Dr. Mary Noble knows there’s a nightmare lurking in most medicine cabinets.
Nearly every time she asks patients to show her what drugs they’ve got, they bring in vials and vials of unwanted, outdated and potentially dangerous medications.
“They’re drugs they don’t tolerate, don’t finish or don’t remember what they’re for,” said Noble, an internal medicine specialist at Group Health Cooperative in Spokane. “It’s kind of scary sometimes how old the medications are.”
Too often, disposing of the unwanted drugs has meant tossing them in the trash or down the toilet, where the experts say the medications remain a hazard to people – and the environment.
“It does get rid of them, but we’re learning that it’s not the best way,” Noble said.
A statewide pilot project, however, is offering people in Spokane and across Washington an innovative alternative for drug disposal.
Since October, the PH:ARM program – Pharmaceuticals from Households: A Return Mechanism – has collected and discarded more than 600 pounds of unwanted medications from seven Group Health pharmacy sites, said Shirley Reitz, associate director for clinical pharmacy services.
“What we want to do is develop a system that’s sustainable, reproducible and inexpensive,” said Reitz, who is part of a coalition that has spent more than two years working on the issue.
By mid-May, the pilot program is expected to expand to 25 places across the state – including four sites in Spokane – where people can slip the drugs into distinctive receptacles in the pharmacy lobbies.
“It looks like a big, blue mailbox,” Reitz said. Inside each mailbox is a 5-gallon bucket that is filled and refilled with the unwanted products. Workers examined the first 50 buckets to ensure that no household trash or other detritus was being dumped.
“They found just what they thought they’d find,” she said. “Old and expired medications, cough syrup, inhalers, pills, tablets.”
The material was secured and sent to a Group Health pharmacy warehouse in Tukwila before being shipped to Spokane for incineration.
Emma Johnson, a state Department of Ecology employee who helped create the program, said the project has generated more than 100 bucketfuls of drugs that were burned in Spokane’s Waste-to-Energy Plant earlier this year.
The plant is a safe way to dispose of the drugs because it burns hot for a garbage incinerator, Johnson said. Besides, the amount of drugs burned as part of the pilot program is only a fraction of the medications already present in ordinary garbage, said David Stitzhal, coordinator of the Northwest Product Stewardship Council.
Ideally, he and other organizers would like to send the material to a hazardous waste incinerator in Utah, which offers even higher temperatures and better control, Stitzhal said.
But Utah officials won’t agree to process the material until they receive a waiver from the federal Drug Enforcement Administration, which would allow disposal of controlled substances, he said.
A similar roadblock is hampering complete implementation of the Washington program, believed to be a first in the nation, Reitz said. Under federal regulations, certain controlled drugs can only be returned to law enforcement agencies.
However, research conducted by PH:ARM advocates showed that people would be likely to return unwanted drugs to pharmacies or other convenient places, but they’d be unlikely to return them to a local sheriff’s office, for instance.
Organizers of the medication take-back program have applied to the DEA for a waiver that would allow acceptance of controlled substances.
The sites are secure and well-monitored, noted Jim Campbell, pharmacy manager at Group Health’s Riverfront Medical Center.
“The unit is bolted to the floor and to the wall,” he said. “It takes two people to open it and process it. And it’s locked at night. It’s only open during operating hours.”
A DEA spokesman, Bernie Hobson, said Friday that a decision on the waiver is still pending.
Although Group Health has sites in Idaho, no effort has been made to include that state in the pilot project, Stitzhal said.
“We thought we’d be lucky to get this off the ground in Washington,” he said.
But Idaho, which has no state-sponsored take-back program or guidelines, is closely watching Washington, said Jan Atkinson, senior compliance officer with the Idaho Board of Pharmacy.
Atkinson said some consumers are confused by the differing programs in both states. In Idaho, pharmacists do not accept unused medications. Law changes have been enacted in recent years, however, that allow nursing homes, for instance, to return unused drugs that remain in their original unopened packages. But the law doesn’t cover the mounds of open pill bottles that are sometimes leftover when an ill person dies. Public schools are also increasingly finding themselves stuck with medications left behind from students who have moved. Often, these drugs are controlled substances, like Ritalin.
“They’re stuck with those drugs,” Atkinson said. “They have to get rid of them.”
Typically, the drugs are flushed. Others are burned during Idaho’s twice yearly incinerations of drugs seized by law officers.
Atkinson believes drug manufacturers should help fund a solution, as they do in British Columbia, where a program has operated for a decade.
“The drug companies should be responsible for paying for some of these programs to help get the drugs out of circulation,” Atkinson said. “I think they owe everybody a certain amount of responsibility in all these things.”
Something needs to be done, she said. “I just applaud Washington – at least they’re trying.”