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RE: Pharmaceuticals

Sorry I'm getting in on this conversation late...
Take back of expired drugs (including samples):  many reverse distributor (RD) companies accept samples from doctor's offices as well as expired drugs from pharmacies.  Most reverse distributors have a mail-in service and do not have a minimum quantity (although they may have a minimum charge).  So these services are available to health care facilities with small amounts of expired drugs.  Check with your state hazardous waste program and clarify with the individual reverse distributor whether the samples are managed as "waste" or "product."  Generally, drugs going to a RD are managed as "product."  However, samples could be subject to debate (more than for the typical expired drug) as to whether there is any endpoint for them other than disposal. 
Take back from patients:  For controlled substances (CS), the DEA regulations currently prohibit pharmacies or RD's from accepting "patient returns."  The DEA system tracks controlled substances from raw material thru dispensing to the patient.  DEA registrants can only accept CS from other registrants.  Because patients are not registrants, unused drugs returned by patients can't legally re-enter the system.  In my survey, I didn't find any companies in the US accepting patient-returns (even if they aren't CS), unless it is being returned as suspected defective product.  This is an interesting area for some creative thinking and cross-agency collaboration to search for workable solutions.
Just-in-time delivery of drugs:  I understand that policies of insurance companies, Medicaid, and Medicare often mandate purchasing 30-day supplies of drugs as a cost-cutting measure.  On the other hand, many hospitals have a system called "Pyxis" that is like a computerized drug vending machine at the nurse's station.  When a patient needs medication, only the dose needed is dispensed, one pill at a time.  The machines are stocked by the hospital pharmacy.
Drug shelf-life extension:  The military has put some effort into a program to accomplish this.  It involves testing and an FDA process.  I'm not familiar with the program, but it doesn't look easy.  http://www.usamma.army.mil/html/dodshelf.html
Available on our program website are two documents that can provide additional insights into disposal of expired pharmaceuticals.  
Resource Directory for the Management of Pharmaceuticals in King County:  This directory provides contact information on reverse distribution and returns companies, hazardous waste incinerators, and companies providing sharps management. Also included are best management practices as suggested by the returns industry.
Reverse Distributor SurveySummarizes results of a national phone survey of pharmaceutical reverse distributors for services available to small businesses in King County. Reverse distributors (also referred to as the returns industry) typically accept shelf-life expired drugs and arrange for credit processing thru the original drug manufacturer. Manufacturers offer credits back to drug dispensers for excess stocks as a marketing tool and to reduce liability risks for managing excess pharmaceuticals.

Alice I. Chapman, PE
Local Hazardous Waste Management Program in King County
130 Nickerson St, Suite 100
Seattle, WA  98109-1658

206-263-3058, phone
206-263-3070, fax

From: Thomas Vinson-Peng [mailto:tvinson@mail.utexas.edu]
Sent: Thursday, May 13, 2004 9:07 AM
To: P2tech
Subject: Pharmaceuticals

Well, I am in my new home at the University of Texas, and am finally putting my head above the mass of administrative issues to get back to P2.
I got one of my first calls and it is a big issue. 
The caller coordinates a series of hospice operations.  He has been getting an increasing number of calls from people who want to know what to do with pharmaceuticals that are left over.    I am sure we all know this is an emerging issue. After a lot of research he came my way.  To date the best solution he has heard is to water down the chemicals, pour them over kitty litter and trash them...GASP!  Others are flushing them into the POTW system.So far H2E list serve is telling me that there isn't really a good strategy yet...so I know this crowd of creative thinkers will come up with something.   A series of local programs are attempting to address it with take back and disposal programs. They all remind me of control or remediation.  Even these programs are challenged because you are dealing with controlled substances that also pose a hazard to the environment.    
I spoke with some POTW people and they are also vexed. Not only is disposal an issue, but much of the chemical finds it's way into the toliet as urine.
Anybody got a good idea? 
I will get ahead of some of the more philosophical people and say the ultimate source reduction is not to get sick.  Barring that, what should be done with left over pharmaceuticals from home health care/hospice?
Thomas Vinson-Peng
Southwest Network for Zero Waste
University of Texas
10100 Burnet Rd.  CEER-R 7100
Austin, TX 78758
Phone: 512/232-7149
Fax: 512/471-1720

The Southwest Zero Waste Network is a proud member of the National Prevention Resource Exchange http://www.p2rx.org