The Maine way to get rid of drugs

We’ve all encountered the problem: pharmaceutical leftovers.

Perhaps you’ve been prescribed a medicine with directions to take as needed — but in the end you didn’t need much. Or some drug you were prescribed caused a nasty side effect; so your doctor told you to stop taking it —immediately. In our household, an elderly relative died recently, leaving drawers, coat pockets and handbags containing literally dozens of bottles, vials and tubes of medicines.

What are we supposed to do with these?

As recently as five years ago, a pharmacist told me — as a journalist seeking information for dissemination to readers — that the best way to dispose of unused drugs was to flush them down the toilet. But municipal sewage-treatment plants haven’t been designed to remove medicines. Which helps explain why surveys of waterways around the nation turn up trace residues of a pharmacopeia of prescription medicines — from narcotics and cholesterol-lowering drugs to aspirin and antidepressants.

Drug-tainted waters are not good for fish or other aquatic organisms. And they’re not what should come out our kitchen tap or end up in our pools and bathwater. But they’re ending up in these waters, these fish — and inevitably getting recycled at trace concentrations back into us. Ugh.

At a committee hearing on Capitol Hill, this morning, Anne Perry, a nurse practitioner who also serves in Maine’s statehouse, described a pilot drug-disposal program that’s been underway in a few Maine communities for much of the past year. It’s simple, convenient, and comes at no cost to consumers.

People just pick up a prepaid mailer at their local pharmacy and then drop in the unwanted meds — after first removing any names from the drugs’ packaging (to ensure anonymity). Then you drop the package in a mailbox. It goes straight to the Maine Drug Enforcement Agency, which incinerates the contents as hazardous waste.

In the past, several ad hoc programs by pharmacists or other well-intentioned groups to take-back unused drugs ran afoul of the law. Federal rules proscribe anyone but law-enforcement officials from collecting prescription medications since there will be no way to prove that everything collected actually gets discarded — and not diverted.

Pharmaceutical manufacturers who sell their products in Maine pay a fee that covers the production and distribution of the mailers, Perry explained. And consumers are welcome to get rid of any drugs this way — including over-the-counter products, and even, presumably, pet meds.

As of April, 2,264 of the 7,230 mailers that given away at pharmacies in the four test towns had been returned, bringing in a total of 74,696 pills, capsules and tablets. Of these, 52 percent had never opened. This program “also lets us look at what is being throwing away,” Perry notes. She reported that a spot check identified the top 10 discards (in order) as:

— metoprolol, a blood-pressure-lowering drug sold as Toprol and Lopressor
— lisinopril, a so-called ACE inhibitor used to also lower blood pressure, and sold as Zestril or Prinivil
— ibuprofen, an over-the-counter anti-inflammatory and fever medicine sold as Advil and Motrin
— aspirin
— acetaminophen-hydrocodone, a narcotic form of Tylenol that’s sold under such names as Vicodin, Anexsia, Lorcet and Norco
— metformin, a diabetes drug sold under such names as Glucophage, Glumetza, Fortamet and Riomet
— tramadol, a pain killer that goes under the name Ultram
— furosemide, a diuretic sold as Delone, Detue and Lasix
— naproxen, an anti-inflammatory pain killer sold as Aleve, Anaprox, Naprelan and Naprosyn
— and warfarin, a blood thinner sold as Coumadin

This pilot program is now being readied for statewide introduction, Perry reported. By why not go further, she asked.

Laws in Europe and many Canadian provinces require that manufacturers collect and dispose of unwanted drugs, Perry noted. “I feel it is time for the U.S. to have a similar program, financed and administered by these same manufacturers.”

When asked whether such a program could be scaled up and go national, Perry told Madeleine Z. Bordallo (D-Guam), who chairs the House Subcommittee on Insular Affairs, Oceans and Wildlife, that she saw no reason why not.

Indeed, why not?

NEXT: Hospitals have a bigger problem discarding drugs.