Valerie Briggs, MBA
A recent University of Michigan study published in the journal Environmental Science and Technology found that disposing of unwanted medicines in the trash may be a more environmentally-friendly option than disposing of the drugs at a take-back pharmacy. The logic, as explained in various news stories is that take-back programs, like Dispose My Meds, result in a greater emission of greenhouse gases and pollutants due to the travel to the take-back pharmacy and the shipping of the drugs elsewhere for incineration.
Aside from the often debated dangers of disposed medications in the trash, landfills and water supply, what this study does not address are the health benefits of talking face-to-face to a pharmacist during the take-back process and the ultimate cost savings derived from this type of interaction. We encourage pharmacy owners in the Dispose My Meds program to place the TakeAway box or envelope display behind the counter to require interaction between the patient and pharmacy staff when bringing in medications for disposal. This allows the opportunity for counseling for the patient and drug therapy as needed. New England Healthcare Institute (NEHI) research estimates that patients who do not take their medications as prescribed by their doctors cost the U.S. health care system an estimated $290 billion in avoidable medical spending every year. At that cost, any and every opportunity for counseling is important, and community pharmacists have made medication adherence in pharmacy practice a top priority.
By having a take-back solution available every day, patients are able to drop off unused medications at their convenience, as part of their ongoing relationship with the pharmacist. When surveyed, more than two-thirds of the owners of Dispose My Meds participating pharmacies believe the take-back programs helped to build existing patient relationships. One could argue that if these patients are shopping and picking up prescriptions while also disposing of unwanted medications, then the issue of greenhouse gas emissions and pollutants due to travel cannot be solely attributed to take-back services.
While the study suggests that trashing drugs is best, incineration of unwanted drugs has been recommended by the World Health Organization and many state regulatory agencies. NCPA’s partner in the Dispose My Meds program, Sharps Compliance Inc., are the creators of the TakeAway Environmental Return System, a special line of drop boxes and envelopes designed for use in the return and incineration of unwanted medications, excluding controlled substances. Sharps Compliance is currently undergoing tests that will allow the residual ash resulting from that incineration to be diverted to Sharps® patent-pending Waste Conversion Process (WCP). In the near future, WCP will repurpose the processed unused medications into a safe raw material used in the manufacturer of industrial applications. Additionally, the TakeAway Environmental Return System relies on established mail and parcel carriers, whose vehicles are already on the roads every day carrying other cargo, eliminating the emissions from duplicate specialized medical waste disposal vehicles.
Lastly, the study downplays the issue of the potential for drug abuse/diversion that exists when drugs are thrown in the garbage (now available to dumpster divers and landfill scroungers) or worse yet, left in the home stored insecurely. According to this story on NPR.org, Drug Enforcement Administration (DEA) spokeswoman Barbara Carreno said collection programs like the periodic DEA Take Back Days (the most recent one held on April 28, 2012) bring in individuals who might otherwise never have disposed of their drugs. She mentions examples of people bringing in medicines for disposal that had been retained for 40 years. Our member pharmacies in the Dispose My Meds programs have cited similar experiences, with patients bringing in drugs from deceased loved ones, stored for many years, looking for an environmentally-friendly and an emotionally-friendly solution.
And that is ultimately, how this study falls short. While it studied the environmental effects of the various disposal options, it doesn’t consider the greater benefits associated with take-back programs and assigns costs to some steps of the process while not assigning the appropriate value to others.