E-DRUG: Response to recent prescription drug abuse reports
----------------------------------------------------------
The following letter is being prepared to send out and signatories and
supporters, individual and organizational are asked to reply by email if
they feel in agreement to Stevan Gressitt, M.D. gressitt@uninets.net by
Thursday, 5 pm EST in order to compile a list of supporters. The short time
line was unavoidable. It is our hope that this will contribute to addressing
improper drug donations.
The report by CASA, the recent announcement by DAWN, and the latest report
from the Partnership for a Drug Free America regarding the incidence and
significance of pharmaceutical misuse or abuse leading to emergency room
visits and levels of drug abuse across the country is alarming. For several
years, for some of us longer than that, there has been an effort to begin to
focus on this very problem. The State of Maine has passed legislation which
is the first in the country to address the return of unused consumer
medication to prevent and combat drug abuse.
Amongst the many issues pertinent to unused consumer medication, we have
focused on addressing five specific and significant problems. These five
include:
1) Childhood poisoning, the unintentional
pharmaceutical poisonings of children, resulting in morbidity and mortality
2) Teenage "pharming", that is, the theft and
social use and abuse of pharmaceuticals by teenagers and also household
burglary and theft from medicine cabinets;
3) Accumulation among older adults, particularly
rampant non-compliance and poor adherence to medication regimens - greatly
deteriorating patient outcome
4) The potential deleterious effects on wildlife
and humans due to drug accumulation in waterways of all varieties and sizes
throughout the country from both disposal and excretion pathways
5) The under regulated and poorly controlled
methods of international donations to countries in need, resulting in
massive amounts of "gifts" of unused and expired pharmaceuticals, or in
other words a transfer of (potentially) toxic waste. In short, the need to
preclude improper drug donations to disaster areas worldwide where more harm
than good can be done even with the best of intentions.
At this point there have been meetings, EPA and DEA sponsored conferences,
list-serves developed, and broad ongoing discussions among a diverse group
of stakeholders. These discussions have, at times, been fragmented by
geography and across professions and organizational interest(s.) There are
efforts to address unused medication in California in the news today (May
15, 2006.) Florida, Indiana, Michigan, Minnesota, Massachusetts, Oregon,
Vermont, Washington, and Maine have all begun the process of discussion and
collection. Australia, Finland, France, British Columbia, Ontario, among
others, all have ongoing programs. In Sweden the process of environmental
assessment and labeling of pharmaceuticals is beginning. Thousands of
pounds, kilograms, even tons of unused medicine have already been removed
from circulation. This process of discussion and collection has already
demonstrated the reduction of harm, the improvement of healthcare, and
protection of environment and healthcare dollars to come from such a
program. Each wasted pill or capsule represents wasted health care dollars.
The problem of unused medicine in the household has brought together
physicists, chemists, nurses, engineers, physicians, drug investigators,
hospice workers, law enforcement, and environmentally oriented professions.
Groups focusing on the aging population, children, or teenagers have been
involved.
But as of today, there is no active national or statewide program in the
United States that can alert and assist average consumers to keep their
households safe from and the environment unharmed by unused medications.
There is no currently accepted consensus regarding what to do with unused
medications that accumulate in the household. Without a solution there is an
ever increasing amount of pharmaceuticals available for illicit and unsafe
use as such medicines become the source for poisonings or the target of
theft. As recent reports indicate, the unintentional poisoning of children
due to stockpiled drugs cannot be overlooked. This issue needs to be
addressed from both the disposal dilemma as well as understanding why unused
medicines accumulate in the medicine cabinet. We accept some supplies of
medications eventually expire in medicine cabinets, but poor adherence and
non-compliance continues to be a major source of concern in the US and
around the globe. The number of consumers who do not follow medication
regimens in this country continues to be substantial and we must address
this issue as it has in itself a causal correlation with patient outcome and
morbidity.
To help unify and streamline our efforts, all drug return or take back
programs and pilots have an opportunity to provide data to a national
registry in Houston, Texas, which has been operational for the past year and
which is noting an increased volume of pharmaceutical returns data.
Hospitals are increasingly expressing interest or actually conducting unused
medicine "take-backs", as Mid Coast Hospital in Maine recently did. The
capacity of such local programs, however, has not kept pace with the demand
wherever it is known that these exist.
The CASA, DAWN, and now the Partnership for a Drug Free America reports
sadly portray a healthcare problem with many sources, in need of many
solutions - a problem that urgently needs to be addressed as the public
health problem that it is. Solving the problem of disposal of unused
medicine in households across the country is one of the most significant
legacies that the current generation can leave for the next. Federal and
state agencies, the pharmaceutical industry, health care insurers, the
medical, pharmaceutical, and nursing professions, healthcare providers,
clinicians, caregivers, foundations, and the public alike have an
opportunity, and obligation, now to go beyond just furthering the dialogues
about the benefits of unused pharmaceutical returns and to move at a quicker
pace toward curtailing overdoses, and emergency room visits.
Signed:
Stevan Gressitt MD
gressitt@uninets.net