Unused meds drive

More than two tonnes of unused medicines were returned to pharmacies in the MidCentral region during 2009–2010 as part of the district wide project for the Safe and Efficient Disposal of Unused Medicines.

The collection for the year to March is up 14.5% over the previous year and suggests patients are not taking their medicines regularly.

SEDUM is arguably the only continuously running project funded by a DHB that aims to get unwanted medicines out of homes to reduce the risk of poisoning, to dispose of them safely and to collect information about prescribing and waste patterns.

Several other DHBs run sporadic, short-term campaigns for Disposal of Unused Medicines through Pharmacies (DUMP).

Regular funding for the MidCentral project began in April 2005, following a successful pilot run by Central Pharmacy in Palmerston North during the previous year. Since then, nearly 250,000 items have been returned from over 53,000 people in the region, including 651,549 individual tablets of paracetamol – recently the subject of media reports for overdosing.

Between 1 April 2009 and 31 March 2010, omeprazole was the most returned medicine with 79,311 capsules from 2397 returns, followed closely by aspirin with 2321 returns (57,293 tablets). At least $36,000 worth of schizophrenia medicine, olanzapine, was also returned during the period – $1460 worth of it from a single patient.

Susan Judd, owner of Central Pharmacy and the brains behind the SEDUM project, says the concern is not so much over money wasted on 2385kg of dumped medicines in a single year, but the health risks that patients are exposing themselves to by not taking their medicines as directed.

For instance, six of the top 13 most frequently returned medicines were preventative cardiovascular medications, a trend that has remained consistent since the start of the project. Of this, more than 68,535 tablets were of simvastatin.

Ms Judd says, although the value of reducing cholesterol levels to prevent future cardiac problems is well known, people may stop taking statins because they don’t feel immediate benefits from taking them or, sometimes, they have unpleasant side effects.

The top reasons given for returning medicines were that they were “surplus”, the medication had changed or the patient had died. About 30% of the returns came from resthomes where medications are usually better managed.

The service is cost neutral to participating pharmacies. They publicise it through posters, collect unused medicines from patients, ask them a few questions, eg, who the medicine was for and why it is being returned, and put them in a bag provided by Central Pharmacy. These bags are regularly picked up by courier.

Ms Judd says pharmacies that participate in the SEDUM Project were asked in a recent survey to rate the benefit to their pharmacy on a scale of 1 to 10 (1 = no benefit; 10 = enormous benefit), in which 88% of respondents rated the service an 8, 9 or 10.

Since March 2006, Central Pharmacy has also been the collection pharmacy for the disposal of diabetic sharps. Ms Judd says the disposal rates continue to increase each year, from 393 during 2007–2008 to 1084 in the year to March 2010.


Nelson Bays pharmacies collect 200kg

Nelson Bays Primary Health, in a DUMP project it ran during November 2009, collected 200kg of unused medicines for safe disposal on behalf of the Nelson Marlborough DHB.

Pharmacy facilitator Caroline Allen quotes the project report saying 61% of medicines were returned due to a change in the medicine treatment or condition, as reported by patients or their whanau, 32% were returned due to an excess stock/clean out/ bereavement, and 7% were returned due to an adverse drug reaction.

Of the total medicines returned, 21% of items were dispensed within one year (September 2008–2009) and a further 6% were dispensed within two years (September 2007–2008). The oldest medicine returned was a bottle of morphine that was dispensed in 1958.

The most expensive medicine returned was two injections of adalimumab (Humira) on Special Authority, costing $1799.92 each.

The returned medicines also included 1857 asthma inhalers worth $15,537, or around 18% of the value of all returned medicines. This suggests problems with compliance as hospitalisations due to complications of uncontrolled asthma are among the major health issues facing the local DHB.

A detailed report on the campaign also makes 11 recommendations to Nelson Marlborough DHB to reduce waste and support prescribers, pharmacists and patients to utilise medicines more effectively.

Some of these are:

A collaborative approach to reducing medicine wastage, with prescribers and pharmacists educating patients about their medicines, the risk/ benefit of treatment and improving compliance. Patient education should focus on addressing the reasons why medicines are wasted in the first place.

A more “pharmacist friendly” process for returning unwanted medicines to Nelson Hospital or a central location for analysis. Pharmacists may be more willing to accept returned medicines and ensure appropriate disposal if a more acceptable arrangement is in place. The public will know they can return unused medicines to pharmacy any time, not just during the DUMP campaign.

Ongoing analysis of returned medicines to see if the results are repeatable and identify if trends are developing. Also, see if steps taken to reduce wastage are working.

Future DUMP campaign’s access to pharmacy management systems to aid the identification and pricing of medicines as part of the process.

The support of medicine use reviews by Nelson Marlborough DHB will assist pharmacists to target patients on respiratory inhalers to educate them about and increase their compliance with these medications, potentially reducing medicine wastage and avoidable hospitalisations.

Consider extending the sharps disposal service to at least some pharmacies to support the safe disposal of sharps.

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