A report released in November of 2018, from the Centers for Disease Control and Prevention, show that drug overdoses killed a record number of more than 70,000 Americans in 2017. To put this phenomenon into perspective, drug overdose deaths are higher than deaths from H.I.V., car crashes, or gun violence at their peaks.
We at AffirmHealth report often about the nationwide epidemic, but today we take a closer look at the state of New York. In 2015, New York prescribers wrote 10.2 million opioid prescriptions or 51.3 prescriptions per 100 patients–a 7.8 percent decline since 2013. This is also less than the national rate of 71 prescriptions per 100 patients (IMS Health).
Although, statewide prescription numbers declined in that data set, New York City’s health department reported there was a 2 percent overall increase in drug overdoses in 2017. The numbers overall increased year over year, just not as sharp as the 51 percent uptick reported in 2016. Some view this slowed growth as progress, however, the trend continues an upward rise with 1,487 drug overdose deaths in 2017 (62 more than 2016) and 437 more deaths in 2016 than 2015. Fentanyl was detected in 57 percent of all overdose deaths in New York City, up from 44 percent in 2016.
Where do the pills go that aren't taken by patients as prescribed?
According to a survey in JAMA, most adolescents and adults reporting recent non-medical use of opioid medications obtain these medications through their family or friends. “The fact that people are sharing their leftover prescription painkillers at such high rates is a big concern,” noted senior author Colleen L. Barry, Ph.D., MPP who directs Bloomberg’s Center for Mental Health and Addiction Policy Research. “It's fine to give a friend a Tylenol if they're having pain but it's not fine to give your OxyContin to someone without a prescription.”
Additionally, nearly half of the adults with recent opioid medication use did not recall receiving information on safe storage (48.7%) or proper disposal (45.3%) in the JAMA study.
How do you dispose of your medication?
Flush it? Crush it? Toss it? But then where does it go?
CBS News reported multiple substances were found in trace amounts in NYC drinking water including Acetaminophen, Butalbital, Ibuprofen, and Meprobamate to name a few. To answer the question posed above, it was not historically uncommon for consumers to be told to flush unwanted prescription drugs. Ongoing research discussed in The Associated Press shows a correlation between exposure to low levels of medications and adverse impacts on fish and other aquatic wildlife. In 2016, New York Governor Andrew Como enacted legislation allowing pharmacies in New York to collect and dispose of unused, expired, and unwanted drugs under federal controlled substances disposal rules.
Fast forward to 2018 and the opioid epidemic continues to ravage America. On April 25, 2018, the New York State Senate passed a bill creating the “Drug Take-Back Act.” Later last summer, on June 16, 2018, the Senate published the “Drug Take Back Act” and the legislation was then passed into law on July 10, 2018. The Act requires pharmaceutical manufacturers to finance and manage the safe collection and disposal of unused medications. Sponsored by Senator Hannon and Assemblywoman Gunther, the Act requires pharmacies with ten or more U.S. locations to participate as drug collection sites to help ensure convenient access for residents and will be implemented in mid-2019.
Senator Hannon, Chair of the Senate’s Health Committee, commented, "New York has an opioid epidemic demanding attention now. Communities, law enforcement, elected officials and pharmacies holding special take-back days is just not enough. More aggressive efforts to curb the tide of opioid addiction are essential. Providing New Yorkers with safe and accessible disposal methods will help prevent addiction, which often starts with misuse of unused medications. This legislation not only helps address the opioid epidemic, it makes sure all medications are properly disposed of and do not contaminate our water supplies.”
“It’s incredibly important to do anything and everything we can to complement and support the efforts of local law enforcement and other community leaders to combat prescription drug abuse.”
Unused Medication in the Home
The Product Stewardship Institute stated in their press release, “Unused medications accumulate in the home, where they are accessible to potential abusers and a danger to seniors, children, and pets. When improperly disposed down the drain or in the trash, unused drugs contaminate New York waterways and harm aquatic organisms. New York is the fourth state to require manufacturers to fund and safely manage drug take-back, preceded by Massachusetts, Vermont, and Washington, along with 22 local governments throughout the U.S.”
They continue on, “the new law designates the New York State Department of Health (DOH) to oversee the program. The DOH has authority to develop regulations for effective implementation. Notably, the legislation gives pharmacies and other collectors the option to use kiosks, mail-back, or "other" approved systems. Kiosks are the most convenient and cost-effective collection method and can be required by the DOH.”
The Act requires drug manufacturers to develop and implement a statewide drug take-back program for unwanted household drugs. Drug manufacturers will have until July 2019 to submit their proposed Drug Take-Back programs to the New York Department of Public Health. These plans must include stipulations for patients who live in rural areas as well. Manufacturers will be responsible for all operational and administrative costs associated with the program.
Mail-order prescription companies will also be required to provide prepaid envelopes to mail back unused drugs at no cost to patients. Mail back envelopes are available to be ordered (for a fee) by pharmacies from approved vendors. A list of vendors can be found here.
What's Considered a Covered Drug in the Drug Take Back Act?
"Covered Drug" means any substance recognized as a drug under 21. As amended, and any regulations promulgated thereunder that are sold, offered for sale or dispensed in the state, whether directly or through a wholesaler, in any form including prescription and nonprescription drugs, drugs in medical devices and combination productions, brand and generic drugs and drugs for veterinary use etc.
In short, the Act includes both prescription and non-prescription drugs but doesn't include vitamins.
Take-Back Program Open Enrollment
New York's Department of Environmental Conservation is now accepting applications to participate in the Pilot Pharmaceutical Take-Back Program Open Enrollment.
Enrollment is now open to all New York State health care entities such as:
- Retail Chain and Independent Pharmacies
- Hospitals and Medical Clinics with On-Site Pharmacies
- Pharmacies Servicing Long-Term Care Facilities (Class 3A Facilities in NYS)
DEC will pay for a US Drug Enforcement Administration (DEA) compliant medication collection drop box, replacement inner liners, and the cost of pick up, transport, and destruction of all collected waste pharmaceuticals by a DEA-registered reverse distributor for two (2) years. The pharmacy will be responsible for any costs related to the installation of the medication collection drop box.
Out of state pharmacies that service New York State long-term care facilities are eligible to apply.
The end goal is simple. For people who become addicted to opioids, the first supply often comes from a friend or family member who has left-over prescription medication. The hope is that the drug take-back program will cut off this source of the supply chain and will close that window of opportunity.
As this program takes shape in New York, AffirmHealth will keep tabs on its progress. Subscribe to our blog to stay up to date on this topic and many more.