Healthy Living - January 29, 2018

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BANGOR, Maine (WABI) - Maine is among the top ten states with the highest number of opioid-related overdose deaths. Every single day, a person residing in Maine, dies from complications related to narcotic use. It is an epidemic that has hit our beloved home with a brutal unforgiving force and the government and medical community has taken strong steps towards mitigating its effects and halting its spread.

As a trauma and general surgeon, I have several daily encounters with patients whose disease process, whether related to injury, inflammation, or surgery, causes them a fair amount of pain and discomfort. It is one of our primary roles as physicians and health providers to alleviate that pain as best as possible and narcotics allow us to do just that. We send patients home every day with prescriptions according to our best estimation of their pain tolerance, pain relief needs and use frequency, alongside rigorous instructions for appropriate use. Many times, however, patients are left with a certain amount of unused medications, which pose a significant risk if not disposed of properly.

Very frequently, patients choose to keep their medication in storage, in anticipation of future illnesses. That is an unsafe practice that opens the door to very dangerous incidental and intentional misuse or abuse. It also endangers children heavily. Accidental pediatric exposure by children below the age of six years is responsible for 60,000 yearly Emergency Department visits and 45,000 calls to poison centers. There are many safe medication disposal options that we should be well acquainted with. They fall under three categories: medicine takeback options, disposal in household trash, and flushing down the toilet.
Takeback means that patients are encouraged to return the medication that they haven't used and is leftover to appropriate registered collectors. There are two main takeback options: periodic events hosted by the DEA (drug enforcement agency) or local law enforcement agencies, and permanent collection sites. The latter usually include DEA registered collectors, retail pharmacies, hospital or clinic pharmacies, and law enforcement facilities. Some pharmacies also employ mail back programs or even provide on-site drop boxes. Please check with your local resources which of the above options exist for your community.

Another option is simply throwing the medication in your house trash. Before you do that, you should always check whether the medication in question comes with specific instructions about safe disposal. Most narcotic medications are not safe to throw in the regular trash as they would still pose a risk. If the medication can be trashed safely, the FDA recommends not crushing tablets or opening capsules, mixing the pills with an unpalatable substance, placing in a plastic bag and then throwing in the trash. The containers should then be unlabeled and disposed of as well.

For some higher risk medications, if takeback options are not readily available, it is usually recommended to flush them down the toilet as early as possible. These are usually drugs that pose a great risk for abuse or death related to overdose. They come with instructions to flush down when able and include most narcotics prescribed for post-trauma or post-surgical pain. The list includes but is not limited to: bupernorphine, fentanyl, diazepam, hydrocodone, hydromorphone, meperidine, methadone, morphine, and oxycodone. From my personal experience, when I've instructed patients to dispose of those drugs by flushing, there has been some concerns about elevating the level of opioids in surface water. The FDA has studied this matter extensively, and though there are very small amounts of these medications in surface water, it is believed that the predominant source is human excrement and urine. Their recommendation is very clear: the risk of not flushing these drugs far outweighs the risk of increasing these levels.
It is everyone's responsibility to keep our children, our loved ones,and ourselves safe from the claws of the opioid epidemic. I encourage everyone to choose the safe options for medication disposal.
For more information, please visit the below resources
· Where and how to dispose of unused medicine?

https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm
· Drug Takeback programs - Maine

https://www.productstewardship.us/page/1049