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Toe J, Orok E, Erah P. Assessment of knowledge and disposal practices of unused and expired household medicines in a community in Liberia. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100369. [PMID: 38058360 PMCID: PMC10696106 DOI: 10.1016/j.rcsop.2023.100369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/18/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023] Open
Abstract
Background Expansion of pharmaceutical industries and improved availability of pharmaceuticals across the world have contributed to an increase in drug usage and accumulation in homes. Improper disposal of expired and unused medications has several consequences such as environmental pollution, and childhood poisoning. Objectives The aim of the study was to assess the knowledge on disposal as well as disposal practices of unused and expired household medicines in the Parker Corner Road Community in Brewerville, Liberia. Methods This study was a cross-sectional survey conducted among 162 residents of Parker Corner Road Community using face-to-face interviews. Outcomes measured were knowledge of disposal as well as disposal practices of unused and expired household medicines. The data collected were analysed using descriptive statistics. Results Majority of respondents (55.6%) were female and 23.5% had university education. 71% of the respondents reported that they had not received any information on safe disposal practices while 64.2% admitted that they often did not read and follow disposal instructions. The most popular disposal practices were disposal of the drugs along with household waste (61.1%) and flushing them down the toilets or sinks (25.3%). Majority of the respondents (82.1%) were aware of the health effects arising from improper disposal of unused and expired medicines while 64.2% usually read medicine disposal instruction on the package. Only about 3% of them knew of expired medication take-back system and 33.3% knew nothing about medication expiration date. Conclusion The study revealed insufficient knowledge as well as inappropriate disposal practices of unused and expired medicines among residents of Parker Corner Road Community in Brewerville. There is need to organize a public enlightenment programme on safe, appropriate use, as well as disposal of unused and expired medicines.
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Affiliation(s)
- Jerry Toe
- School of Pharmacy, University of Liberia, Liberia
| | - Edidiong Orok
- Department of Clinical Pharmacy and Public Health, College of Pharmacy, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
| | - Patrick Erah
- Department of Clinical Pharmacy & Pharmacy Practice, Faculty of Pharmacy, University of Benin, Benin, Nigeria
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Tata V, Al Saadi R, Cho SK, Varisco TJ, Wanat M, Thornton JD. Physician perspective on the implementation of risk mitigation strategies when prescribing opioid medications: a qualitative analysis. BMC Health Serv Res 2023; 23:1185. [PMID: 37907915 PMCID: PMC10617230 DOI: 10.1186/s12913-023-10136-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE To understand the physician perspective on the barriers and facilitators of implementing nine different opioid risk mitigation strategies (RMS) when prescribing opioid medications. METHODS We created and dispersed a cross-sectional online survey through the Qualtrics© data collection platform among a nationwide sample of physicians licensed to practice medicine in the United States who have prescribed an opioid medication within the past year. The responses were analyzed using a deductive thematic analysis approach based on the Consolidated Framework for Implementation Research (CFIR) to ensure a holistic approach to identifying the barriers and facilitators for each RMS assessed. In concordance with this method, the themes and codes for the thematic analysis were defined prior to the analysis. The five domains within the CFIR were used as themes and the 39 nested constructs were treated as the codes. Two members of the research team independently coded the transcripts and discussed points of disagreement until consensus was reached. All analyses were conducted in ATLAS.ti© V7. RESULTS The completion rate for this survey was 85.1% with 273 participant responses eligible for analysis. Intercoder reliability was calculated to be 82%. Deductive thematic analysis yielded 2,077 descriptions of factors affecting implementation of the nine RMS. The most salient code across all RMS was Knowledge and Beliefs about the Intervention, which refers to individuals' attitudes towards and value placed on the intervention. Patient Needs and Resources, a code referring to the extent to which patient needs are known and prioritized by the organization, also emerged as a salient code. The physicians agreed that the patient perspective on the issue is vital to the uptake of each of the RMS. CONCLUSIONS This deductive thematic analysis identified key points for actionable intervention across the nine RMS assessed and established the importance of patient concordance with physicians when deciding on a course of treatment.
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Affiliation(s)
- Vaishnavi Tata
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA.
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA.
| | - Randa Al Saadi
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA.
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA.
| | - Sang Kyu Cho
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - Tyler J Varisco
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - Matthew Wanat
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
- College of Pharmacy, Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, 77204, USA
| | - J Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4349 Martin Luther King Jr. Blvd, Houston, TX, 77204, USA
- Prescription Drug Misuse and Education Research (PREMIER) Center, University of Houston College of Pharmacy, Houston, TX, 77204, USA
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Varisco T, Patel H, Saadi RA, Wanat M, Thornton D. Patients prefer free drug disposal options delivered by pharmacists at the point of care: Results of a decision tree analysis of a national factorial vignette panel survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104045. [PMID: 37156066 DOI: 10.1016/j.drugpo.2023.104045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/01/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Unused opioid medication in the home increases risk of medication diversion, misuse, and unintended harm. The United States Federal Food and Drug Administration is currently considering the implementation of a risk evaluation and mitigation strategy (REMS) program that would require US pharmacists to provide drug disposal products with opioid prescriptions. Still, little is known about consumer preference for drug disposal method. The objective of this study was to identify product and program characteristics associated with consumer preference for at-home drug disposal products. METHODS A 2x2x3x3 full-factorial design was employed to text-based vignettes representing opioid analgesic disposal scenarios. Each vignette varied on four characteristics: product cost (free vs paid), ease of use (a mail back envelope, bringing medication to a takeback site, and an at-home drug deactivation pouch), potential environmental impact (incineration), and point of access (pharmacy, community organization, and prescriber). Of the 36 possible vignettes, 12 were removed as they represented a non-realistic combination of vignette characteristics. The remaining 24 were administered to a panel of patients with controlled-substance use in the past six-months. Decision tree modeling and general linear mixed (GLM) models were used sequentially to identify product characteristics associated with patient drug preferences RESULTS: A total of 1,006 participants completed all vignette drug disposal scenarios. Regression tree analysis found that the most important predictor of use was cost followed by ease of access and product design. GLM showed that takeback programs offered at a pharmacy were the most preferred disposal option followed by at-home products (mailed envelope or deactivation system) dispensed with the prescription. CONCLUSION Programs that provide disposal resources directly to the patient at no cost with their prescription are likely to optimize willingness to dispose. Findings support the FDA's plan for a REMS program requiring pharmacies to distribute mail-back envelopes to patients when dispensed opioids.
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Affiliation(s)
- Tyler Varisco
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA.
| | - Harshil Patel
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Department of Pharmacy, The University of Texas Medical Brach Correctional Managed Care, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA
| | - Randa Al Saadi
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA
| | - Matthew Wanat
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA
| | - Douglas Thornton
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA
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Al Rawwad T, Tata V, Wanat MA, Campbell D, Thornton D. Evaluating the feasibility of implementing a prescription drug misuse prevention intervention in the community: a mixed methods study. BMC Public Health 2023; 23:728. [PMID: 37085838 PMCID: PMC10120215 DOI: 10.1186/s12889-023-15608-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND This study is part of a state-wide effort to promote the safe disposal of prescription medications and mitigate prescription drug misuse. The objective of this study was to evaluate the implementation of a two-component prevention intervention through Community Prevention Organizations (CPOs) in Texas. The first component involved the distribution of in-home disposal products (IHDP) and the second focused on providing education of the risks of prescription drug misuse. METHODS This study followed a mixed methods sequential explanatory study design. In the quantitative phase, the extent to which CPOs carried out the intervention was determined by the distribution rate - a proportion representing the number of IHDP distributed to end users from the amount of IHDP the CPO was shipped. This measure was used to organize the CPOs in to one of three performance categories. In the qualitative arm of the study, stratified random sampling was used to select five CPOs from each performance strata to participate in an in-depth, semi-structured interview about their distribution activity. The interview guide and the data analysis were guided by Bowen's Feasibility Framework. The interviews were transcribed and analyzed using a content analysis approach by two research team members. All qualitative analyses were conducted in ATLAS.ti© V7. RESULTS There was a total of 47 CPOs contacted and asked to be part of this study. Of them, 44 CPOs participated in the quantitative phase of the study. This phase revealed that all CPOs had existing relationships with organizations throughout the community such as pharmacies and schools that could act as points of distribution. Following the quantitative phase, 15 CPOs were selected for more in-depth interviews about their distribution practices. In the qualitative phase, this finding was reinforced through the theme "partnerships with local institutions and ability to implement the intervention at community events". Similarly, education promotion efforts were unanimously emphasized as a strategy to increase utilization of IHDP among end users. All CPOs indicated that the intervention was supplemental to their overall goals. CONCLUSION CPOs have unparalleled access to community events, local institutions, and the general population they serve, thus, they have the potential to be active facilitators in implementing prevention interventions.
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Affiliation(s)
- Tamara Al Rawwad
- School of Social Work, The University of Texas Rio Grande Valley, 1201 W. University Drive, Edinburg, TX, 78539, USA.
| | - Vaishnavi Tata
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4849 Calhoun, Health 2, Houston, TX, 77204-5000, USA
| | - Matthew A Wanat
- Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, 4849 Calhoun, Health 2, Houston, USA
| | - Danielle Campbell
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4849 Calhoun, Health 2, Houston, TX, 77204-5000, USA
| | - Douglas Thornton
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, 4849 Calhoun, Health 2, Houston, TX, 77204-5000, USA
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Stubbings J, Crawford SY, Menighan TE. A safe in-home disposal system with every opioid prescription? Food and Drug Administration is considering a potential new Risk Evaluation and Mitigation Strategy that could impact pharmacists. J Am Pharm Assoc (2003) 2021; 62:413-418. [PMID: 34872856 DOI: 10.1016/j.japh.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/22/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Misuse of prescription opioids contributes to the ongoing crisis of opioid-related overdose and deaths in the United States. The failure of patients and caregivers to safely dispose of unused opioids contributes to the problems. In 2018, Public Law 115-271 provided the U.S. Food and Drug Administration (FDA) authority to mandate a Risk Evaluation and Mitigation Strategy (REMS) for safe disposal packaging or safe disposal solutions for opioid analgesic medications. The FDA has been collaborating with stakeholders to determine whether a new REMS is needed. A new or revised opioid REMS could substantially affect opioid packaging, pharmacist roles and services, and dispensing activities such as education, counseling, and product distribution. The pharmacy profession has provided limited input to FDA regarding a potential new or revised opioid REMS. In this commentary, we aim to (1) provide awareness and raise questions on pertinent issues regarding opioid use and safe home disposal, (2) offer considerations for regulators on needed research in the development and assessment of a new REMS, and (3) highlight actions for pharmacist engagement in patient care services to promote safe use and safe home disposal of opioids. Consideration of a potential mandate regarding enhanced safety packaging or safe disposal solutions for opioids presents opportunities to revisit professional roles and engage proactively with the FDA and other stakeholders. We hope this commentary stimulates timely feedback by pharmacy leaders, researchers, and practitioners on whether and how options for safe home disposal of opioids should be included in a REMS in contemplation of potential benefits, unintended consequences, expanded professional roles, timeline, assessment of program effectiveness, and adequate compensation. We support a shared opioid REMS that funds the counseling of patients and caregivers on safe opioid use and safe home opioid disposal options and provides appropriate education and products to facilitate that disposal.
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Macdonell M, Kawedia JD, Zhang YP, Roux R, Myers AL. Chemical Degradation of Intravenous Chemotherapy Agents and Opioids by a Novel Instrument. Hosp Pharm 2021; 56:576-583. [PMID: 34720163 DOI: 10.1177/0018578720931456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To assess chemical degradation of various liquid chemotherapy and opioid drugs in the novel RxDestruct™ instrument. Methods: Intravenous (IV) drug solutions for chemotherapy and pain management were prepared using 0.9% normal saline in Excel® bags to a final volume of 500 mL. We investigated duplicate IV solutions of methotrexate (0.1 mg/mL), etoposide (0.4 mg/mL), doxorubicin (0.25 mg/mL), cladribine (12.4 µg/mL), fentanyl (1.0 µg/mL), and hydromorphone (12.0 µg/mL) in this study. Solutions were poured into an automated instrument to undergo pulsatile chemical treatment (Fenton reactions) for 20 minutes, and then discharged from the instrument through a waste outlet. Extent of intact drug degradation was determined by measuring concentrations of drugs before entry into the instrument and after chemical treatment in the filtrate using high-performance liquid-chromatography with ultraviolet detection (HPLC-UV). Results: Following chemical reactions (Fenton processes) in the automated instrument, infusion solutions containing methotrexate, etoposide, doxorubicin, and cladribine had levels below the HPLC-UV limit of quantification (LOQ), indicating <50 ppb of each. This equated to >99.5%, 99.99%, 99.9%, and 99.8% intact drug loss, respectively. Likewise, processed samples of fentanyl and hydromorphone contained levels below the LOQ (78 and 98 ng/mL, respectively), indicating extensive degradation (>92.2% and 99.2% intact drug loss, respectively). Conclusion: The novel instrument was capable of degrading intact chemotherapy and opioid drugs prepared in infusion solutions to undetectable quantities by HPLC-UV. RxDestruct™ is a possible alternative for disposal of aqueous medication waste.
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Affiliation(s)
| | | | - Yan Ping Zhang
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan Roux
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alan L Myers
- University of Texas Health Science Center, Houston, TX, USA
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Hendaus MA, Darwish S, Saleh M, Mostafa O, Eltayeb A, Al-Amri M, Siddiqui FJ, Alhammadi A. Medication take-back programs in Qatar: Parental perceptions. J Family Med Prim Care 2021; 10:2697-2702. [PMID: 34568157 PMCID: PMC8415692 DOI: 10.4103/jfmpc.jfmpc_1141_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/23/2020] [Accepted: 08/30/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose: To identify parental perception of a take-back program for medications. Materials and Methods: A cross-sectional study using a questionnaire was conducted at Hamad Medical Corporation, the only tertiary pediatric hospital in the State of Qatar at the time of the study. Qatar is a rapidly developing country with limited national data on the awareness of medication misuse among adults living with children at home and on the safety practices regarding medication disposal. Results: 305 questionnaires were completed (response rate = 90%). More than 80% of parents were in between 20 and 39 years of age, 70% of them were females, and 80% were college graduates. Approximately 90% of participants have immediate relatives who were taking medications for chronic diseases. Almost 60% of parents stated that they keep unused medications at home, whereas 10% were not aware of the fate of the left over medications. Approximately 95% of the parents dispose the expired medications. In terms of the mode of disposing the medications, 66% of caregivers dispose the medication bottle or package in the trash can, whereas 14% remove the medications from the bottles or packages and throw them in the trash, and 15% put them through the drain. When asked if participants read disposal measures in the medication pamphlet, only 10% answered “always,” whereas 26% answered “sometimes.” Participants were asked if they have heard of any medications take-back programs, 75% answered no, whereas 14% were not sure. However, almost 60% of them will use the take-back program if available and 18% were not sure. Conclusion: Parents residing in the State of Qatar have deficiencies in knowledge about medication disposal. Parent's attitudes and perceptions are considered indispensable targets for community health intervention. Our next step is to share our data with the ministry of health to spread awareness about the proper disposal of medicines and take-back programs in Qatar.
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Affiliation(s)
- Mohamed A Hendaus
- Department of Pediatrics Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Section of Academic General Pediatrics, Hamad Medical Corporation, Doha, Qatar.,Department of Clinical Pediatrics, Weill-Cornell Medicine, Doha, Qatar
| | - Shereen Darwish
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Manar Saleh
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Omar Mostafa
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Eltayeb
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Al-Amri
- Department of Pediatrics, Section of Academic General Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Faisal J Siddiqui
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Alhammadi
- Department of Pediatrics Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Section of Academic General Pediatrics, Hamad Medical Corporation, Doha, Qatar.,Department of Clinical Pediatrics, Weill-Cornell Medicine, Doha, Qatar
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Leishman E, Wang Y, Channu R, Boyst E, Hartmann M, Stas J. Development and implementation of SafeMedWaste, a chemical denaturant for non-hazardous disposal of controlled medications. Sci Rep 2021; 11:1129. [PMID: 33441864 PMCID: PMC7806595 DOI: 10.1038/s41598-020-80388-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
Substance use disorders are a significant public health issue. Options to dispose of controlled medications are limited, increasing the risk of diversion. Providing an alternative for disposal, a chemical denaturant, SafeMedWaste, was designed to destroy controlled substances irreversibly and safely be placed in non-hazardous landfills. Via HPLC–MS, four formulations of SafeMedWaste were tested with 34 different liquid controlled medications from DEA schedules I–V. Beta testing assessed the efficacy of SafeMedWaste in a clinical setting and on waste generated in a manufacturing setting. Furthermore, a formulation of SafeMedWaste was tested on solid controlled medications. All 34 of the liquid medications tested (e.g., amphetamine, diazepam, fentanyl, ketamine) were fully destroyed in SafeMedWaste within 2–24 h. Analysis of a beta test sample of SafeMedWaste containing fentanyl, midazolam, and morphine waste collected in a hospital showed full denaturation of these drugs in 24 h. Variants of SafeMedWaste were optimized to denature six different controlled substance waste samples from a manufacturing facility. In contrast to side-by-side studies with a charcoal disposal system using the same drugs, SafeMedWaste fully inactivated and destroyed the controlled substances in the waste streams. Another formulation of SafeMedWaste was tested on solid medications, which were fully denatured in 48–72 h. In conclusion, SafeMedWaste irreversibly denatures controlled medications that present a problem in our society.
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