2007 Model Practice Application (Public)

Responsible Collection and Disposal of Unwanted Prescription Drugs

Rock County Health Department

The Responsible Collection and Disposal of Unwanted Prescription Drugs program targets all Rock County residents and addresses the issue of prescription drug disposal. The program's first goal is ground/surface water protection. Past disposal recommendations have been to flush drugs down a toilet or place them in the trash; both methods potentially place water supplies at risk. Trace levels of many drugs are being discovered in both surface waters and groundwater. Research at the Marshfield Clinic and UW-Madison has indicated that pharmaceutical drugs usually are not inactivated in septic systems or wastewater treatment plants. Furthermore, Rock County has groundwater resources that are geologically susceptible to contaminants yet they provide 100% of drinking water to residents of Rock County and are an important recreational asset. This is the initial step to change public preference for drug disposal from “just flush it down the toilet’ to a better disposal method that is safer for the environment. The second program goal is prevention of accidental poisonings/misuse. Safety of the public was another concern. Unused pharmaceutical drugs in a household pose a significant risk for improper or illegal use by others. Even over-the-counter drugs (e.g. stimulants, appetite suppressants and decongestants) have the potential to be lethal to children.

The event was a resounding success, with 261 pounds of drugs collected, including 37 pounds (231 prescriptions) of controlled substances consisting of 7,842 tablets or capsules and 3,050 mL of liquids. ‘Letters to the Editor’, phone calls to the health department and editorials indicate strong, positive community support of this and future events.

The NACCHO-funded PACE-EH assessment of 2004 began a systematic process to provide a safe and environmentally responsible way to dispose of hazardous household chemicals to the citizens of Rock County. Prescription drug disposal, while mentioned, was not considered a high priority need at that time. The county’s recent September 2006 Clean Sweep-Hazardous Household Chemical Collection and subsequent phone inquiries showed increased interest in a responsible way to dispose of household drugs that were expired or no longer needed. Various county agencies, such as the coroner’s office, the courts and the sheriff’s office further emphasized the need to establish a formal procedure to dispose of these items.

Prior to 2006 there were no drug collection efforts in Wisconsin. Rock County was the fourth county to conduct a collection program in the state, building upon the efforts of the initial three collections, resulting in the following innovations:

• Countywide coordination with coroner and law enforcement for drug disposal.
  
  
• A drive-thru vs. drop-off collection: Increased safety for staff and volunteers, increased security at collection site (only staff in ‘Health Department” vests in area). An initial screening process to make ensure receipt of pharmaceuticals only(not hazardous waste or sharps). A process that took two minutes per vehicle from entry to exit.
  
  
• Advertising innovations using posters and ‘bag stuffers’, veterinary clinics, stores, pharmacies, retiree and other community newsletters.
  
  
• Low cost of disposal.
  
  
• Investigate the feasibility/legality of recycling unopened/unexpired drugs to those with the most need.
  
  
• On arrival, a participant survey to determine disposal habits, future needs, how they learned of the collection (type of advertising), and suggestions on how future collections should be conducted.
  
  
• As vehicles left the facility information about safe pharmaceutical disposal and a gratuities from community partners to say ‘thank you’.
  
  
• Published a “How to Guide” for other organizations to use in the March/April 2007 issue of The Journal of the Pharmacy Society of Wisconsin.

The Rock County Health Department coordinated the efforts of many partners including local pharmacists, the Janesville Leadership Development Academy, Board of Health, coroner, Highway Department and sheriff who helped create an efficient, well thought-out process. Local cable, radio and newspapers enthusiastically supported the event. All parties indicate a desire to participate in future events. This was an aggressive planning period (four months), only attainable with early buy-in by local pharmacists and the law enforcement community.

The largest expenditure for conducting this event was employee hours. The bulk of this time was connected to the Health Department staff for coordination and promotion, the Rock County Sheriff for providing the three officers during the event and transportation of drugs to the disposal site. Not including wages, the largest out-of-pocket expenses for the Health Department included printing ($300) and drug disposal ($200). These costs were covered by in-kind donations for printing from two office supply stores, disposal containers from three retail stores, and event-day lunches from a local hospital. In addition, cash donations from businesses and individuals totaled more than $450 to offset event costs.

Plans for a pharmaceutical drug collection program were initiated at the July 2006 Rock County Board of Health meeting. The Health Department researched how unwanted drugs are disposed of at various county agencies such as law enforcement, the coroner, health care facilities and the public in general. This led to the discovery of the need for a formal disposal process in Rock County that would be accessible to both local government and county residents. Environmental and public safety reasons were the foremost considerations in the decision to hold Rock County’s first Drug Collection Program. Implementation occurred as follows:

• July 2006: Researched the legal and logistical issues of drug disposal and gathered information on all previous collection events in Wisconsin.
  
  
• August 2006: Presented to the Board of Health a summary of drug disposal options and feasibility of holding a collection in Rock County.
  
  
• September 2006: Decision made at Board of Health meeting to plan a collection event in Rock County. A waste collection firm was selected and approved by DNR for disposing of the pharmaceuticals. Law enforcement was initially contacted to assist with the collection. Pharmacists were recruited through professional societies (e.g. the Pharmacy Society of Wisconsin), community organizations (e.g. Health Net) and business (e.g. Target, Wal-Mart., Kmart, ShopKo, OfficeMax, Staples, Walgreens, CVS, Aurora Healthcare, Mercy Hospital etc.).
  
  
• October 2006: The collection time, date and location (county highway department) was confirmed, publicity initiated and volunteers recruited. Obtained final DEA approval conditional on strict law enforcement presence. Corporate sponsors were sought to offset advertising and disposal costs. A coordination meeting was held with pharmacists and law enforcement.
  
  
• November 2006: Public relations were ramped up during final two weeks before the event. A final coordination meeting was held with pharmacists, law enforcement and volunteers. Collection site was prepared the day prior to the event.

Based on the strong public response to the program, this was considered a much-needed service that they would like to see repeated. All participants enthusiastically noted the strong sense of camaraderie among the staff and overwhelmingly indicated a willingness to contribute to or participate in future collections.

The goal of this practice is the safe disposal of unwanted and unused prescription and over the counter drugs.

Objective 1: Ground/surface water protection.

Performance Measures: Baseline surveys have been conducted detecting trace levels of many drugs are being discovered in both surface waters and groundwater. Research at the Marshfield Clinic and UW-Madison has indicated that pharmaceutical drugs usually are not inactivated in septic systems or wastewater treatment plants. This is a pilot program whose effectiveness at ground and surface water contamination prevention can only be evaluated in time after the new disposal procedures have been widely implemented. Quantity and type of pharmaceuticals collected.

Outcome: Verified by the quantity of drugs collected. Verification will only occur after wide adoption of the practice among communities/governmental agencies and subsequent testing of ground water.

Objective 2: Prevention of accidental poisonings/misuse.

Performance Measures: 'Letters to the Editor', phone calls to the health department and editorials indicate strong, positive community support of this and future events. Quantity and type of pharmaceuticals collected.

Outcome: Verified by the quantity of drugs collected.

Lessons learned include:

• Selling the importance of proper drug disposal has been easy and well received; however, the following are some ideas or changes that will likely be implemented to improve future collections: periodically rotate the event to new locations to serve others in different parts of the county; investigate the feasibility/legality of recycling unopened/unexpired drugs; pharmacists will redesign the controlled drug login sheet to better suit their needs.
• Having the event as a “drive-thru” collection. The public enthusiastically accepted this method. By keeping the public in their cars at all times the collection moved swiftly, there was less confusion for the pharmacists and it was appreciated by the law enforcement agency since they did not have the public to watch during the collection/identification process.