Army Seeks to Take Back Prescription Drugs to Avoid Medication Abuse Errors

by U.S. Medicine

December 7, 2011

WASHINGTON — The Army is seeking permanent authority to accept unused or old prescription drugs from military healthcare beneficiaries who wish to get rid of them.

In January, Gen. Peter Chiarelli, Army vice chief of staff, asked that the Drug Enforcement Administration (DEA) permit the Army’s military-treatment facilities and pharmacies to accept excess prescription medicine for disposal, but the request was denied.

In 2010, Petty Officer 1st Class David Ochsenfeld, assigned to the security department at Naval Hospital
Camp Pendleton in California packs returned medications into boxes during the Drug Enforcement
Administration’s first National Prescription Drug Take Back Day. (U.S. Navy photo Douglas Allen/
Released)

Col. Carol Labadie, the Army pharmacy consultant, said the Army is still very interested in getting that authority and is working on that issue with the DEA. The way the law is written, only DEA registrants that buy or distribute controlled substances can take back controlled substances from other DEA registrants, she said.

“So pharmacies could buy from a wholesaler because they are also registered with the DEA because they sell the drugs. They cannot take them back from a non-DEA registrant, which would be a patient,” she said. “So we cannot take them back from the patient once we have dispensed them to the patient.”

The only way that such “take-back” initiatives can be conducted is with the involvement of law enforcement.

The issue does not just affect the military. Congress passed legislation last year asking the U.S. Attorney General to look at ways that unwanted or unused medications could be returned. The DEA is working on developing a policy on how people should dispose of unwanted controlled substances medication nationwide.

CDC Director Thomas Frieden, MD, said last month that the U.S. is in the midst of an “epidemic” when it comes to prescription drug overdose.
A report released by CDC’s Nov. 1 Morbidity and Mortality Weekly Report found that, in 2008, 36,450 deaths were attributed to drug overdose, a rate of 11.9 per 100,000 population, among which a drug was specified in 27,153 (74.5%) deaths. One or more prescription drugs were involved in 20,044 (73.8%) of the 27,153 deaths, and opioid pain relievers  were involved in 14,800 (73.8%) of the 20,044 prescription-drug overdose deaths.
“The epidemic of prescription-drug overdoses in the United States has worsened over the last decade, and, by 2008, drug-overdose deaths (36,450) were approaching the number of deaths from motor-vehicle crashes (39,973), the leading cause of injury death in the United States,” the report stated.
In fact, Frieden said, more people are killed from prescription narcotics than from heroin and cocaine combined.
“There are about one out of every 20 adults who have a history of inappropriately using prescription narcotics,” he said. “This stems from a few irresponsible doctors and in fact now the burden of dangerous drugs is being created more by a few irresponsible doctors than drug pushers on street corners.”
CDC’s report recommended that healthcare providers should only use opioid pain relievers in “carefully screened and monitored patients when non-OPR treatments have not been sufficient to treat pain, as recommended in evidence-based guidelines.”
“The healthcare profession can do a better job of improving their practices in prescribing, ensuring that appropriate quantities are prescribed,” Frieden said.

He said that, for those with chronic pain, narcotics should be “a last resort.”

The Army wants that authority as soon as possible, however, and would like beneficiaries to be allowed to turn in excess medications to military pharmacies.

“It would be a way ahead for us in the right direction to be able to get these medications back,” said Labadie. 

Take-Back Programs

The ability for consumers to give back prescription medications that they are not using at designated sites is part of larger effort in the U.S. to help prevent prescription drug abuse and to offer an environmentally responsible way to dispose of medications.

Recently, the U.S. Drug Enforcement Administration (DEA) held its third National Prescription Drug Take-Back Day on October 29, in which it said more than 377,086 pounds of unwanted or expired medications were disposed of by their owners at the 5,327 take-back sites available in all 50 states and U.S. territories.

Many military installations also participated that day, with DoD and medical leaders encouraging beneficiaries to take part in the anonymous collection events.

“The Army’s participation in the National Prescription Medication Take-Back Day is critical, because our soldiers and their families share many of the issues facing the nation at large,” said Col. Kevin Galloway, chief of staff of the Pain Management Task Force, in a news release promoting the recent Take-Back Day.

Still, the need for DoD to be able to collect these medications on an ongoing basis was highlighted in a recent report on military suicide. That report stated that prescription drug misuse is an “obstacle” to addressing military suicide and said DoD needed authority to be able to “accept and destroy excess prescription medication” from troops.

“When military doctors prescribe an alternative medication or dosage from what a servicemember was previously prescribed, there is no request made for the servicemember to return the remainder of his or her prior medication. Instead, military doctors dispense additional medications, because only law-enforcement personnel can conduct ‘take-back’ programs for medications,” Washington’s Center for New American Security report stated.

For injured troops who might be on multiple medications, the issue goes beyond getting rid of prescription drugs that might later be abused, Labadie said. It also is a patient-safety issue for patients who have no intention of abusing the medications.

“When you have got multiple medications and, if everything is mixed together, and some you are taking and some you are not taking, a patient can easily get confused about which one they are supposed to take,” she said. “Or, if there is a caregiver helping them, the caregiver may not realize that this medicine is no longer supposed to be taken and given in addition to the others. So there are patient-safety-issue reasons why we would want to get those medications back, in addition to the national issues of the potential abuse of medication.” 

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