drugs stores have collected more than 48,000 pounds of medicines since 2010.
Use of these limited medicine take-back programs and collection events demonstrate a desire by King County residents to safely dispose of their leftover medications, but there are not enough drop-off locations to serve all county residents. A comprehensive system for safe disposal of unneeded prescription and OTC drugs from residents does not yet exist in King County or nationally.
How much will the proposed secure medicine return system cost?
There will be no cost to users of the take-back program.
The cost of the medicine return system will depend on exactly how the drug companies design the program, and on the amount of medicines collected for safe disposal. Total costs to all drug companies selling medicines in the County are estimated to be in the ballpark of $1 million per year, which is less than 0.1% of annual medicines sales in the County -- or a few pennies per prescription to the drug manufacturer. Annual sales of medicines in King County are more than $1.1 billion per year.
What is the federal government's role?
The Drug Enforcement Agency, together with local law enforcement, has offered biannual Prescription Drug Take-back events since October 2010.
In December 2012, the DEA has released a proposed regulation to expand options to collect prescription drugs that are controlled substances, like narcotics and stimulants. Currently controlled substances can only be collected at drug take-back programs operated by law enforcement. The proposed regulation would allow authorized retail pharmacies, drug manufacturers, and drug distributors, law enforcement, and others to operate drop-off sites and mail-back programs for controlled substances along with all other medicines. This change has great potential to make take-back programs more widely available because it will make it simpler to operate them.
What is the BOH's role?
The Board of Health is interested in exploring ways to protect public health by addressing the drug overdose and poisoning epidemic through reducing the amount of unused medicines in our homes, encouraging safe storage of medicines in the home, and ensuring convenient and safe options for disposal of unused medicines.