THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 486.2 Guest: Angelo Voxakis, P.D. Topic: Drug Disposal Host: Richard Roeder Producer: Ed Graham

NEMA: This is a discussion about safe storage and disposal of prescription medications with pharmacist Dr. Angelo Voxakis from the Hereford Pharmacy in Parkton, Maryland.

NEMA: Dr. Voxakis, most of us could probably go through our medicine chests and find drugs that are old and out of date. How often do you recommend that people go through their medications and dispose of the old stuff?

Voxakis: We usually recommend at least once a year, pick a date to do spring cleaning and what we encourage at our pharmacy - we have what they call "medicine brown bags days" where the patients can take all their medications that they haven't used, they can bring them into us in a brown bag and then we'll sit down with them and we'll explain to them what the medications are for, we'll look at the expiration date, we'll look at the product itself to see if there's any deterioration of the actual medication. It helps patients clean out their medicine chest plus it also prevents people from sharing medication because that's the worse thing in the world and we hear it all the time when they didn't finish their antibiotic so they have four capsules left and their friend's not feeling too great so here, take my four capsules. Again, that goes into another whole topic of how detrimental that can be to a patient so we encourage what we call a "medicine brown bag." Put them in a brown bag and bring them in to us and we'll sit down with you and we'll explain what they were for, what the indications were, if they're any good, we'll tell you what to throw away and if the patient wants us to destroy it, then we'll destroy it.

NEMA: An ongoing source of contention is the child-proof cap and the inability of adults to sometimes get their medications out of the bottle because of it. However, have you had the experience that child-proof caps seem to be effective in protecting children from injury?

Voxakis: To be perfectly honest with you, the majority of the answers we get every time we fill a patient's prescription when we ask them if they want child-proof or non-child-proof, and inevitably 95% of the time what you will hear is "I can't open them. I've got to go to my child to open it anyway." The vials that we use can be either/or. We put the child-proof on and then we show the patient how to take it off but at the same time they can reverse it if they're finding difficulty and make it easy-off as a screw top.

NEMA: How often have you heard of improperly stored medications finding their way into the stomachs of pets?

Voxakis: We'll hear about two or three incidences a year.

NEMA: Are there any special precautions that need to be taken when disposing of medications or is just throwing them in a trash can adequate?

Voxakis: As a matter of fact, today one of our patients passed away and the wife called me up and he was on many many medications and the wife called me up and says "What should I do with these medications?" And again what we tell our patients - you can either bring them in to us, we'll destroy them for you or I explained to her - this is how we do it. What we do is we take each vial and we add just water to it. Quite simple. Just add the water to it, fill it up, cover all the tablets, close it with a child-proof container and let it sit overnight. Then what we do is we take a spatula or a glass rod and we mix it to make sure they all dissolved and at that point, we flush them down the toilet. We don't throw them in the trash. That's the worst thing in the world to do.