Between 10 and 30 percent of all prescription and over-the-counter drugs sold are left unconsumed, according to a State of Washington report, and all those leftover medications pose significant risks to public health and the environment. Drugs that are flushed down the toilet or tossed in the trash can – rather than properly disposed of – can end up in oceans and waterways, threatening both marine life and human health. Meanwhile, many individuals don’t get rid of their unused medications at all; they simply store the drugs in their medicine cabinets – a practice that can lead to drug misuse and abuse.
CVS Health has decided it wants to do its part to stem the tide of prescription and over-the-counter medications filling up our medicine cabinets and clogging our waterways. In 2013, the retailer and health care company launched its CVS/pharmacy Medication Disposal for Safer Communities Program, a grant initiative in which the company distributes drug collection bins to police departments and municipalities, so they can set up environmentally responsible local drug disposal programs. These specialized drug disposal units meet federal requirements to collect and securely store prescription medications that are also considered “controlled substances” – drugs that have the potential for abuse or dependence and are highly regulated by law enforcement agencies.
Since the program began awarding grants last year, CVS/pharmacy has donated 275 of these drug collection bins to localities, and all these bins are currently being used for community drop-off programs, said Eileen Howard Boone, the company’s senior vice president of corporate social responsibility and philanthropy. The first 100 bins collected nearly 6,500 pounds of old medications in their first six months of use. The goal of the initiative, Boone said, is to award a total of 1,000 drug collection bins to local governments across the U.S.
CVS/pharmacy has also been an active participant in National Prescription Drug Take-Back Day, a joint-program of the Justice Department and Drug Enforcement Administration to collect unwanted prescription medications across the country twice a year. Last year’s take-back days collected a total of 1.4 million pounds of medication, Boone said. CVS/pharmacy hosted more than 400 of these drug collection events, she said, allowing law enforcement agencies to take advantage of the retailer’s convenient location and traffic access – rather than sending the public out to remote hazardous waste facilities or inconvenient police stations to drop off medications.
A step toward producer responsibility
It is not uncommon for the private sector to be involved in collecting and properly disposing of medications in other countries. In Canada, Mexico and many European countries, the government requires pharmaceutical companies to finance and manage drug take-back – a policy approach called extended producer responsibility (EPR), in which the manufacturers or sellers of a product take responsibility for the environmental and social impacts of the product throughout its lifecycle – from sourcing the material and production to consumer use and disposal. EPR has many benefits, especially for toxic or difficult-to-recycle items: It relieves governments and taxpayers from the high costs of product disposal and can motivate manufacturers, now compelled to confront the externalities of their operations, to make their products in a more environmentally and socially responsible way.
With no such federal EPR law for medication in the U.S., cash-strapped municipalities and law enforcement agencies have struggled to come up with their own disposal programs for unused drugs. A handful of jurisdictions, like San Francisco and King County, Washington, have enacted local EPR ordinances against opposition from the pharmaceutical industry, but a bill introduced last year to require drug take-back in California died in committee.
Many EPR programs for medications include collecting unused drugs at pharmacies and hospitals – the same places where patients pick up their prescriptions and a much more convenient drop-off location than a faraway hazardous waste collection facility or landfill.
The DEA recently passed regulations that allow pharmacies to have disposal units on site. The regulations, however, are complex and there is interplay with state environmental laws that make it difficult in some states to have such units, CVS Health said. Soon, CVS/pharmacy will conduct tests of these units in its stores. Given the current operational and regulatory hurdles, CVS/pharmacy’s Medication Disposal for Safer Communities Program is a step in the right direction and, frankly, more than most retailers and health care companies are doing to address pharmaceutical waste. However, Boone said that the company is exploring other ways to participate in drug take-back, including potentially collecting medications at stores.
Beyond the bottom line: The business benefits of take-back
But why would a company like CVS Health decide to participate in medication take-back, when it’s not the industry standard or required by law? Are there long-term business benefits to EPR programs for medications?
There are often financial and customer engagement benefits to product take-back programs, said Heidi Sanborn, executive director of the California Product Stewardship Council. In Canada, several pharmacies began collecting used syringes and needles voluntarily as a way to attract diabetic patients, who make up a large percentage of a pharmacy’s revenue with their prescriptions and other medical needs, Sanborn said. And the take-back program worked: When one pharmacy chain set up free needle disposal, other pharmacies lost customers — which is why a large majority of the 6,000 non-regulated community pharmacies in Canada voluntarily accept sharps at their own expense: because it make good business sense, Sanborn said.
But collecting medications is a different animal and may not always lead to increased customers and sales, Sanborn said. During a pilot drug drop-off program at a pharmacy in Sacramento, California, the pharmacy was inundated with unwanted medications from Kaiser patients who continued to use their Kaiser – and not the pharmacy with the drug disposal program – to fill their prescriptions.
Because CVS Health only collects medications at some of its pharmacy locations on National Take-Back Days, it’s difficult to determine the benefit it sees from increased foot traffic – potential new customers coming into the store to drop off old medications who may end up making purchases while they’re in the store.
For CVS Health, its medication take-back initiative isn’t about helping its bottom line; it’s about a greater societal problem – preventing prescription drug abuse – and protecting the health of its customers and patients.
“Prescription drug abuse, especially in teens, has soared in recent years,” Boone said. “More than 70 percent of teenagers say it is easier to get prescription drugs from their parents’ medicine cabinets, according to a 2014 study conducted by our partner, Partnership for Drug-Free Kids.”
That’s why CVS Health made a commitment to prevent half a million teenagers from abusing prescription medication by 2017, she said.
“Prescription drug abuse is a national issue that requires the active involvement of stakeholders throughout the health care community, as well as law enforcement and regulatory agencies,” Boone went on. “CVS Health and CVS/pharmacy are committed to being part of the solution to this problem. We think we can have an impact by identifying and working with allies and partners to bring about lasting systemic changes. We also believe this is the right thing to do for our customers and patients.”
And “doing the right thing” by providing drug disposal options for its customers is a service that more and more consumers are willing to expect and desire from their local pharmacies. According to a 2014 study of residents conducted by the City of Roseville, California, 72 percent said medication take-back programs should be 100-percent or at least partially-funded by pharmaceutical companies, pharmacies and hospitals.
Image credit: Flickr/Dawn McIlvain Stahl