California Pharmacies: Failing Grades on Antibiotic and Narcotic Disposal Education
Rachel E. Selekman, MD, MAS, Thomas W. Gaither, MD, Aron Liaw, MD, Zachary Kornberg, BA, Jeremy Z. Goodman, BA, Hillary L. Copp, MD, MS.
University of California, San Francisco, San Francisco, CA, USA.
Improper disposal of unused, unwanted, and expired medications results in environmental pollution, antibiotic resistance, and childhood poisoning as well as intentional misuse. Pharmacies are in an ideal position to provide disposal information, but there is limited evidence regarding the accuracy of the information they provide. This study evaluates consumer education provided by pharmacies regarding correct disposal of unwanted antibiotics and narcotics, two of the most commonly prescribed medications in a pediatric surgical practice.
A stratified random sampling of all retail pharmacies in California based on rural urban commuting area was performed. Six callers followed a predetermined script and inquired regarding disposal of unwanted antibiotics (Bactrim pills, if asked) and Schedule II Controlled Substances (liquid Hycet, if asked). Time of day, day of week, length of call, and occupation of respondent(s) were recorded in addition to caller gender. The primary outcome was correct disposal per U.S. Food & Drug Administration. Medications may be disposed of at a take-back location. Antibiotics may be mixed with an unpalatable substance and disposed of in the trash in a sealed container. Schedule II Controlled Substances may be flushed.
915 of the 6,368 pharmacies with retail licenses in California were sampled and 898 retail pharmacies (98%) responded within two calls. 43% of pharmacies provided correct information regarding antibiotic disposal and 32% provided correct narcotic disposal information. 23% of all pharmacies incorrectly advised mixing the narcotic with an undesirable substance. Only 10% of pharmacies reported take-back programs at their location. 15% of pharmacies providing correct disposal information for antibiotics and 22% for narcotics advised the caller to purchase a product to deactivate it or an envelope to mail it to a take-back site. On univariate analysis, correct information for the disposal of both medications was not more likely to be given by a pharmacist versus a technician (p=0.229), a pharmacy chain versus an independent pharmacy (p=0.550), or pharmacy located in an urban versus a non-urban location (p=0.380). On multivariate analysis, correct information was more likely to be given on a weekday for antibiotics [OR 5.7 (95% CI 2.27-14.49, p<0.001)] and narcotics [OR 8.5 (95% CI 2.16-33.25, p=0.002)] and to a male caller inquiring about antibiotics [OR 1.6 (95% CI 1.10-2.42, p=0.015)] and narcotics [OR 1.6 (95% CI 1.07-2.49, p=0.023)].
Despite changes in legislation and efforts by multiple agencies to promote correct disposal of unused, unwanted, and expired medication, less than half of retail pharmacies in California were able to provide this information and only approximately one-tenth of pharmacies report take-back programs at their location. Predictors of providing correct disposal information included a weekday inquiry and a male caller. Considering only the minority of pharmacies in
California provided correct disposal information, current educational campaigns may not be reaching the consumers who need it.
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