To:
From:
Date:
Subject:
Bryan Rizzardo, Rexall Drugstore Regional Pharmacy Director
Andrea Raven, Rexall Drugstore Pharmacy Assistant
October 3, 2015
Proposal to Increase the Return of Unused or Expired Medications
at Rexall Drugstore located at Royal Centre Mall in Vancouver
Introduction
Drugs taken by humans and animals find their way into rivers, lakes, and drinking
water with potentially devastating effects on the environment. The cause of the
problem is unsafe disposal of pharmaceuticals. A 2014 global review of
pharmaceuticals in the environment found 631 of 713 drugs tested for were
above acceptable detection limits. This study covered 71 countries and found
commonly prescribed drugs such as antibiotics and oral contraceptives had the
highest rates of detection (Owens, 2015).
Statement of Problem
Many homes contain expired or unused prescription drugs, over-the-counter
medications and natural health products. Pharmacies take back these
pharmaceuticals; however the existing Take-Back programs collect only a
fraction of unused and expired pharmaceuticals. The rest end up in the
environment. A recent scientific study showed drugs including metformin (an
antidiabetic medication) were found in Lake Michigan above concentrations of
environmental concern (Blair, Crago, Hedman, & Klaper, 2013). These
pharmaceuticals were located near fish spawning sites and aquatic organisms
such as perch. Fish ingesting these drugs exhibit changed behaviors and in
some cases were unable to reproduce. The study determined Lake Michigan’s
ecosystem is at high risk for pharmaceutical pollution (Blair et al., 2013). As
Lake Michigan is the sixth largest lake in the world, it is of grave concern that
dilution of the drugs is insufficient to mitigate this risk.
In addition to environmental concerns, persons may take expired or unused
medications that are no longer effective. Unused and expired drugs may also
end up in the wrong hands if they are not returned to the pharmacy. Nonmedical use of prescribed opiods costs the United States approximately $50
billion annually, primarily due to lost productivity and crime (Hansen, Oster,
Edelsberg, Woody, & Sullivan, 2011). This has motivated police departments
and health organizations to organize Drug Drop Off days which encourage
citizens to anonymously drop off drugs at specified locations (Eggertson, 2013).
These initiatives are successfully removing potentially harmful drugs from the
streets of major cities.
Proposed Solution
One possible solution to the problem is to increase public awareness of Rexall
Drugstore’s Take-Back program to encourage customers to return unused or
expired medication. Initiatives such as Medi-Drop and Drug Drop Days have
succeeded in increasing the number of safely disposed drugs. Similar initiatives
could encourage more customers to return unused or expired pharmaceuticals to
Rexall Drugstore.
The benefits of this proposed solution include:
 Reducing the amount of pharmaceuticals available in homes for possible
diversion and accidental poisonings
 Identifying unused pharmaceuticals to inform prescribing practices
 Increasing awareness of safe storage and disposal practices
 Reducing the environmental impact associated with improper disposal of
pharmaceuticals in the garbage and sewer system
Scope
To increase the number of returned, unused or expired pharmaceuticals, I plan to
pursue the following areas of inquiry:
 What is the current rate of return of unused or expired pharmaceuticals?
 What is stopping people from returning all of their unused or expired
medications?
 What are ways to increase consumer awareness of Rexall Drugstore’s
Take-Back Program?
 What is the feasibility of initiating a Drug Drop Day or Medi-Drop at Rexall
Drugstore?
 What are the costs associated with these initiatives?
Methods
My primary data sources will include pharmacists that I work with, including my
pharmacy manager Framin Mark, and surveys of our current customers. I will
also investigate the Take-Back programs of other pharmacies to compare them
to ours.
Secondary sources will include peer-reviewed articles on the effects of unsafe
drug disposal. I will also research initiatives to address this problem.
My Qualifications
I have been working as a pharmacy assistant at Rexall Drugstore in Vancouver
for one and one-half years. Prior to that I worked for a community pharmacy in
Langley. I studied pharmacology during my undergraduate years, which
combined with my work experience has given me a solid understanding of drug
properties. My studies in ecology made me aware of and interested in mitigating
environmental hazards.
Conclusion
It is clear that action is necessary to remove harmful pharmaceuticals from the
environment. The National Association of Pharmacy Regulatory Authorities
(NAPRA) has published Model Standards of Practice for Canadian Pharmacies,
including ensuring safe, legal, and environmentally sound disposal of
medications. Accepting this proposal will show that Rexall Drugstore strongly
supports NAPRA’s standards for the disposal of unused or expired
pharmaceuticals.
Works Cited
Blair, B.D., Crago, J.P., Curtis, J.H., & Klaper, R.D. (2013). Pharmaceuticals and
personal care products found in the Great Lakes above concentrations of
environmental concern. Chemosphere. 93: 2116-2123.
Eggertson, L. (2013). Prescription drug drop-off day in Ontario. Canadian
Medical Association Journal. 185(10): E469.
Hansen, R.N., Oster, G., Edelsberg, J., Woody, G.E., & Sullivan, S.D. (2011).
Economic Costs of Nonmedical Use of Prescription Opioids. The Clinical
Journal of Pain. 27(3): 194-202.
Owens, B. (2015). Pharmaceutical in the environment: a growing problem.
The Pharmaceutical Journal. 294(7850).