Clinical Scorecard: Assessing the Disposal of Antimicrobials at Six Community Pharmacies Through Ongoing Medication Take-Back Initiatives: A Critical Element of a One Health Strategy for Antimicrobial Stewardship

At a Glance

Key Highlights

• Between November 2021 and May 2023, six community pharmacies in central North Carolina collected and safely disposed of 144,084 UUE prescription tablets/capsules containing approximately 19.3 kg of active pharmaceutical ingredients, including 1.3 kg of antimicrobial APIs.
• Antimicrobials accounted for 2.6% of all disposed tablets/capsules and 6.6% of total APIs, with doxycycline, amoxicillin, clindamycin, cephalexin, and ciprofloxacin being the most commonly disposed antibiotics.
• Medication disposal programs in pharmacies are preferred by patients over police station-based programs but remain underutilized, with only 13.5% of North Carolina pharmacies implementing such programs as of 2021.

Guideline-Based Recommendations

Diagnosis

• Identify presence of unused, unwanted, or expired medications in patient homes through patient interviews or surveys.

Management

• Establish and promote ongoing medication disposal programs at community pharmacies to facilitate responsible disposal of UUE medications.
• Use approved disposal systems (e.g., Deterra Multi-purpose or Rx Destroyer) to deactivate medications before disposal according to product instructions and legal regulations.
• Educate community members on the importance of responsible medication disposal to reduce environmental contamination and antimicrobial resistance.

Monitoring & Follow-up

• Quantify and track the amount and types of UUE medications returned to pharmacies to assess program effectiveness and environmental impact.

Risks

• Improper disposal of antimicrobials can lead to environmental contamination, promoting antimicrobial resistance.
• Disposal via trash or flushing can introduce pharmaceuticals into water systems and ecosystems.

Patient & Prescribing Data

Patients with unused, unwanted, or expired prescription medications, including antimicrobials, in their homes.

Despite national initiatives, a high proportion of patients retain UUE medications at home, with low awareness and participation in disposal programs; pharmacy-based disposal programs are more acceptable to patients than law enforcement-based sites.

Clinical Best Practices

• Incorporate education on medication disposal into antimicrobial stewardship efforts emphasizing One Health principles.
• Implement longitudinal medication take-back programs in community pharmacies to improve accessibility and participation.
• Use environmentally safe disposal technologies and comply with federal and state regulations for medication disposal.
• Engage pharmacy faculty and students in ongoing monitoring and community education to sustain program success.

References

• FDA Guidance on Medication Disposal
• EPA Recommendations on Medication Disposal
• DEA National Prescription Drug Take Back Day
• WHO One Health Approach to Antimicrobial Stewardship