Prudent disposal of medications: Model programs in the U.S. and Canada

The safe disposal of unused or expired medications is a major challenge to aging societies. Improperly disposed pharmaceuticals pollute our waterways and constitute hazards to a society's health, safety and environment. Older adults are major consumers of medications. In 2003, outpatient prescription drug expenses in the U.S. civilian non-institutionalized population totaled $178 billion and accounted for approximately 20% of total health expenses. An Associated Press investigation in 2008 found pharmaceuticals were present in drinking water supplies of 24 major metropolitan cities, serving 41 million Americans.

While the U.S. is beginning to recognize the problem of pharmaceutical waste, British Columbia (BC) has more than a decade of experience. Established in 1996 by the pharmaceutical industry, the Medications Return Program is regulated under the Post-Consumer residual Stewardship Program Regulation. Consumers are able to return at no charge unused or expired medications to more than 90% of participating pharmacies in the province.

Maine and California were the first to enact pharmaceutical disposal programs in 2003 and 2007 respectively. EPA's Aging Initiative funded a state-wide mail-back pilot in Maine and a “take back” pilot project at pharmacies located in a grocery store chain in St. Louis, Missouri region.

Findings from these demonstrations will be analyzed. Models will be examined from both a cost and effectiveness perspective. The urban and rural models of the Maine and St. .Louis models will also be compared and contrasted. Implications from these pilots should inform public policy makers should the U.S. decide to explore a national program.