BETHESDA, MD 23 Mar 2016—Patients who need to dispose of unwanted controlled substances and other medications are embracing the convenience of drug disposal kiosks managed by their local health-system pharmacies.
"We've collected a little over two tons, in the last year, of unwanted medications," said Buck Stanford, community pharmacy operations director for Intermountain Healthcare in Utah.
"I'm a little surprised at how much medicine we're taking in. So that just goes to show that we have an abundance of medication that's out there that needs to be disposed of," he said.
Stanford said all 25 of Intermountain Healthcare's community pharmacies have a way for patients to dispose of their medicines.
The health system last February installed drug disposal kiosks in 21 of its outpatient pharmacies. At the 4 facilities that lack space for a kiosk, patients are given preaddressed envelopes that they can use to mail some unwanted medications for incineration.
On the other side of the country, Kristina L. McGill, director of pharmacy at Beth Israel Deaconess Hospital–Plymouth, said the hospital last fall became the second in Massachusetts to set up a drug disposal kiosk and the first to install one outside of the pharmacy.
McGill said the 155-bed community hospital has shipped off medications from the 38-gallon kiosk twice since the unit was installed.
Both health systems obtained their kiosks, known as MedSafe units, from Sharps Compliance Inc. of Houston. The steel kiosks are double padlocked and contain an inner receptacle consisting of sturdy inner and outer cardboard boxes plus plastic liners and absorbent pads. The inner boxes double as a shipping container for sending the medications away for incineration.
Stanford said pharmacists and technicians, working in pairs, are able to unlock the kiosks and seal up the contents for shipping and disposal. Replacement liners are shipped to the pharmacies at regular intervals. When a new liner arrives, the staff collects the old one and sends it out to be incinerated regardless of how full it is.
Stanford said most of his pharmacies were on a quarterly liner replacement plan when the program started. But the kiosks have proved so popular that most sites now get replacement liners every month or two.
McGill said she and her chief of security open their unit about every two weeks to make sure the inner receptacle isn't overflowing and to "fish out" anything readily visible that doesn't belong in the kiosk.
"Although it says very clearly on the MedSafe not to put any sharps in it, people put in their unopened insulin pens and [enoxaparin syringes]. I take those out, and we dispose of that in our pharmacy trash," she said.
Instructions on the units describe substances that are not acceptable for deposit, including liquid medications in volumes greater than 4 ounces.
The Drug Enforcement Administration (DEA) in October 2014 implemented a regulation that allows pharmacies and other healthcare entities to register as collection sites for controlled substances and other unwanted medications [see November 15, 2014, AJHP News]. Healthcare entities must apply to have the "authorized collector" status added, at no cost, to their DEA registration before obtaining a drug disposal kiosk from a vendor.
A DEA spokeswoman said that as of February 29, a total of 882 DEA registrants had been designated as collectors.
The Utah and Massachusetts health systems obtained their kiosks for the same reason: to help stem the epidemic of opioid abuse in their community.
"Here at our hospital in Plymouth, we probably see somewhere between two and five overdoses a week," McGill said.
She said the hospital's response to the opioid abuse epidemic has included moving to an electronic prescribing system to prevent the fraudulent use of paper prescription pads. The hospital also supports a multipronged abuse-prevention initiative led by the Massachusetts Hospital Association.
"We, as a hospital, have spent the last year and a half really focusing on how we can use fewer narcotics," McGill said. "So we use a lot of i.v. acetaminophen, i.v. ibuprofen, i.v. ketorolac. We use a lot of multimodal therapy, and then we try and reserve actual narcotics if that doesn't work. We've redone all our order sets, and so it's a pretty big deal."
The association recommends that, unless there is a clinical need, hospital emergency departments prescribe no more than a five-day supply of an opioid to a patient. That recommendation is intended, in part, to reduce the supply of excess opioids in communities.
After McGill discovered that another hospital in the state had set up a drug disposal kiosk in an outpatient pharmacy, she approached her chief executive officer about getting one for the hospital. His response was, "Yes, get it right away," McGill recalled.
McGill said the kiosk is a valuable service to the community, and the lobby location is convenient for dropping off unwanted medications. She said people can even use the hospital's free valet parking service while they go inside to place medicines in the unit.
"And we have a lot of volunteers, and they're excited to just be able to bring their stuff in as they come in to volunteer and just drop it in there. Even my staff has made use of it" for personal medications, McGill said.
Stanford said he's used Intermountain's kiosks to dispose of unwanted medicines from his home. He said that making the kiosks available in the pharmacies is "an extension of what we are already doing to try to protect the health of the people in our state."
In Utah, according to the most recent data from the state's department of health, 49 people die each month from drug poisoning, and about 75% of the deaths are related to opioid use.
McGill said she had to demonstrate, before obtaining the kiosk, that the lobby location was monitored and secure.
"We had to make sure that it was under camera surveillance. Not that we want to see who is putting something in our kiosk; we wanted to make sure nobody is trying to take it away," she said.
But she said thieves would have a difficult time removing or breaking into her hospital's locked kiosk.
"It probably weighs about 300 or 400 pounds, and it's bolted to the floor," she said.
Stanford likewise said there were concerns, before the kiosks were installed, that they could be targets for theft. "But we haven't had any issues yet," he said, adding that the kiosks are under video surveillance.
Stanford said he's considered placing kiosks at locations outside the pharmacy, such as outpatient clinics for patients with behavioral health and substance abuse problems.
"But so far, we haven't needed to do that because of the amount of locations that we have with the MedSafes already," Stanford said. "They're already really convenient."
Both pharmacists were enthusiastic about the units and have recommended kiosks to their colleagues.
"I think everybody should do it," McGill said, though she cautioned that some planning is necessary before setting up a kiosk.
"You need to have a space for it and you need to be committed to it, because it doesn't take care of itself," she said.
Walgreens in February announced that it plans to install drug disposal kiosks in more than 500 of the drugstore chain's locations. Some police stations have also installed drug disposal kiosks or established other programs for the collection of unwanted medications.
ASHP policy 0614, Safe Disposal of Patients' Home Medications, encourages pharmacists to develop patient-oriented medication disposal options that minimize the risk of accidental poisoning, drug diversion, and adverse effects on the environment.