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How Much Unused and Expired Medicines are You Stockpiling at Home

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					                                                     How Much Unused and Expired Medicines are You Stockpiling at Home?
                                                                                Unused and Expired Medicines Registry
               Community Medical Foundation                                                                                Matthew C. Mireles, Ph.D., M.P.H. (PI)                                                                                                                                             Kelsey Research Foundation
                                                                                                                                                                                                                                                                                                             th
               For Patient Safety                                                                                                                                                                                                                                                                           7 Annual Health Services and
               The Community of Competence™ and Foundation for Life
                                                                                                                                   Acknowledgements                                                                                                                                                       Outcomes Research Conference:
                                                                                                                                                                                                                                                                                                        Improving the Quality of HealthCare
                                                                                                                  Elizabeth A. Smith, Ph.D.; Anita Hampton, M.S., Fellow;
                                                                                                                Racheal Johnson, B.S., M.P.H. Intern; John Sullivan; Ye Sun;
                                                                                                                            Sonali Patel, B.A., and Faye Wang
                       BACKGROUND                                                                                    OBJECTIVES                                                                                                RESULTS                                                                        CONCLUSION
 Why do we have unused and expired medicines?                                             A relatively unknown but extremely dangerous epidemic is                                      Sample 1 (n=87) from Maine: Antidepressants (12%)                                          UEM is a significant public health and patient safety
                                                                                          the stockpiling of unused and expired medicines (UEM) at                                      were the most UEM. Prescription medicines comprised                                        problem in the U.S., which has not been widely recog-
 More medicines are available today                                                                                                                                                                                                                                               nized and investigated. Most people are not aware of the
                                                                                          home. The researchers present a method to collect data                                        98% of UEM. Reason for UEM was “doctor discontinued
 Doctors are prescribing more medicines                                                  about UEM to answer the following research questions:                                         meds”. Estimated cost based on AWP is $3,922.                                              dangers of UEM, and they lack basic knowledge about the
 People are taking more medicines                                                           Can a drug-return system be devised to safely and                                                                                Prescription Drugs
                                                                                                                                                                                                                                                                                   correct and appropriate use of prescription medications.
                                                                                              legally collect UEM?                                                                                                 Unused                                                          The high cost of UEM is emerging as a strong evidence to
 30% -50% of people do not take medicines as                                                                                                                                                                       40%

                                                                                                                                                                                                                                                                                   support further study of cost allocation, prescription
                                                                                                                                                                                                                                                               Used

                                                                                          
                                                                                                                                                                                                                                                               60%
  prescribed by their doctors                                                                 Can a national registry be set up to collect the UEM
                                                                                              data?                                                                                                                                                                                assistance programs, and patient compliance or
 People think medicine is too expensive to throw away                                                                                                                                                                                                                             adherence.
                                                                                             What kinds of UEM are stockpiled at home?
 People stop taking medicine and stockpile it at home
                                                                                                                                                                                                                                                                                   The Unused and Expired Medicines Registry is the
                                                                                                                                                                                                                              Percentage of Federally
  beyond expiration date; medicine becomes unwanted                                          Why are the medicines unused?                                                                                                   Controlled Substances
                                                                                                                                                                                                                                                                                   only national registry and an important data collection
                                                                                                                                                                                                                                                      Federally


                                                                                             What is the cost of UEM?
                                                                                                                                                                                                                                                     Controlled


 Some people do not believe medicines expire
                                                                                                                                                                                                                                                     Substance


                                                                                                                                                                                                                                                                                   system necessary to improve our understanding of the
                                                                                                                                                                                                                                                        6%
                                                                                                                                                                                                              Not Federally

                                                                                             Other questions…                                                                                                 Controlled


 Someone dies, and medicines are unused                                                                                                                                                                                                                                           problems with UEM in our homes. More data are needed
                                                                                                                                                                                                                  94%




 There is no city, county, state, or national system to                                                                                                                                                                                                                           to characterize the types and quantity of UEM according
                                                                                                                        M E T H O DS                                                                                                                                               to geographic locations and demographic profile and to
  take back unwanted medicines from home                                                                                                                                                Sample 2 (n=1230) from Maine: Analgesics (13%) were
                                                                                          From collection events that involved law enforcement (21                                                                                                                                 devise educational and health promotion programs about
                                                                                                                                                                                        the most UEM. Prescription medicines comprised 74% of                                      the safe and appropriate use of medicines as well as the
   What are the main problems with unused and                                             CFR 1301.24), environmental groups, healthcare profess-
                                                                                                                                                                                        the sample. Reason for UEM was “expired meds”. From                                        safe disposal of UEM.
               expired medicines?                                                         sionals, and consumers, UEM were collected, inventoried,
                                                                                                                                                                                        preliminary analyses: an estimated cost of UEM was
                                                                                          and destroyed by controlled, witnessed incineration (21 CFR
 Children and pets can accidentally ingest these                                                                                                                                       $67,000; 15% of UEM (n=400) was potentially hazardous                                                                     DISCUSSION
                                                                                          1307.21). UEM data were transferred to CMFPS* for coding
  medicines and get poisoned                                                                                                                                                            to environment (PBT: 4-9)—mostly antibiotics.
                                                                                          and analysis; data are compiled into the UEM Registry using                                                                                                                              The UEM Registry, based in Texas and maintained
 Elderly can confuse different medications and make                                      standardized classifications and codes developed by CMFPS.                                                                            Percentage of Federally
                                                                                                                                                                                                                                Controlled Substances                              independently by CMFPS, can provide numerous
                                                                                          Variables for each register include drug name, dosage, con-
                                                                                                                                                                                                                                                           Federally


  mistakes taking them, causing drug interactions
                                                                                                                                                                                                                                                          Controlled
                                                                                                                                                                                                                                                          Substances
                                                                                                                                                                                                                                                             10.5%                 applications for users. A national steering committee to
                                                                                          trolled substance class, quantity returned, national drug                                                                                                                                investigate UEM in U.S., as well as the State of Maine
 Patients do not get therapeutic benefits of medicine
                                                                                                                                                                                                              Not Federally
                                                                                                                                                                                                              Controlled


                                                                                          code #, reason for return, average wholesale price (AWP),
                                                                                                                                                                                                              89.5%


  when they do not use it as prescribed                                                                                                                                                                                                                                            (LH1826), has officially recognized CMFPS and the
                                                                                          environmental hazard class, and zip code. Each register has                                                                                                                              Registry in this effort. CMFPS is planning a pilot study in
 People, particularly teenagers, can misuse or abuse—                                    50 data fields. Reports are based on descriptive analysis.                                                                                                                               the Houston area to collect and dispose of UEM. Potential
  “pharming”--medications
                                                                                                         UEM Registry Medicine Return Form (Anonymous)                                   Environmental hazard potential coding is based on the Swedish PBT Index                   users of the Registry are shown below.
 Medications can be stolen from the home                                                                                                                                                                     database (www.janusinfo.se)
                                                                                                                                                                                                                                                                                                            Environmental                  Drug/Law
 Unused and expired medicine means wasted dollars                                                                                                                                                                                                                                                            Protection                  Enforcement

  (minimum of $1 billion yearly in the US)
 Improper or illegal disposal of unwanted medicine can                                                                                                                                                                                                                                          Patient Safety
                                                                                                                                                                                                                                                                                                                                                        Medical
                                                                                                                                                                                                                                                                                                                                                        Practice
  contaminate our water supplies                                                                                                                                                                                                                                                                                            Registry

 Sometimes, unwanted medications are given to other                                                                                                                                                                                                                                                                                               National
                                                                                                                                                                                                    P= persistence in environment; B= bioaccumulation; T= toxicity                                    Marketing
  foreign countries and cause more problems                                                                                                                                                                                                                                                                                                        Security

                                                                                                                                                                                                                                                                                                                             Consumer
                                                                                                                                                                                                                                                                                                                             Protection


*Community Medical Foundation for Patient Safety is a nonprofit, 501(c)(3), active learning organization that specializes in the research of patient safety. Our mission is to promote patient safety and healthcare quality through education, research and the demonstrated practice of patient-centered medicine within a supportive organizational culture of
safety. Our research and educational programs include safety reporting systems for patients and families, safety checklists to prevent medical errors, and various publications, workshops and services for patients, families and healthcare professionals to increase the awareness of and the involvement in patient safety. The philosophy of our
Foundation is based on the Community of Competence™, an organizational concept developed and trademarked by the Founder Elizabeth A. Smith, Ph.D. Improvement of our healthcare system can be achieved by learning and building a Community of Competence in healthcare and an organizational culture that is truly patient-centered and focuses
on quality and safety. For more information, visit us at 6800 West Loop South, Suite 190, Bellaire, Texas 77401; 832-778-7777; www.communityofcompetence.com

				
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