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Unused MedicationsWhere are we now?
Prepared for: U.S. Drug Enforcement
Administration
By: Dr. Jeanie Jaramillo and Dr. Stevan Gressitt
July 19, 2011
Disclosures
• Poison Center Incentive Grant funded by HRSA
• No other potential conflicts of interest
Context
Acknowledgement
This presentation includes information collected and compiled by the
Pharmaceutical Collection Monitoring Group
through use of thePharmaceutical Collection
Monitoring System™
Purpose for Visit
• There’s an elephant in the room– Not that unused medications are a problem
• Now common knowledge:– Meds as a source of poisonings– Source of abuse (and diversion)– Source of misuse– Source of environmental contamination
• Finding a solution– Band aid approach is no longer enough
• Take back events are a band aid approach
Root Cause Analysis is Needed
1. Define the problem factually2. Gather data and evidence3. Ask “why” and identify causes4. Identify corrective actions that will prevent
recurrence5. Implement actions6. Observe effect
Purpose for Visit
• We’ve hit a brick wall at step #2 (gather data and evidence)
• We need the help of the DEA• Outline
– Discuss successful collection events– Data utility– Share results– Request support
Data Collection
• Numerous take backs across country• Several high-quality data sets
– Gressitt– Mireles– Gottlieb– Jaramillo
• All data sets collected different data points– No consistency– Merging of data difficult if not impossible
Pharmaceutical Collection Monitoring System™ (PCMS)
• Web-based recording and reporting tool• Provides for collection of consistent data
across multiple sites• Accessible by users anywhere that internet
service is available
A Case Report: Car #188
• Amarillo, Texas • Population: ~180,000• Community Medication Take Back Event• Drive through• Collaborative effort with Amarillo Police
Department
Car #188
Car #188
• 2 large boxes• Medications from deceased parents
and cat• Speculatively parents both suffered
from chronic, terminal diseases• Reporting today only the controlled
substances from this vehicle
Controlled Substances from Car #188
Drug Name Strength # ContainersQty
Collected AWPLow-High End
Street Value
diazepam 5 mg 18 2,320 $167 $2,320 - $46,400hydrocodone/ APAP 10/325 mg 4 520 $363 $1,040 - $10,400
Lorcet® 5/500 mg 2 2 $3 $6 - $18
Lyrica® 75 mg 6 84 $227 $420 - $1,680
morphine sulfate 30 mg 61 10,080 $5,352 $80,640 - $302,400
MS Contin® 30 mg 3 6 $17 $90 - $300
oxycodone/APAP 5/500 mg 15 802 $95 $802 - $4,010
temazepam 30 mg 2 180 $32 $180 - $3,600
111 13,994 $6,256 $85,498 - $368,808
Values obtained from NDIC reports. Indicate estimates.
Car #188
• Rare occurrence or more common than we think?
• No data • Of what use would the data be? Would it
really help anything?
What data do we have?
April 30th DEA Take Back Day
• Eight organizations• 11 sites• Conducted events and logged data• Goal: data from at least first 50 participants• Result: data from items of 411 participants
was collected• 3,800 line items logged
April 30th DEA Take Back Day
6%
60%
33%
Percentage Collected by Classification - All Sites Combined
Controlled Substances
Non-Controlled Substances
Over-the-counters
Unknown/unidentified
Most Commonly Collected Controls
Acetaminophen with hydrocodone 22.7%
Acetaminophen with propoxyphene 21.3%
Benzodiazepines11.3%
By Schedule
See handout report• C II• C III• C IV• C V
Medication Utilization/ Wastage
• Controlled substances collected/documented– On average, 67% of dispensed controls were
brought to take back events for disposal– 67% = wasted
• Overprescribed?• Over-marketed?
60% 20%
18%
10%
*total >100% as some participants selected >1 answer
Percentages indicate what event participants would do with meds if event was unavailable.
Why come to the DEA
• Data has utility; greatly needed• Lost participation of sites due to lack of DEA
support• Current directives
– No questions– No counts– No handling of meds
Why come to the DEA?
• Need DEA to be part of the solution– Funding? – Letter of support?– Letter of understanding?
Academia
PCMS
Community Partners.
Local Law Enforcement
.
DEA