Prescription Drug Takeback Programs

Description

Prescription drug takeback programs offer a mechanism for consumers to safely and legally return unused drugs to the proper authorities.

Objective(s)

To reduce the supply of prescription drugs available for diversion, misuse, or abuse

Typical Elements

  • While takeback programs can be structured in several different ways, the four most common types are pharmacy-based permanent collections, law-enforcement-based permanent collections, event-style programs in the community, and mail-back programs.
  • Takeback programs generally accept all forms of drugs, including over-the-counter and prescription drugs, both uncontrolled and controlled (U.S. Drug Enforcement Administration [DEA], 2014b, 2014c, 2014d).
  • Takeback programs that accept controlled drugs must be operated in conjunction with a collector who is authorized by the DEA or with local law enforcement. The following DEA registrants can receive authorization to take back controlled drugs: retail pharmacies, manufacturers, distributors, reverse distributors, narcotic treatment programs, hospitals, and clinics (DEA, 2014b, 2014c, 2014d). 
  • Authorized collectors can maintain collection receptacles at a registered location and/or operate mail-back programs (if the collector has an onsite means of destruction) (DEA, 2014b, 2014c, 2014d). Retail pharmacies, hospitals, and clinics with onsite pharmacies can manage collection receptacles at long-term care facilities (DEA, 2014b, 2014c, 2014d).
  • Authorized collectors must comply with certain collection, handling, storage, transportation, and disposal regulations (Product Stewardship Institute [PSI], n.d.) that are set by federal, state, and local entities and vary by state and locality. Takebacks also are subject to DEA regulations that place restrictions on the nature of the secured drop-off bins (DEA, 2014b, 2014c, 2014d).
  • Costs can vary, depending on the structure of the program (mailback vs. drop-off bins) (Avalere Health, n.d.); some programs can expend more than $300,000 for secured drop-off bins (Simons, 2010).
  • Law enforcement entities (such as the local police) can collect controlled substances according to their own established protocols (DEA, 2014c, 2014d).
  • Individuals are required to dispose of only the drugs that they are lawfully permitted to possess (drugs that were prescribed to them, to their dependents, or to a deceased person whose property they are in charge of) (DEA, 2014c, 2014d).
    • Note: The National Alliance of Model State Drug Laws (NAMSDL) compiles the status of state-specific takeback legislation, including funding and collection information where available (NAMSDL, 2015). The PSI Go-to-Guide for Safe Drug Take-Back offers state-specific information on takeback initiatives in select states.
  • Pharmacies who wish to become a takeback location should do the following:
    • Apply for collector status
    • Check with state regulatory agencies, local government agencies, and state boards of pharmacy to evaluate local policy regarding local collection, handling, storage, transportation, and disposal regulations (PSI, n.d.)
    • Determine what collection tools (for example, secured drop-off bins) they will use, and develop policies and procedures to ensure compliance with all applicable laws and regulations
    • Work with their reverse distributor to ensure proper destruction (as per local laws)
    • Consider the costs associated with collection tools and destruction, and identify potential revenue streams
    • Consider whether they wish to offer an incentive for participation in the takeback program (Fass, 2011)
  • Communities who want to support local takeback programs should do the following:
    • Identify existing collection locations through the DEA Office of Diversion Control’s search utility
    • Consider working with the retail pharmacies in the community
    • If no local pharmacies wish to operate a takeback program, contact local law enforcement or a local Drug Free Community coalition for additional guidance
      • Note: The nearest coalition can be found on the website of the Community Anti-Drug Coalitions of America. Communities might also consider a mailback program or a DEA-style takeback event and the costs associated with each design (such as envelopes and collection personnel), or destruction options (through law enforcement or a reverse distributor) and the associated costs.
  • ​​Factors that contribute to the success of a prescription drug takeback program include legal and regulatory compliance (federal, state, and local), consumer convenience, sustainability (including but not limited to funding), outreach and education, and partnerships with law enforcement (Avalere, n.d.; PSI, n.d.).

Populations

General population, DEA-registered collectors (including pharmacy staff)

Outcomes

While no evaluations have found a relationship between takeback programs and rates of prescription drug misuse or abuse (or related measures), some information is known about takeback programs (Haegerich, Paulozzi, Manns, & Jones, 2014):

  • Between 2009 and 2011, takeback events in Tennessee and Virginia collected 16,956 containers of prescription drugs, of which 9.3% were controlled drugs (Gray & Hagemeier, 2012).
  • From 2011 to 2012, in 11 drug takeback events in Hawaii, more than 8,000 pounds of prescription drugs were collected, of which 10% were controlled substances (Ma, Bartz, Juarez, & Ladao, 2014).
  • Between 2011 and 2013, 11 sites in Maine collected 553,019 units of prescription drugs at DEA takeback events, of which controlled substances accounted for 9.1% (Stewart et al., 2014).
  • Controlled drugs accounted for 17% of those returned to Maine’s mailback program as of 2010 (University of Maine, 2010). 
  • Between 2012 and 2014, the DEA’s National Take Back Day collected 4,823,251 pounds of prescription drugs (DEA, 2014a).
    • Note: All of these data reference takebacks that were conducted prior to the implementation of the Secure and Responsible Disposal Act of 2010 even though publication dates are post 2010.

Guidelines

Disposal Regulations: Registrant Fact Sheet

Disposal Act: Long-Term Care Facility Fact Sheet

Lessons Learned: Voluntary Pharmaceutical Take-Back Programs in the Great Lakes States. 

Starting a Drug Take-Back Program. 

Safe Medicine Disposal for Maine: A Handbook and Summary Report.

Acknowledged by

U.S. Environmental Protection Agency. How to Dispose of Medicines Properly. 

U.S. Food and Drug Administration. Disposal of Unknown Medicines: What You Should Know.

National Conference of Insurance Legislators. Best Practices to Address Opioid Abuse, Misuse and Diversion.

Office of National Drug Control Policy. Epidemic: Responding to America’s Prescription Drug Abuse Crisis.

U.S. Senator Ed Markey (D-MA). Overdosed: A Comprehensive Federal Strategy for Addressing America’s Prescription Drug and Heroin Epidemic.

References

Avalere Health. (n.d.). Safe disposal of unused controlled substances: Current challenges and opportunities for reform. Retrieved from http://www.ncdoi.com/osfm/safekids/Documents/OMD/SafeDisposalOfUnusedControlledSubstancesReport.pdf

Fass, J. A. (2011). Prescription drug take-back programs. American Journal of Health-System Pharmacy, 68(7), 567–570.

Gray, J. A., & Hagemeier, N. E. (2012). Prescription drug abuse and DEA-sanctioned drug take-back events: Characteristics and outcomes in Rural Appalachia. Archives of Internal Medicine, 172(15), 1186–1187. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1203518

Haegerich, T. M., Paulozzi, L. J., Manns, B. J., & Jones, C. M. (2014). What we know, and don’t know, about the impact of state policy and systems-level interventions on prescription drug overdose. Drug Alcohol Dependence, 145, 34–47.

Ma, C. S., Bartz, F., Juarez, D. T., & Ladao, L. C. (2014). Drug take back in Hawai’i: Partnership between the University of Hawai’i Hilo College of Pharmacy and the Narcotics Enforcement Division. Hawaii Journal of Medicine and Public Health, 73(1), 26–31. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3901169/

National Alliance for Model State Drug Laws. (2015). Controlled substances: Return and disposal bill status update. Retrieved from https://namsdl.org/wp-content/uploads/Controlled-Substances-Return-and-Disposal-2016-Legislative-Session-Bill-Status-Update.pdf

Product Stewardship Institute. (n.d.). Starting a drug take-back program. Retrieved from http://www.productstewardship.us/?page=Start_Drug_Takeback

Simons, T. E. (2010). Drug take-back programs: Safe disposal of unused, expired, or unwanted medications in North Carolina. Retrieved from http://www.ncdoi.com/osfm/safekids/documents/omcwhitepaper.pdf

Stewart, H., Malinowski, A., Ochs, L., Jaramillo, J., McCall, K., & Sullivan, M. (2014). Inside Maine’s medicine cabinet: Findings from the Drug Enforcement Administration’s medication take-back events. American Journal of Public Health, 105(1), e65–e71.

University of Maine. (2010). Safe medicine disposal for Maine: A handbook and summary report. Retrieved from https://digitalcommons.library.umaine.edu/moca_service/1/ 

U.S. Drug Enforcement Administration. (2014a). DEA and partners collect 309 tons of pills on ninth prescription drug take-back day. Retrieved from https://www.dea.gov/press-releases/2014/11/05/dea-and-partners-collect-309-tons-pills-ninth-prescription-drug-take-back

U.S. Drug Enforcement Administration. (2014b). Disposal of Controlled Substances: Final Rule: 21 CFR Parts 1300, 1301, 1304, et al. Retrieved from http://www.deadiversion.usdoj.gov/fed_regs/rules/2014/2014-20926.pdf

U.S. Drug Enforcement Administration. (2014c). Disposal regulations: Registrant fact sheet. Retrieved from www.deadiversion.usdoj.gov/drug_disposal/fact_sheets/disposal_registrant.pdf

U.S. Drug Enforcement Administration. (2014d). Disposal act: Long-term care facility fact sheet. Retrieved from http://www.deadiversion.usdoj.gov/drug_disposal/fact_sheets/disposal_ltcf.pdf