Few Pharmacies Give Correct Drug
Disposal Information

Ricki Lewis, PhD

December 30, 2019

Fewer than half of nearly 900 pharmacies surveyed in California provided correct information about the disposal of unused prescription antibiotics and opioids, and only 11% reported take-back programs at their location, according to findings of a brief research rreport published online today in Annals of Internal Medicine.

Pouring unused liquid medications down the drain or tossing unused pills in the trash can have serious consequences: contributing to antibiotic resistance, pollution, poisoning of children who might mistake pills for candy, and intentional misuse. Pharmacies seem an obvious resource for informing patients about proper disposal of prescription drugs, but evidence on the accuracy of provided information is limited.

Rachel E. Selekman, MD, MAS, of Children’s National Hospital, Washington, DC, and colleagues analyzed a random sample of California pharmacies, stratified to equally evaluate urban and rural pharmacies (the rural ones represent only 6% of the pharmacies).

To test pharmacy feedback, four male and two female callers telephoned pharmacies; reading from a script, they posed as parents of a child who had undergone surgery and had leftover antibiotics (sulfamethoxazole-trimethoprim tablets; Bactrim, Roche) and opioids (hydrocodone–acetaminophen). The "secret shoppers" called on all days, but if there was no initial response, a second attempt was made on a weekday.

A "right answer," according to US Food and Drug Administration recommendations, was one of three actions: the pharmacy takes back the drug; the parent mixes antibiotics with an unpalatable substance such as kitty litter and throws it into the trash in a sealed container; or flushing opioids. Responses were interpreted as correct, incorrect, or incomplete.

The investigators contacted 915 pharmacies. Of the 898 pharmacies that responded, 47% provided correct antibiotic disposal information, 19% did so for opioids, and 29% did so for both drugs.

Timing of the call made a difference, with weekend queries receiving a worse response. Information on antibiotic disposal was correct 49% of the time if the call came during the week, but only 15% of the time for weekend calls. For opioids, the figures were accurate 20% of the time for weekday calls and 7% of the time for weekend calls.

Only 11% of the pharmacies reported take-back programs for disposal of antibiotics or opioids.

"[W]e have discovered that pharmacies don't uniformly provide accurate information to our patients. Patients, families, and healthcare professionals who advise families should work together to help improve and expand safe disposal options for these powerful medications," Selekman said in a news release.

Limitations of the study include not investigating disposal education for employees of the pharmacies, and the fact that the study covered only one state (although California accounts for 10% of US pharmacies).

"Improving disposal practices will require a combined effort of strengthening education of patients and those advising patients as well as expanding disposal programs to ensure access," the researchers conclude.

The researchers have disclosed no relevant financial relationships.

Ann Int Med. Published online December 30, 2019. Abstract

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