Pharmacy Corner: spring clean your medicine cabinet!

We take spring cleaning pretty seriously here at HCA Healthcare. There is one place in your home that may not be on your list to de-clutter and dust, but it should be – the medicine cabinet. Spring is a great time to re-evaluate the safety of your family’s medicine cabinet and clean out your household supply of prescription and over-the-counter (OTC) medications.

Consider this – nearly 80 percent of Americans using heroin right now say they got hooked on prescription opioids first. Could spring cleaning your medicine cabinet be the end of this deadly trend?

We sat down with Karla Miller, vice president of pharmacy services and clinical therapeutics at HCA Healthcare, for insight on proper medicine storage and disposal to prevent accidental poisonings and overdoses.

Karla Miller, HCA Healthcare’s vice president of pharmacy services and clinical therapeutics

Why is cleaning out your medicine cabinet important?

Keeping unused medications in your medicine cabinet undoubtedly increases the risk for theft of medication and resultant consequences that are likely to occur from this activity, such as calls to poison control centers, hospitalization and even death.

According to the 2017 National Survey on Drug Use and Health, six million Americans misused controlled prescription drugs.  This study shows that a majority of abused prescription drugs were obtained from family and friends, often from the home medicine cabinet.

The Substance Abuse and Mental Health Services Administration recently provided more data to strengthen the link between failing to discard unused medications and deviant activity. They conducted a national survey that found 53 percent of people 12 years or older who misused prescription pain relievers in the past year obtained the pain relievers most often from a friend or relative. It is important to routinely clean out your cabinet to avoid misuse and medication diversion, sharing and trading medicines, theft of medication, doctor shopping or buying medications from patients.

What’s the biggest concern of having old or unused medications?

The biggest concern of having old or unused medications around the house regards the risk to our pediatric population. The statistics may shock you:

• According to the report published by the American Association of Poison Control Centers’ National Poison Data System (NPDS), every minute of every day, a poison control center answers a call about a young child who has accidentally ingested a medication.
• The American Association of Poison Control Centers (AAPCC) receives more than half a million reports of medicine poisonings in children less than six years of age every year. Many of these instances of unintentional ingestion are not benign, either, and warrant medical treatment.
• About 60,000 preschoolers are rushed to hospitals each year after accidentally swallowing medicine, whether prescription or over-the-counter, according to the U.S. Centers for Disease Control and Prevention.¹

What is HCA Healthcare doing in the pharmacy space to ensure medications like opioids, for example, don’t get into the wrong hands?

HCA Healthcare has developed a multidisciplinary Pain Steering Committee dedicated to appropriate use of opioids and multimodal treatment of pain. We are taking multiple measures to minimize the abuse of opioids among our patients by reducing the volume of these medications prescribed.  This begins by having a conversation with patients about their expectations for pain management, explaining they may experience some pain after surgery.

HCA Healthcare also recently implemented the Enhanced Surgical Recovery Program, which is devoted to maximizing function after surgery instead of heavily focusing on pain management.  Our caregivers have often elected to provide non-opioid medications for patients seeking pain relief.

Furthermore, physicians now have access to aggregated electronic health record providing data that will allow them to prescribe medications like opioids judiciously. By the end of 2019 we will have over 2000 physicians electronically prescribing controlled substances.  Electronic prescribing of controlled substances decreased the risk of these medications getting in the wrong hands.

In 2013, HCA Healthcare’s Physician Services Group developed controlled substance monitoring guidelines for its physicians and advanced practice providers. Recommendations include screening state prescription drug monitoring programs, implementing controlled substance agreements with patients and using random drug screens when deemed necessary.

We’ve also partnered with leaders in our company’s sustainability program to create a continuing education course for our pharmacists and nurses and educational and guidance materials that are shared with the healthcare industry.

What are 3-5 tips people can use to safely dispose of their medication at home?

1. The safest and most responsible option is to take unwanted medications to a drug take-back site.

The U.S. Drug Enforcement Agency (DEA) hosts National Prescription Drug-Take Back Events periodically devoted to providing an opportunity for people to discard their unused medications. Local law enforcement agencies may also conduct drug take-back programs.

The next DEA Take-Back Day observance occurs today, April 27, 2019.

Click here to find a Drug Take-Back Collection Site near you.

HCA Healthcare will be hosting a Take-Back Day in the fall of 2019.

If you can’t find a convenient disposal site or take-back event in your area, here are some suggestions for safe medication disposal:

2. Check the dates on your medications, including ointments, supplements and vitamins. Discard any of these products that are beyond their expiration date due to the loss of effectiveness and potential for them to become toxic.
3. Discard items that have changed color, smell or taste, including those medications whose colors have faded. This indicates that the medication has been exposed to too much sunlight.
4. For prescription medications, follow the “one-year cut off” rule. Discard any prescriptions that are more than one year old.
5. Discard medications that are in unmarked containers, especially if they cannot be identified. In the future, ensure that medications that are still within their expiration date and being used by the patient are kept in their original containers so that they may be easily identified.
6. At HCA Healthcare, due to potential harm to the environment, we take steps to not throw medications out or flush them down the toilet. Similarly, flushing medications down the toilet at home is not recommended. Instead, a method that is available to almost everyone at home is to simply place all medications in a sealable bag. For solid medications, add some water to dissolve them. Then, add items such as coffee grounds, kitty litter, sawdust or any material that mixes well and makes the medication unappealing for children or animals to eat.  Seal the bag, and place it in the garbage.  After properly disposing of the medication, remove any identifying information on the prescription bottle, clean it, and recycle.

For more information, check out the FDA’s website on disposing of unused medication, which offers further details on how to safely dispose of certain medications.

Happy spring cleaning!