January 27, 2013

New rules could hurt Maine drug takeback programs

Federal and state proposals could erode health-care savings and pave the way for less ecologically sound disposal methods.

By Colin Woodard cwoodard@pressherald.com
Staff Writer

AUGUSTA – Maine leads the nation in drug takeback efforts, in which citizens voluntarily return unused pharmaceuticals to keep them out of the environment and the hands of those who would sell or abuse them. Year after year, Mainers have handed in tens of thousands of pounds of drugs during federally sponsored national takeback days, more per capita than any other state.

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Lewiston Police Sgt. David St. Pierre and Officer Craig Johnson crate unused prescription drugs at the U.S. Drug Enforcement Administration’s Portland office April 28, 2012, during National Prescription Drug Take-Back Day.

Maine Sunday Telegram file photo/John Patriquin

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Unused prescription drugs collected during a 2008 Sagadahoc County drug disposal effort are sorted at Mid Coast Hospital in Brunswick. A U.S. DEA proposal would ban authorities from gathering data on what drugs are being returned during drug takeback programs and in what quantities. Such data has been used to cut the cost of MaineCare by imposing 15-day limits on the initial prescriptions of often-wasted drugs.

Maine Sunday Telegram file photo/Shawn Patrick Ouellette

But expected changes in federal and state policies could weaken some of the programs' benefits, both in terms of environmental protection and in driving down health care costs. The state is seeking to change how collected drugs are disposed of, while proposed changes on the federal level would outlaw efforts to tabulate what drugs are being wasted.

The U.S. Drug Enforcement Agency has proposed rule changes for drug takeback programs that forbid authorities from gathering data on what drugs are being returned and in what quantities. Such data has been used to reduce the cost of MaineCare -- the state's Medicaid program -- by imposing 15-day limits on the initial prescriptions of often-wasted drugs, many of which are opiates.

"If we see a certain drug that is being wasted a lot, we can come up with programs that might reduce that, for instance by changing prescribing behavior," said Rodney Larson, founding dean of the Husson University School of Pharmacy, who has been involved in the tabulating of returned drugs by the University of Maine Center on Aging. "This is valuable information, and DEA's new regulations forbid it from happening in the future."

Researchers -- many of them pharmacy students -- have counted drugs returned to collection boxes at Maine pharmacies and by a now-defunct mailback program while under close supervision by law enforcement. But the proposed federal rules say collected drugs "may not be individually handled, counted, inventoried, or otherwise discerned."

The DEA says it considered allowing authorized people to collect data but that such efforts "would require individualized identification of the contents, increase the number of hands through which controlled substances pass and ... greatly increase the risk of diversion" to illegal users. It concluded that the risks "outweigh the potential benefits."

Asked whether the DEA had considered the potential cost savings to state Medicaid programs, DEA spokeswoman Barbara Carreno declined to comment, citing the provisional nature of the rule.

The proposed rules are undergoing a 60-day public comment period that ends Feb. 19.

Sen. Susan Collins -- who spearheaded key 2010 federal law supporting drug takeback programs -- expressed concern over the proposed measure on learning of it from a reporter.

"It is important that these drugs are inventoried, in a way that respects the privacy of patients, before they are destroyed," Collins, R-Maine, said in a written statement. "This helps determine exactly what drugs are being prescribed and purchased, but are going to waste ... (which) can lead to better prescribing practices, improved patient education, and lower health care costs."

"I intend to ask the DEA to further explain why its proposed rule would prohibit the gathering of this information," Collins said.

Nationally, an estimated 40 percent of drugs prescribed outside of hospitals go unused, creating a health and environmental hazard. Flushed down the toilet or discarded in landfills, their contents can contaminate birds, fish, and drinking water. Left in the medicine cabinet, they can be stolen by criminals or abused by children and teens. Maine has the oldest population in the country -- a source of drugs -- and a serious prescription drug problem, particularly in rural areas.

Takeback programs aim to provide a safe, secure and anonymous way for people to dispose of unused and unwanted drugs. Since 2010, the DEA has sponsored five national "takeback day" events and paid for disposal of the collected drugs. In Maine, drugs turned in to collection boxes at police stations have been handed over to DEA on takeback days for disposal.

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