Great Falls, Montana Prescrip on Drug

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The over prescrip2on of pharmaceu2cals by providers and not counseling pa2ents on safe disposal are major policy issues that have not been adequately ...
Aruru  Meghana  V1,  Salmon  JW2.,  Salmon  B.R3   1Roosevelt  University    2,3University  of  Illinois  at  Chicago  

Introduc:on  

Results  

Pharmaceu;cals   are   oHen   improperly   disposed,   leaching   ac;ve   ingredients   that   contaminate       our   soil,   water   and   air.   Serious   environmental   consequences   may   poten;ally   be   risks   to   aqua;c   and   soil   environments,   food   supplies,   along   with   growth   and   resistance   of   microorganisms   in   sewage   treatment.  Drugs  for  humans  end  up  in  the  sewage   system   from   dumping   expired   and   unused   prescrip;ons   and   hospital   and   nursing   home   dumping   from   deceased   pa;ents.   Ecologically,   biologically   ac;ve,   toxic,   and   hormone   disrup;ng   compounds   may   lessen   sewage   plant   effec;veness   and   eventually   contaminate   water   in   municipal   water  supplies.         LiIle   tes;ng   is   done   to   detect   drug   residues   that   may   addi;onally   accumulate   due   to   leakage   from   landfills   and   runoffs   from   agricultural   land.   Direct   consequences   of   drug   residue   and   ac;ve   metabolites   in   the   environment   may   be   related   to     rising   disease   epidemics   of   unknown   e;ology.     Consider   that   new   paIerns   of   breast   cancer,   rare   site   CA,   an;bio;c   resistance,   au;sm,   ADHD,   early   onset   puberty,   MRSA,   mental   disturbances,   and   more,   may   have   origins   from   unprescribed   medica;ons  in  water.  EPA,  DEA  and  FDA    policies  on   p r o p e r   d i s p o s a l   o f   p h a r m a c e u ; c a l s   a r e   contradictory,   and   drug   disposal   is   not   well   regulated   nor   hardly   enforced.   There   is   no   substan;al   data     on   how     minute   quan;;es   of   powerful   and   dangerous   pharmaceu;cal   mixes   affect   the   fetus,   children,     folks   with   chemical   sensi;vi;es,   and   other   vulnerable   groups   of   pa;ents.      

The   over   prescrip;on   of   pharmaceu;cals   by   providers   and   not   counseling   pa;ents   on   safe   disposal   are   major   policy   issues   that   have   not   been   adequately   addressed.   Non-­‐adherence   is   a   documented   reality,   which   leads   to   greater   disposed  quan;;es.       Safe   disposal   of   prescrip;on   and   non-­‐prescrip;on   OTC   drugs,   along   with   upgrading   for     proper   s e w a g e   t r e a t m e n t ,   a r e   n e c e s s a r y   a H e r   implemen;ng   beIer   public   policies,   strengthening   the  regulatory  agencies,  and  promo;ng  community   ac;ons.   Lack   of   personnel   to   ini;ate   large-­‐scale   pharmacy   take-­‐backs   by   drug   stores   and   within   communi;es  can  prevent  misuse  as  well  as  reduce   environmental   contamina;on,   but   consumer   educa;on   about   this   cri;cal   issue   is   s;ll   lagging.   Different   federal   agencies   regulate   poorly   and   enforce  liIle,  oHen  being  contradictory  and  out  of   s y n c   w i t h   s t a t e   a n d   l o c a l   a u t h o r i ; e s .   Pharmaceu;cal   plant   waste   needs   careful   monitoring   in   addi;on   to   drugged   livestock   waste   that  flows  into  river  tributaries.         Nevertheless,   the   main   culprits   seem   to   be   dumping   expired   drugs   and   unused   medica4ons   into   toilets   and   landfills   in   homes,   hospitals   and   Par:cipants   nursing   homes.   In   the   absence   of   more   effec4ve   regulatory   oversight,   organized   take-­‐back   programs   have   spread   across   communi4es   and   produced  a  greater  public  awareness    of  ecological   issues.       However,     there   is   s;ll   a   great   need   for   scien;fic   inves;ga;ons   to   determine   poten;al   long-­‐term   hazards   from   minute   exposures   to   mixtures   of   powerful   and   dangerous     unprescribed     substances,     which   are   needlessly   medica;ng   our   popula;on.  Proper  safe  disposal  methods,  such  as   incinera;on   or   landfills,   are   also   s;ll   ecologically   undetermined.   As   municipal   water   treatment   plants  and  infrastructure  become  an;quated,  with   liIle  systema;c  tes;ng  of  water  for  drug  residues,   correc;ve   federal   and   state   policies   need   to   be   formulated  now.  

Methods   This   study   assesses   policies   related   to   crea;ng   environmental   responsibility   for   all   par;es;   it   cri;cally   examines   the   role   of   various   agencies   in   the   absence   of   coordina;ng   efforts   of   personnel   and   authority   to   impose   penal;es   for   non-­‐ compliance.     A   select   community   drug   take-­‐back   program  in  Montana  is  highlighted    as    an  example   of  community  ac;on.  

Contact:  Meghana  V.  Aruru,  Ph.D   [email protected]  

Conclusions   ü  Pharmaceu;cals  in  our  water  supplies  are  always  found     ü                             safer  public  health.       in   mixtures,   though   liIle   systema;c   tes;ng   is   undertaken.   Given   a   societal   acceptance   of   ecological   ü  Drug   store   take-­‐back   programs     have   been   degrada;on,   it   remains   paramount   that   communi;es   spoIy   and   haphazard   with   few   efforts   by   become   aware     of     poten;ally   dangerous     drug   disposal   pharmacies   and   manufacturers   to   inform   prac;ces   and   seek   to   remedy   them.   Pharmaceu;cal   consumers  of  “best  prac;ces”  for  disposal.     firms,   chain   drug   stores,   prescribers,   and   health   ins;tu;ons   bear   the   chief   responsibility   for   drug   ü  The   FDA,   EPA,   DEA,   DOA,   and   the   U.S.   disposal   and   should   be   mobilized   for   correc;ve   ac;on   Geological   Survey   should   review   their   policies,   and   bear   costs   of   local   governments   for   improving   coordinate  and  then  seek  strengthening  of  their   sewage   and   landfill   cleanup.   Providers   must   lead   by   authori;es   to   assist   states   and   local     example   and   educate   pa;ents   on   proper   disposal   of   governments  in  efforts  to  address  these  issues.     pharmaceu;cals  and  drug  waste.                                                                                                                                    Policymakers                                                                should                                      find     funding   for   interven;ons   within   the   Pharmaceu;cal   ü  Scien;fic   inves;ga;ons   are   long   overdue   to   evaluate   industry   and   corporate   chain   drug   stores,   and   the   poten;al   detrimental   effects   from   pharmaceu;cal   make  sure  health  care  ins;tu;ons  enact  proper   waste  to  our  bodies  and  the  ecology.  Moreover,  data  on   disposal  prac;ces.     current  disposal  prac;ces  is  not  even  available  ongoing   disease  condi;ons,  let  alone  to  seek  remedies  for    

Spotlight:  Great  Falls,  Montana  Prescrip:on  Drug  Take-­‐Back  

s  

In  response  to  the  high  diversion  of  pharmaceu:cals  for   abuse  (est.  $19.6  M),  the  Montana  State  Highway  Patrol   and   the   Great   Falls   Weed   &   Seed   began   a   voluntary   prescrip;on  drug  take-­‐back,  Opera:on  Medicine  Cabinet,   in   April   2011.   Prescrip;on   drug   abuse   was   iden;fied   as   the   second   commonly   abused   illicit   substances   and   a   threat   to   public   safety   in   Montana.   A   lockbox   was   provided   at   the   Highway   Patrol   office   to   receive   prescrip;on  and  illicit  drug  drop-­‐offs  daily.  Special  events   collected   800-­‐1200   lbs.   over   weekends   across   Montana,   indica;ng   heavily   u;liza;on   with   wide   community   support.   Opera;on   Medicine   Cabinet   overcame   several   obstacles  with  incinera;on,  MEPA  oversight,  finances,  and  

Take-­‐Back  Success  

law   enforcement   constraints.   However,   Opera;on   Medicine  Cabinet  and  other  programs  similar  to  it  across   the   country   con;nue   to   face   poli;cal,   regulatory   and   opera;onal   difficul;es.   Without   policy   support   in   place,   state   and   local   prescrip;on   drug   disposal   programs   will   con;nue  to  face  uphill  baIles  for  safe  remedies.     Nevertheless,   Great   Falls   can   be   considered   a   model             voluntary   take-­‐back   program   of   significant   success   for   drug   diversion,   heightened   consumer   awareness   of   disposal  dangers,  and  coalescing  public  support.    

Prescrip;on  Drug  Drop-­‐Box   Incinerator  Unit