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How Much Unused and Expired Medicines are You Stockpiling at Home?

Unused and Expired Medicines Registry

Community Medical Foundation Matthew C. Mireles, Ph.D., M.P.H. (PI) Kelsey Research Foundation
For Patient Safety 7th Annual Health Services and
The Community of Competence™ and Foundation for Life
Acknowledgements Outcomes Research Conference:
Improving the Quality of HealthCare
Elizabeth A. Smith, Ph.D.; Anita Hampton, M.S., Fellow; November 14, 2006
Racheal Johnson, B.S., M.P.H. Intern; John Sullivan; Ye Sun;
Sonali Patel, B.A., and Faye Wang
Why do we have unused and expired medicines? A relatively unknown but extremely dangerous epidemic is Sample 1 (n=87) from Maine: Antidepressants (12%) UEM is a significant public health and patient safety
the stockpiling of unused and expired medicines (UEM) at were the most UEM. Prescription medicines comprised problem in the U.S., which has not been widely recog-
• More medicines are available today
home. The researchers present a method to collect data 98% of UEM. Reason for UEM was “doctor discontinued nized and investigated. Most people are not aware of the
• Doctors are prescribing more medicines about UEM to answer the following research questions: meds”. Estimated cost based on AWP is $3,922. dangers of UEM, and they lack basic knowledge about the
• People are taking more medicines • Can a drug-return system be devised to safely and Prescription Drugs
correct and appropriate use of prescription medications.
legally collect UEM? Unused The high cost of UEM is emerging as a strong evidence to
• 30% -50% of people do not take medicines as 40%

support further study of cost allocation, prescription



prescribed by their doctors Can a national registry be set up to collect the UEM
data? assistance programs, and patient compliance or
• People think medicine is too expensive to throw away adherence.
• What kinds of UEM are stockpiled at home?
• People stop taking medicine and stockpile it at home Percentage of Federally
beyond expiration date; medicine becomes unwanted • Why are the medicines unused? Controlled Substances The Unused and Expired Medicines Registry is the
only national registry and an important data collection

• What is the cost of UEM?


• Some people do not believe medicines expire


system necessary to improve our understanding of the

Not Federally

• Other questions…

• Someone dies, and medicines are unused problems with UEM in our homes. More data are needed

• There is no city, county, state, or national system to to characterize the types and quantity of UEM according
METHODS to geographic locations and demographic profile and to
take back unwanted medicines from home Sample 2 (n=1230) from Maine: Analgesics (13%) were
From collection events that involved law enforcement (21 devise educational and health promotion programs about
the most UEM. Prescription medicines comprised 74% of the safe and appropriate use of medicines as well as the
What are th
the main pro
roblems with unused and CFR 1301.24), environmental groups, healthcare profess-
the sample. Reason for UEM was “expired meds”. From safe disposal of UEM.
expired medicines? sionals, and consumers, UEM were collected, inventoried,
preliminary analyses: an estimated cost of UEM was
and destroyed by controlled, witnessed incineration (21 CFR
• Children and pets can accidentally ingest these $67,000; 15% of UEM (n=400) was potentially hazardous DISCUSSION
1307.21). UEM data were transferred to CMFPS* for coding
medicines and get poisoned to environment (PBT: 4-9)—mostly antibiotics.
and analysis; data are compiled into the UEM Registry using The UEM Registry, based in Texas and maintained
• Elderly can confuse different medications and make standardized classifications and codes developed by CMFPS. Percentage of Federally
Controlled Substances Federally independently by CMFPS, can provide numerous
mistakes taking them, causing drug interactions Variables for each register include drug name, dosage, con- Controlled
10.5% applications for users. A national steering committee to
trolled substance class, quantity returned, national drug investigate UEM in U.S., as well as the State of Maine
• Patients do not get therapeutic benefits of medicine
Not Federally

code #, reason for return, average wholesale price (AWP),


when they do not use it as prescribed (LH1826), has officially recognized CMFPS and the
environmental hazard class, and zip code. Each register has Registry in this effort. CMFPS is planning a pilot study in
• People, particularly teenagers, can misuse or abuse— 50 data fields. Reports are based on descriptive analysis. the Houston area to collect and dispose of UEM. Potential
UEM Registry Medicine Return Form (Anonymous) Environmental hazard potential coding is based on the Swedish PBT Index users of the Registry are shown below.
• Medications can be stolen from the home database (
Environmental Drug/Law
• Unused and expired medicine means wasted dollars Protection Enforcement

(minimum of $1 billion yearly in the US)

• Improper or illegal disposal of unwanted medicine can Patient Safety
contaminate our water supplies Registry

• Sometimes, unwanted medications are given to other National

P= persistence in environment; B= bioaccumulation; T= toxicity
foreign countries and cause more problems Marketing Security


*Community Medical Foundation for Patient Safety is a nonprofit, 501(c)(3), active learning organization that specializes in the research of patient safety. Our mission is to promote patient safety and healthcare quality through education, research and the demonstrated practice of patient-centered medicine within a supportive organizational culture of
safety. Our research and educational programs include safety reporting systems for patients and families, safety checklists to prevent medical errors, and various publications, workshops and services for patients, families and healthcare professionals to increase the awareness of and the involvement in patient safety. The philosophy of our
Foundation is based on the Community of Competence™, an organizational concept developed and trademarked by the Founder Elizabeth A. Smith, Ph.D. Improvement of our healthcare system can be achieved by learning and building a Community of Competence in healthcare and an organizational culture that is truly patient-centered and focuses
on quality and safety. For more information, visit us at 6800 West Loop South, Suite 190, Bellaire, Texas 77401; 832-778-7777;