Part 1: The Prescription Drug Abuse Epidemic

Prescription drug abuse has become a growing epidemic in the United States. Fifty-two million people over the age of 12 have used prescription drugs non-medically at least once during their lifetime.1 Every day 44 people die from an overdose of painkillers.2 Prescription drug abuse occurs when drugs have psychoactive (mind-altering) properties and are not taken as prescribed or are taken by someone to whom they were not prescribed.3 The most abused types of drugs are opioids, followed by tranquilizers and stimulants.4

Opioids are pain medications that decrease the strength of pain signals to the brain and affect those brain areas controlling emotion, which reduces the effects of a painful stimulus. Opioids include oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian) and hydrocodone (e.g., Vicodin). Since these drugs affect the regions of the brain responsible for reward, some users may experience a euphoric reaction.5

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Management of Pharmaceuticals at Healthcare Facilities

Medicines improve our quality of life, but there are some important issues regarding the proper disposal of unneeded or unwanted medicines. The disposal of pharmaceuticals when no longer needed poses a threat to our environment. Sharps Compliance has developed a program to manage these unwanted pharmaceuticals safely and in compliance with all federal, state, and local laws and regulations.

One of the ramifications of mismanagement of unused medications is the environmental effects resulting from poor pharmaceutical disposal practices. Through the years, pharmaceuticals have been largely discarded through either flushing or “sinking” them into the wastewater stream or discarding them into the solid waste stream. In the first instance, the wastewater is treated to remove physical, chemical, and biological contaminants, such as sediment, bacteria, and viruses. However, this treatment does not remove all organic molecules, which are inherent in pharmaceuticals. Thus, many of these molecules remain entrained in the treated waste water which is discharged into reservoirs, rivers, or lakes. Likewise, drugs disposed of as solid waste (into landfills) may leach these organic molecules into aquifers and into the fresh water supply.

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Medication Disposal for Long-Term Care Facilities — Including Controlled Substances

On September 9, 2014, the Department of Justice published the final rules for the Secure and Responsible Drug Disposal Act of 2010 allowing proper controlled substance disposal. The regulations go into effect October 9, 2014. The amended rules (found here) allow registered collectors, such as closed-door and retail pharmacies to place receptacles in long-term care facilities to collect and dispose of controlled substances (Schedules II-V). Before the rule update, solutions for disposal in long-term care facilities were minimal and often messy and environmentally unsustainable.

Flushing Medications

Flushing controlled substances, while acceptable in some states, should be avoided as the long-term effects of pharmaceuticals in rivers and streams are unknown. In 2008, the Associated Press found pharmaceuticals in the drinking water of 24 major metropolitan water supplies. Other studies have shown changes in aquatic life such as gender changes in fish, due to pharmaceuticals in the water.

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