The callers pretended to be well-meaning parents who were trying to safely dispose of unneeded antibiotics and opioid-based prescription painkillers after their child's surgery.
Fewer than half of the California pharmacies they called provided correct prescription drug disposal details, a percentage that dropped sharply if the "secret shoppers" made their call on a weekend, according to a brief research report published in Annals of Internal Medicine.
Since the Food and Drug Administration provides advice about the safe disposal of unneeded medicines, and due in part to the importance of pharmacists to the conversation, the American Pharmacists Association maintains that such medication disposal should follow FDA guidelines.
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But very few pharmacies, in California at least, permitted take-back of unwanted prescriptions, and the accuracy of drug disposal information was all over the map, depending largely on whether the call was fielded on a weekday or a weekend.
In other words, there's room for improvement.
WHAT'S THE IMPACT
The multi-institutional research team, led by primary investigator and senior author Hillary L. Copp, M.D., MS, at University of California, San Francisco, identified licensed pharmacies located in urban and rural settings in California, a state that accounts for 10% of all U.S. pharmacies.
They wrote a script that guided four male and two female "secret shoppers" to ask about what to do regarding leftover antibiotics (sulfamethoxazole-trimethoprim tablets) and a liquid opioid-based painkiller (hydrocodone-acetaminophen). From late February to late April 2018, they called 898 pharmacies from 8 a.m. to 8 p.m., asking about the correct way to dispose of these medicines.
According to the FDA, consumers should mix most unused medicines with an unappealing substance, like kitty litter, place it in a sealed container and toss the container in the trash. Medicines that can be harmful to others, like opioids, should be flushed down the sink or toilet. Many pharmacies have programs or kiosks to handle unused prescription medicines.
Of the pharmacies surveyed in California, 389 (47%) provided correct information about disposing of antibiotics; 251 (29%) provided correct information about how to dispose of both antibiotics and opioids; 204 (19%) provided correct information about how to dispose of opioids; 49% provided correct antibiotic disposal information and 20% provided correct opioid disposal information on weekday calls; and 15% provided correct antibiotic disposal information and 7% provided correct opioid disposal information on weekend calls.
Asked specifically about drug take-back programs, just 11% said their pharmacy had one that could be used to dispose of antibiotics or opioids.
THE LARGER TREND
Of course, disposing of medication is only relevant is a prescription is filled in the first place. They often aren't, and high prices are largely to blame.
Unfilled prescriptions remain a problem, with 73% of physicians taking the patient's responsibility for cost into account in making a prescribing decision, according to a March survey released by OptimizeRx. Almost as many physicians, 70%, said they believe the high cost of prescribed medications leads to unfilled prescriptions.
While doctors believe they understand the reasons for patients not filling prescriptions, few track when patients haven't filled their scripts. Only 5% of physicians said they "always" track an unfilled prescription and 18% said they "usually" do. This means that three-quarters of physicians are not tracking unfilled prescriptions.
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