Prescription drug abuse is a growing epidemic in the United States. Opioids, depressants and stimulants are the most abused medications. According to the Los Angeles Times, the leading cause of death from unintentional injuries in the U.S. is drug-related poisonings, which has surpassed automobile accidents. Between 1999 and 2006, deaths from drug poisoning have almost doubled. The first step towards preventing drug abuse is proper medication disposal.
Nurses practicing in senior care have very busy work schedules. From caring for patients to distributing medications to updating records, their days can become overwhelming. One of the more time-consuming tasks is the disposal of unused medication.
When a resident’s medication is permanently discontinued, it must be properly disposed. Prior to updates to the 2014 Drug Enforcement Agency’s regulations which implemented the Secure and Responsible Drug Disposal Act of 2010, few safe, efficient and environmentally-preferred options were available to communities for controlled drug disposal. Typically, the Director of Nursing and another nurse would itemize the drugs to be destroyed and then undertake the time-consuming task of emptying them out of their containers or blister packs. Removing individual pills from blister packs can not only be time-consuming (and therefore, costly) but also painful and difficult. Once removed, the drugs were typically placed into the toilet or mixed with an undesirable substance, such as kitty litter or dissolved in a chemical prior to putting them into the trash. After all of the medication was removed and destroyed, the residents’ identifying information on the packaging had to be concealed and disposed of safely to prevent disclosure of protected health information.
In our last blog post, we explored how prescription drug abuse has become an epidemic in the United States. This week we will discuss how to prevent prescription drug abuse and what to do with any unused medications.
Many opioid abusers get the prescription drugs from friends or relatives for free, according to a study by JAMA Internal Medicine. Other sources include getting a prescription from one or more doctors, stealing or buying prescription drugs from friends or family and buying prescription drugs from drug dealers.1
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 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.