North Dakota MedSafe

Last updated on April 13, 2021

North Dakota’s innovative approach to combating the opioid crisis in rural America involves stakeholders at every level – from pharmaceutical companies to the public. Although the state’s death rate from opioid overdoses is less than half the national average, officials were alarmed when it spiked in 2016. In response, the state launched several new initiatives that focused on education, front-line prevention, and drug collection/diversion using Sharps Compliance MedSafe Medication Disposal System kiosks.

In a recent interview, Mark J. Hardy, Executive Director of the Board of Pharmacy in North Dakota discussed how North Dakota pharmacists, in particular, are working to educate and empower their customers and communities.

One Rx: Educating Pharmacists and Patients

The ONE Rx (Opioid Naloxone Education) program is a pilot project in partnership with North Dakota State University (NDSU). Hardy described it as a tool to help pharmacists screen patients who may need extra consultation and/or education about the dangers of opioids:

“We want to put prevention on the front lines with patients. Pharmacists will have the ability to screen patients, ask questions when they bring in an opioid prescription, and assess the patient’s risk for opioid addiction. In some cases, it may be appropriate to distribute a Naloxone prescription.”

The NDSU School of Pharmacy offers the training as part of statewide community education for pharmacists. The ONE Rx program and training sessions are funded by grants and are part of an effort of multiple partners to proactively help patients and communities.” 

The reason education is important, Hardy said, is because home is often the first access point for opioids. “Someone who gets addicted usually gets it free from their friend or relative first. One Rx begins the conversation about proper storage and disposal of the medication.”

Drug Diversion Initiatives with TakeBack and MedSafe

Once the medication is in patients’ hands, North Dakota offers two free drug disposal options for law enforcement locations and pharmacies. Participating law enforcement agencies offer secure drug takeback receptacles at their locations. Sharps Compliance partnered with the ND Board of Pharmacy in 2017 to offer MedSafe containers at participating pharmacies.

With 126 participating pharmacies, the MedSafe program has been a success, Hardy said, because the demand for the service was there.

“Demand was driven not only by medical and public health professionals but also by members of the general public who want safe disposal options in their communities. Almost everyone has a friend or relative touched by this issue.”

North Dakota funds the MedSafe program through license fees, so there’s no cost to participating pharmacies. Ease of use and public participating is mostly responsible for the growth of the program. The program began in 2017 with 70-80 participating pharmacies, but within the first year, that number almost doubled, Hardy explained.

“From our standpoint, MedSafe has worked really well. It’s relatively hassle-free for the pharmacies. They do have a small amount of maintenance work when they install and maintain the receptacle, but that’s a minimal burden. The customer service is excellent, and pharmacies that were initially reluctant to participate seem very happy to be offering the service.”

North Dakota pharmacies have collected just over three tons of unwanted medications via the MedSafe program, he added. “That’s a fairly significant amount of medications since we started working with Sharps Compliance. I’m sure there’s much more out there that will be returned in the future.”

North Dakota Is a Leader in Drug Diversion

The state’s efforts have been so successful that a General Accounting Office (GAO) study of participation in drug takeback efforts highlighted North Dakota’s success:

North Dakota had the highest participation rate, with 32.0 percent of its pharmacies and other eligible entities registered to be authorized collectors. The state with next highest participation rate was Alaska, with 8.96 percent

Hardy said other states have contacted his office for information about the Board of Pharmacy’s opioid education/collection projects. Some states are launching similar programs. For example, Montana recently announced the purchase of 212 MedSafe Medication Disposal Systems to be placed in pharmacies across the state. Despite North Dakota’s success, Hardy notes that the model isn’t something that larger, more populous states could easily replicate.

“Our smaller state and smaller pharmacy network has made the program easier to implement. In a larger state with thousands of pharmacies, it would certainly be difficult to manage on a statewide basis.”

However, all states and communities can learn from North Dakota’s example. Stakeholders have worked together to create innovative education, treatment, and collection programs – and there are even more statewide and community initiatives that help involve and educate the public.

  • North Dakota Prevention & Resource Center: This state-sponsored Web site contains “innovative and culturally appropriate substance abuse prevention infrastructure, strategies, and resources to individuals and communities.”
  • Take Back Program Locations: The ND Attorney General maintains a list of MedSafe and law enforcement TakeBack locations. Citizens can easily find the closest safe disposal location.
  • Grand Forks Call to Action: The city of Grand Forks hosts numerous opportunities for citizens to learn about the opioid epidemic and be part of the solution.

Hardy is proud of North Dakota’s progress and the role the state’s pharmacists play in fighting the addiction crisis.

“We have a long way to go, but we have pretty much eliminated the need for the semi-annual drug takeback events. North Dakota is a state with 24/7 takeback options, which means there’s a lot less medication sitting around waiting for disposal.”

Sharps Compliance works with pharmacies nationwide to provide safe, DEA-compliant storage, transportation, and disposal of used sharps, medical waste, and unwanted pharmaceuticals.


Wanda Voigt holds a BA in Nursing from Texas Woman’s University and a BBA in Business Management from Texas A&M University. In Fall 2021, Wanda will begin her Master Jurisprudence in Health Law and Policy at Texas A&M University. Wanda has over 20 years of clinical practice in both hospital and private practice practicing in various specialties.

As the Director of Regulatory Compliance, Wanda assists Sharps’ customers in evaluating current federal and state-specific medical and pharmaceutical waste regulations, implementing compliant regulated medical and pharmaceutical waste management programs and processes, and developing training programs for both internal and external customers.

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