Do you have medications that you no longer take, and you don’t know what to do with them? If so, this year’s National Prescription Drug Take-Back Day is for you!
Pharmacists are often asked how to get rid of unwanted or unused medications, and the National Take-Back Initiative is the answer to this increasingly popular question. This program provides an easy and convenient opportunity to discard prescription medications. It is also intended to educate the public concerning the potential for medication abuse.
Who could benefit from attending the National Prescription Drug Take-Back Day?
Anyone who has medications that they are no longer using, that have expired, or that may have belonged to a loved one who has passed away.
What type of medications will the program take?
The National Take-Back Initiative will take any and all medications, whether over-the-counter or prescription. This includes not just tablets and capsules, but topical medications (creams, gels, lotions), oral liquids, patches, inhalers, injectables, and syringes.
Where can I find information on the program in my area?
You can find locations and times for collection sites near you on the DEA’s website. They also offer a help line at 1-800-882-9539 if you need assistance.
You can also check the AWARxE Get Local page for information on how to participate in your state.
Several states have their own websites relating to the National Take-Back Initiative as well, in addition to other disposal programs:
- Arkansas Take-Back
- California Household Medication Waste Disposal
- Colorado Medication Take-Back Project
- Connecticut Drop Box Disposal
- Delaware Prescription Drug Disposal
- Florida Disposal Sites and Events
- Georgia Safe Storage and Secure Disposal Program
- Idaho Prescription Drug Take-Back Program
- Illinois Medication Disposal
- Indiana Unwanted Medicine
- Kansas Medication Disposal Program
- Kentucky Prescription Drug Disposal
- Michigan Residential Drug Disposal
- Missouri P2D2 (Prescription Pill and Drug Disposal)
- Montana Operation Medicine Cabinet
- Nebraska MEDS Coalition
- Nevada Pain in the Drain
- New Hampshire Medicine Disposal Information
- New Jersey Project Medicine Drop
- New York NYC Waste Less
- Ohio Prescription Drug Drop Boxes
- Oregon Drug Take-Back and Collection Boxes
- Rhode Island Safe Disposal
- South Carolina Take-Back Program
- Utah Use Only as Directed
- Washington Prescription Drug Disposal
Are there any other methods to safely dispose of medications?
YES! If you are unable to attend the annual event there are other methods for prescription medication disposal. The FDA offers a guide for how to dispose of unused medications. The EPA also offers a fact sheet on how to dispose of your medications properly.
In order to prevent misuse, medications can be disposed of in the regular trash using the following methods:
- Place the medication in kitty litter
- Place the medication in coffee grounds
- Place the medication in a sealed container
- Follow manufacturer instructions on disposal of certain medications (e.g. patches, inhalers, needles)
You may also want to consider a mail-in disposal kit. These are offered by private companies who will dispose of your medications or other pharmaceutical waste for you, however, they will cost you money and may not accept controlled substances (some prescription pain meds, Adderall, etc). Some examples include the Takeaway Environmental Return System and the Heritage Pharmaceutical Disposal mail-back program.
Is there list of medications that can safely be disposed of by flushing down the toilet?
Yes. Check out the list from the FDA of medicines recommended for disposal by flushing here.
Can I donate my unused medications?
Yes. There are charities and other agencies that will accept unused medication donations.
One such program is the Wyoming Medication Donation Program, a comprehensive drug donation, redispensing, and disposal program. They provide a secure and environmentally safe way for individuals and healthcare organizations to donate unused medications so they may be used to help Wyoming residents who cannot afford their medications.
Similar programs may be available through organizations in your area.
Are they the same? What’s better? What is the prescription I have? It seems complicated but it’s not—let’s shed light on the common players:
Acetaminophen + Codeine:
You may have been prescribed Tylenol #3 or Tylenol #4 in the past. Both have 300 mg of acetaminophen mixed with either 30 mg of codeine or 60 mg of codeine (in the Tylenol #4). While really good for short-term pain—evidence shows that it’s just as good as acetaminophen + hydrocodone—codeine is not recommended for chronic pain management. This is because adverse effects increase disproportionately to analgesic (pain relieving) effects. Get that: long term use of Tylenol #3 is not really recommended because increased doses result in increased side effects. Short term, it’s a great choice.
Acetaminophen + Hydrocodone:
Familiar options in this class include Vicodin, Lorcet, Lortab, Norco and Zydone. Interestingly, short-acting hydrocodone is only available mixed with acetaminophen or ibuprofen in the United States. This group of meds comes in many doses, with the hydrocodone part ranging from 2.5 mg to 10 mg now mixed with lower doses of acetaminophen, usually 300 mg. You’ll remember this was an FDA recommendation because of acetaminophen overdoses in people on these pain meds. A brand new long-acting hydrocodone (without acetaminophen) was just approved and it’s called Zohydro ER. Zohydro ER is taken 10 mg orally every 12 hours. For pain that is going to be short lived, like postoperative pain, you don’t really need a longer-acting medication like Zohydro. Studies comparing Tylenol #3 with Vicodin indicate they both work the same for pain.
Percocet or Roxicet are the brand names in this class. When acetaminophen + oxycodone is used the usual starting dose is 5 mg of oxycodone. Percocet has at most 10 mg of oxycodone in it, as a 10 mg / 325 mg tablet mixed with acetaminophen. Oxycodone is available alone or mixed with acetaminophen or ibuprofen. Oxycodone tablets come as a generic or the brand name Roxicodone. Oxycontin, a popular drug of abuse, is oxycodone that is slow release. Roxicodone comes in 5 mg, 15 mg, and 30 mg tablets while Oxycontin comes in much higher doses of oxycodone.
For short-term use, long-acting formulations like Oxycontin usually aren’t needed.
Also not included in this list are newer mixed mechanism analgesics like Ultram (tramadol) or Nucynta (tapentadol). Those are the so-called “non-opiate opiates,” so they work on the opiate receptors but are not the same as the above listed drugs.
There it is . . . pain meds 101.
However, you may or may not know that brand name Concerta has a very unique delivery system, OROS (Osmotic [Controlled] Release Oral [Delivery] System). This is the way in which the medication is released from the tablet throughout the day once it has been ingested. In fact, Concerta is the only ADHD medication with the OROS delivery system. Since generic Concerta is available from several manufacturers, it is important to understand the various delivery systems and how they may differ from one another.
Which pharmaceutical companies are manufacturing generic Concerta?
- Actavis (formerly Watson)
What strengths do Concerta and generic methylphendiate ER come in?
Concerta (methylphenidate ER) is available in the following strengths: 18 mg, 27 mg, 36 mg, 54 mg. However, generic methylphenidate is not available in all strengths from all manufacturers (the 18 mg strength is not available from Mallinckrodt).
Will the tablets look different between manufacturers?
Yes. The various manufacturers are not required to have the same inactive ingredients—therefore, the tablets most likely will NOT look the same. The variation in tablet color and markings is actually helpful in determining which company made which tablet. You can see how the different tablets look here.
Actavis Delivery System:
Actavis tablets use osmotic pressure (also known as water pressure) to deliver the medication throughout the day at a controlled rate. The tablet consists of two layers— the first layer dissolves within 1 hour and releases an initial dose of methylphenidate, and the second layer releases the rest of the medication over a duration of 6 to 7 hours. This generic is approved under the same application as brand name Concerta, and is similar to the OROS delivery system.
Kremers Delivery System:
Kremers tablets use extended-release bead technology to deliver the medication throughout the day at a controlled rate. These tablets also consist of two layers—the first layer dissolves within 1 hour and releases an initial dose of methylphenidate and the second layer releases the medication over a duration of 12 hours.
Mallinckrodt Delivery System:
Mallinckrodt tablets use a precisely designed diffusion process (similar to Actavis) to deliver the medication throughout the day at a controlled rate. The tablet again consists of two layers—the first layer dissolves within 1 hour and releases an initial dose of methylphenidate and the second layer releases the medication over a duration of 6 to 7 hours
How does the OROS delivery system release Concerta?
The OROS delivery system is similar to the generic Actavis tablets. The tablet has a water-permeable shell with small holes in it; this allows water to enter and push the medication out through the holes as the tablet passes through your body. Concerta uses osmotic pressure to deliver the medication throughout the day at a controlled rate, from a two-layered tablet that releases an initial dose within 1 hour and the rest of the medication over 6 to 7 hours.
It is possible that the shell of the tablet may come out in your stool and may be visible on abdominal x-rays.
Are the generics all interchangeable with Concerta?
Yes. All of these generics can be substituted for Concerta.
Although Concerta is the only ADHD medication to use the OROS drug delivery system, the generic manufacturers have all designed comparable delivery systems that are interchangeable and can be substituted.
Generic manufacturer Teva has received approval from the FDA to launch a generic version of prescription fish oil heart med Lovaza (omega-3-acid ethyl esters). Lovaza is used to lower high triglyceride levels in combination with a healthy diet. Triglycerides are a type of fat found in your blood—similar to cholesterol.
This is good news, and much earlier than generic Lovaza was originally due to be available. The last patents on Lovaza were originally going to expire in 2017. An earlier settlement made a generic possible as early as 2015, but the most recent ruling at the end of 2013 granted Teva and Par Pharmaceuticals permission to launch their generics pending FDA approval.
Teva was the first to file, and will be the first to launch their generic omega-3-acid ethyl esters capsules. They plan to launch immediately, so look for the generic in pharmacies in the next couple of weeks.
No more Namenda? Not really, but the shorter-acting form is going away. Forest Laboratories has announced its plan to discontinue the sale of Namenda 5 mg and 10 mg tablets—but not because of any safety or efficacy issues, just because they have a longer-acting form available.
Namenda is an NMDA receptor antagonist approved for the treatment of moderate-to-severe Alzheimer’s dementia. Both the liquid form, Namenda oral solution, and the extended-release capsules, Namenda XR, will continue to be available.
Forest plans to discontinue the sale of Namenda tablets on August 15, 2014, though your pharmacy will be able to dispense them after that date until their supply runs out. Forest is letting doctors know to transition patients to Namenda XR as soon as possible to maintain treatment continuity.
It is an easy one to one switch, so you can stop Namenda one day and start Namenda XR the next day. A patient on a dose of 10mg twice daily of Namenda tablets can be switched to Namenda XR 28mg once daily. It also looks like Namenda XR is the same price (even a little cheaper) than Namenda so it’s good thing all around.