January 22, 2012

Drug Companies Fight Take-Back Program for Unused Medicine

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Meanwhile, environmental authorities say prescription drugs are turning up in waterways and even drinking water – and it’s happening often enough that the old medications now are considered hazardous waste.

“People don’t have a safe way to dispose of these medicines,” said Margaret Shield, policy liaison for the Local Hazardous Waste Management Program in King County, a consortium of local governments. “Often people don’t think of medicines as being potentially hazardous, but they are in the wrong hands and they need to be properly disposed of just like other household hazardous waste.”

Yet efforts in Olympia to pass a law to force drug companies to pay for a statewide system for properly disposing of old medicines have foundered for five years running now in the face of opposition by the pharmaceutical industry. If the legislation passes, Washington would become the first state to require the industry to fund a drug take-back program.

About one-third of all medicines sold annually in Washington – 33 million containers of pills – go unused, say proponents of stricter regulation. Some get flushed down the toilet, but many more sit unused in medicine cabinets. This stock of drugs is a contributing factor in Washington’s epidemic of prescription drug abuse.

“More people are dying from prescription drugs than out there on the highways,” said Patric L. Slack,commander of the Snohomish Regional Drug Task Force.

Since 2003, drug overdoses have surpassed car accidents as the leading cause of accidental deaths in Washington.  Most of these overdose deaths were from prescription and over-the-counter medications, not illegal drugs.

“More people are dying from prescription drugs than all illicit drugs combined,” Slack said.

These medicines can be dangerous when used or disposed of improperly, he said.  While permanent recycling systems exist for products such as tires, computers and batteries, one for the safe disposal of medication does not.

“And as far as I know, an unused tire has never killed anybody,” Slack said.  “But unused meds have.”

A drug disposal program also would discourage drug addiction, Slack said: “From a law enforcement perspective, we know some drug addictions start in the medicine cabinet.”

Research shows many drug addictions begin with prescription pills. A University of Washington study of heroin users in the Seattle area found that 39 percent said they initially got addicted to painkillers before heroin.

Industry-Funded Model Proposed for Washington

Take Back Your Meds, a group of environmental and health organizations, pharmacies, and law enforcement agencies, has been working to pass legislation in that would create a permanent, statewide drug take-back program.

The proposed Washington legislation would create a drug take-back program similar to the one in Vancouver, B.C.  As in the Vancouver model, which has been in place for 13 years, Washington has proposed that drug companies cover the expenses of the program.

The state legislation to do that has been filed three times by Sen. Adam Kline, D-Seattle, who got the bill to the Senate floor last year but found himself one vote short of passage. Kline plans to push the bill (SB 5234) again in the current legislative session.

Proponents argue that the measure is justified by the mounting prescription-drug abuse epidemic, coupled with potential harm to Puget Sound and other waterways from discarded medicines. They pointed to the take-back program in British Columbia that cost about $400,000 in 2009. That program diverted 112,000 pounds of medicines from improper disposal or abuse.

“Officers and public health officials told me story after story about kids getting high or overdosing on their parents’ prescription medication, or selling and trading them at school,” Kline wrote in explaining his reasoning. “Adults also misuse and sell prescription medications, and they have become a large part of our state’s criminal drug trade.”

The co-sponsor of a companion bill in the House, HB 1370, is Rep. Kevin Van De Wege, D-Sequim. This marks the fifth year the legislation has been filed in the House.

Kline said he believes the pharmaceutical industry is fighting the legislation because the need for it shines a light on widespread over-prescribing of medicines by physicians.

“Physicians are under pressure from Pharma (the pharmaceutical industry) to prescribe more than their patients actually need,” Kline said. “This happens with my own doctor. I get a prescription for 30 of something and I only need three. So I have 27 left over.”

Opponents, though, counter that only half the population in B.C. uses the take-back program, and that evidence cited by the U.S. Environmental Protection Agency shows that most of the prescription drugs detected in waterways come from substances excreted by people in their waste, not from improper disposal.

The opponents, including the Pharmaceutical Research and Manufacturers of America, said in testimony to the Senate Health and Long Term Care Committee that while they are not knowledgeable about addiction, a take-back program has lots of down sides.

“This bill is unnecessary and will not prevent medicine abuse or affect the environment,” says a summary of their testimony. “Three to 7 percent of drugs go unused. We should focus on effective mechanisms to dispose of drugs. The best way is to dispose of medicines in the household trash. … We support teaching patients and caregivers how to store medicines to keep them away from children and how to properly dispose of their medicines.”

Kaelan Hollon, director of communications and public affairs for PhRMA, declined an InvestigateWest request for an interview with the group’s lobbyist in Olympia, Jeff Gombosky. She provided a written statement outlining 10 points of opposition to the legislation, which said in part:

“There is insufficient evidence that such a program is cost-effective or would reduce drug diversion.  Instead, the proposed program could create known sites for or access points to aggregated medicines and could unintentionally increase diversion and abuse.”

Among the reasons PhRMA opposes the Washington legislation is that the federal Drug Enforcement Administration is working on rules based on a 2010 federal law. At the national level, U.S. Rep Jay Inslee and U.S. Sen. Patty Murray, both Democrats from Washington, have been active in pushing take-back legislation. In 2010 Congress passed and President Obama signed the Secure and Responsible Drug Disposal Act, S. 3397, which authorizes the U.S. Attorney General’s Office to allow hospices, nursing homes and other long-term care facilities to take back drugs.

Although Inslee professed to be pleased with passage of the companion measure, his bill would have gone further. It would have required the attorney general to set up such a program, instead of making it optional. It also would have required a study of the environmental effects of prescription-drug disposal.

Existing Drop-Off Options Prove Popular, but Limited

The various safe drug-disposal programs that currently exist sporadically throughout the state depend mostly on unstable funding by taxpayers, government organizations, law enforcement and retailers.

In Snohomish County, many of the drop locations are in police stations.  However, decreasing government budgets make the future of these drop locations uncertain.

At least one healthcare organization has also tackled the drug disposal issue. Group Health Cooperative, a nonprofit health care provider, implemented one of the first safe drug- disposal programs in the state. Since the program’s creation, more than 56,000 pounds of old drugs have been safely disposed of, and the co-op continues to collect an average of 400 pounds of unused medication each week.

The take-back program in Group Health pharmacies began as a two-year pilot program in 2006.  By the end of the first year, there were disposal bins in all 25 Group Health pharmacies, said Shirley Reitz, director of pharmacy clinical services.

Though the program was advertised only to Group Health clients, it was incredibly successful, Reitz said.  After the pilot program ended, Group Health chose to continue it.

For years the advice from pharmacists was to flush unused medication down the toilet, Reitz said.  However, according to Washington State’s Department of Ecology, the pharmaceuticals in the landfill and sewer systems end up in the waterways and in drinking water because most water treatment facilities are not capable of eliminating them.

Shield, of the hazardous-waste consortium, vows to fight on in Olympia in the current legislative session, saying, “It shouldn’t be a partisan issue because it’s about public safety.”

This story is part of an ongoing collaboration between InvestigateWest and public broadcast station KCTS 9. If you enjoyed this story, please consider becoming a member for just $5 a month.

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