Safe Medication Disposal

Do you have unused or expired medications sitting in your medicine cabinet? Don’t know what to do with these medications?

Here are 5 great reasons to motivate you to clean out your medicine cabinet and safely dispose of your unused or expired prescription and over-the-counter (OTC) medications:

o   Over 78,000 children under 5 years of age are treated for accidental drug overdose per year.¹

o   Prescription drugs are more commonly abused than ecstasy, heroin, crack/cocaine and methamphetamines combined in adolescents 12 to 17 years of age.²

o   Drug overdose death rates more than doubled from 1999-2010 in those aged 10 to 19 years.²

o   Nearly one-third of people age 12 years and older who used illicit drugs for the first time in 2010 began by using prescription drugs non-medically.³

o   Drugs such as antibiotics, steroids, pain killers, estrogens, blood pressure medicines, and antidepressants were detected in 80% of water samples in 139 streams across 30 states and may be causing harm to fish and other wildlife.⁴

Unused and expired medications may be in the form of capsules, pills, inhalers/aerosols, creams, etc. Improper storage of these medications can lead to accidental use of the wrong medication, overdose (especially in the case of children and pets), or drug abuse by others in the household. A majority of patients continue to dispose of these medications in the trash or flush them down the toilet or sink. The Illinois Environment Protection Agency (IEPA) recommends against flushing a majority of medications down the toilet or sink. These medications wind up in our drinking water system through improper disposal and natural excretion, and our water treatment facilities do not have the expertise to remove medications from our drinking water supply. Several new changes are being implemented for the safe disposal of unused and expired medications, including an expansion in drug take-back programs across the nation.

Medication disposal dos and don’ts:

Dos:

Do reduce pharmaceutical waste whenever possible. Finish the full course of prescribed medications as recommended by your doctor or pharmacist, and only buy as much as you need.

Do store medications safely out of reach of children, pets, and others to prevent accidental overdose, misuse, or abuse.

Do take unused/expired medications to a local take-back program or mail them to a collection agency. To find a participating program:

·      Call your local police department, village, or city administrative office.

·      Check to see if your local pharmacies participate in the national “TakeAway Environmental Return System” mail-in medication disposal program.

·      Call (217) 524-3300 or visit the IEPA website at http://epa.state.il.us/medication-disposal/ for additional information and frequently asked questions.

·      For one-day collection events and long-term collection facilities, contact:

o   City of Chicago, 1150 N. North Branch on Goose Island, Phone: 311 or 312-744-7672

o   Rockford, 3333 Kishwaukee, Rock River Reclamation District, Phone:815-987-5570

o   Naperville, 1971 Brookdale Rd, Fire Station #4, Phone:630-420-6095

·      If you live in Lake County, contact the Solid Waste Agency of Lake County (SWALCO), Phone:847-336-9340

·      Visit the Solid Waste Agency of Northern Cook County (SWANCC) website for programs at over 20 Chicagoland member communities http://swancc.org/programs/pharmaceuticalsharps-disposal

·      Follow these general tips for medication disposal at participating take-back programs:

o   Keep medications in original containers but blacken-out any personal information with a permanent marker.

o   Acceptable items include: unused/expired prescription medications and expired OTC products.

o   Unacceptable items include: Pharmaceutical controlled substances (e.g. Norco, Vicodin, hydrocodone, oxycodone etc.).

o   Check with your local program for guidance on acceptable/unacceptable items.

·      For pharmaceutical controlled substances disposal, visit:

o   DEA website for designated take-back days and a list of pharmaceutical controlled substances:

http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html

o   Save A Star’s drug disposal program website for location of disposal boxes and a list of all acceptable items:

http://www.saveastar.org/pages/sas_drugdisposal.html

Don’ts:

Don’t share medications with friends and family.

Don’t store medications in the bathroom as this may compromise the integrity of the product.

Don’t flush medications down the toilet or sink or dispose of in the trash as they end up in our environment and drinking water supply.

Don’t burn medications as this may release toxic fumes and lead to air pollution.

If you do not have access to a local take-back or mail-in program, the IEPA recommends disposing of unused/expired medicines in the trash to avoid accidental overdose, misuse, and abuse by following the steps below:

·      Remove medications from original containers or blacken-out any identifying information on the label

·      Mix medication with a small amount of alcohol or water to dissolve or grind them up with kitty litter or coffee grounds

·      Place them in a plastic bag, and dispose of them in the trash

Drug abuse and misuse of prescription and OTC medications has become a significant problem. The medicines we take are increasing ending up in our environment and may be causing harm to wildlife. The previous recommendation to flush unwanted medications down the toilet or sink or dispose of in the trash may no longer be effective in addressing this problem. It is currently recommended to dispose of expired and unused medications at local or mail-in medication collection programs.

Protect your loved ones, drinking water sources, and the earth--dispose of your medications in a safe and environmentally-friendly manner.

References:

1.     Nettesheim T, Boehme SE, Malloy EH. Disposal of unwanted medications. Illinois-Indiana Sea-Grant website. http://www.istc.illinois.edu/special_projects/ppcp-env/1315-boehme.pdf. Accessed October 31, 2013. 

2.     Disposal of unwanted or unused pharmaceuticals fact sheet. IEPA’s medication disposal website. http://www.epa.state.il.us/medication-disposal/facts.html. Accessed October 30, 2013.

3.     A response to the epidemic of prescription drug abuse. Whitehouse drug policy website. Published April 2011. http://www.whitehouse.gov/sites/default/files/ondcp/Fact_Sheets/prescription_drug_abuse_fact_sheet_4-25-11.pdf. Accessed October 31, 2013.

4.     Results from the 2011 national survey on drug use and health: Summary of national findings, NSDUH series H-44, HHS Publication No. (SMA) 12-4713. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.

5.     A national action plan for child injury prevention: reducing poisoning injuries in children. CDC website. http://www.cdc.gov/safechild/NAP/overviews/poison.html. Updated April 1, 2013. Accessed October 31, 2013.

6.     Barnes KK, Kolpin DW, Meyer MT, et al. U.S. geological survey website. 2002. http://toxics.usgs.gov/pubs/OFR-02-94/index.html. Accessed October 29, 2013.

7.     How to dispose of unwanted medicine and personal care products. Illinois-Indiana Sea-Grant and University of Illinois Extension website. http://web.extension.illinois.edu/unusedmeds/. Accessed October 30, 2013.

8.     Medication disposal programs offered across the nation. NABP website. http://www.nabp.net/news/medication-disposal-programs-offered-across-the-nation. Updated August 26, 2011. Accessed October 30, 2013.

Masooma Razvi

Doctorate of Pharmacy Candidate, 2014

What is Mental Health?

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What is mental health?

Mental health encompasses many aspects of our overall health and well-being and is made up of emotional, psychological, and social components.¹ Emotion well-being refers to how satisfied an individual is with their current life situation, happiness, and peacefulness. Psychological well-being includes components such as self-acceptance, personal growth, openness to new experiences, optimism, and self-direction. An individual’s social well-being includes social acceptance, personal self-worth in society, and sense of community. Our mental health plays an integral role in how we function on a day-to-day basis and impacts our thoughts, feelings, and actions. It can also determine how we handle certain situations and has an impact on our personal relationships. Mental illness refers more specifically to a diagnosable mental disorder.² Common mental illnesses include anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, eating disorders, mood disorders, personality disorders, and schizophrenia. Depression is the most common mental illness, affecting more than a quarter of the U.S. adult population.

When to see your doctor or mental health provider.

Although it may be difficult to recognize when something is impacting your mental health, there are a few signs that may suggest it is time to have a discussion with your doctor or a mental health provider.³

Mood: Mood swings from feelings of “highs” to feelings of “lows” may be a sign of poor mental health. Also, persistent feelings of sadness, depression, or irritability lasting beyond two weeks may be an indication that it is time to speak with your healthcare provider about your mental health. Feeling more tense, nervous, or anxious than usual are also signs of many mental health concerns. Other changes in mood could include the inability to cope with daily problems or stress, feelings of guilt, or excessive anger, hostility, or violence.

Loss of interest or pleasure: A recent loss of interest or pleasure in activities, hobbies, or work that you once enjoyed is a common sign that you may need to discuss your mental health with your doctor. You may also find that it is more difficult to complete tasks or assignments in an efficient manner. Withdrawal from friends and family can also signify a significant mental health problem.

Appetite: Changes in eating habits such as eating too much or too little may indicate that it is time for a mental health checkup. Craving certain types of foods that are high in fat or sugar is also a stress response that could result in lower levels of energy and could have an even more negative result on your mood. A significant amount of weight loss without attempting to lose weight or a significant weight gain could be diagnostic of a mental health problem.

Sleep: Recent changes in sleep patterns or habits may also signify a problem with your current mental health. When faced with higher amounts of stress, people often respond with having trouble either falling asleep or staying asleep throughout the night. The quality of sleep could also be impacted and you may find yourself waking up without feeling re-energized. In comparison to not being able to sleep well at night, sleeping more than the normal amount of 7 to 9 hours per night can also be a symptom of a mental health problem.

Feeling of restlessness or being slowed down: You may feel that you are unable to sit still and must always be up moving. You could also experience feeling shaking or have unusual movements. By contrast, you could also feel slowed down and not able to move as quickly or as graceful as you normally would.

Energy: Along with problems getting the appropriate amount of sleep each night, feelings of not having enough energy to get through the day are also common with many mental health problems. Many patients with depression or anxiety issues complain of feelings of significant fatigue and low energy and are not able to complete things that they either must do or want to do.

Concentration: Many mental health issues can contribute to an individual’s ability to focus and concentrate. You can recognize your ability to concentrate by noticing if your productivity levels have decreased, if you’re unable to make deadlines, or if you’re unable to complete simple daily tasks such as housework. You may also find that you are unable to make appropriate decisions in a timely manner.

Physical symptoms: some mental health illnesses may manifest with physical symptoms such as stomach pain, back pain, headaches, and other general body aches and pain.

Preparing for your first visit.

Experiencing even just a few of these signs and symptoms is a reason to see your doctor or a mental health provider, especially if they are interfering with your ability to function on a day-to-day basis. You may choose to discuss your mental health concerns with your primary care doctor or you may go directly to a mental health provider, such as a psychiatrist or psychologist. In preparation for your first appointment, you should think about a number of questions that your doctor may ask you. These include:

When did you first notice your symptoms?

Has your day-to-day life been affected by your symptoms?

What have you tried to treat your symptoms on your own?  

Do you notice anything that makes you feel worse? Do your symptoms have a specific trigger?

Have your friends or family members commented on your mood?

Does mental illness run in your family?

What do you expect from treatment?

What medications, supplements, or herbs to you currently take?

Do you drink alcohol or use illegal (street) drugs?

It is important for you to think about the types of questions you should ask your doctor or other mental health provider prior to your first appointment. Examples of the types of questions to ask your doctor include:

What type of treatment will I receive?

Will counseling or therapy help?

Are there medications that will help?

How long will it take for my treatment to start working?

Is there anything I can do on my own to help myself?

Do you have any brochures that I can have to read?

Suicide Prevention.

If you feel that you are in a crisis or having thoughts of killing yourself please call the Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) immediately. The Suicide Prevention Lifeline is a 24-hour service available to anyone in need of help.

Where to find more information.

If you would like to find out more about mental health or mental illness, below are a few helpful resources:

American Psychological Association: http://www.apa.org/

National Institute of Mental Health: http://www.nimh.nih.gov/index.shtml

American Psychiatric Association: http://www.psychiatry.org/mental-health

Mental Health America: http://www.mentalhealthamerica.net/

National Alliance on Mental Illness: http://www.nami.org/

Maggie Thomas

Doctor of Pharmacy Candidate

College of Pharmacy, University of Illinois at Chicago

UIC Pharmacy

November 2013

References

1.     What is mental health? U.S. Department of Health and Human Services. http://www.mentalhealth.gov/basics/what-is-mental-health/index.html. Accessed November 12, 2013.

2.     Mental health. National Institute of Mental Health. http://www.nimh.nih.gov/health/publications/depression/index.shtml. Accessed November 12, 2013.

3.     Warning signs of mental illness. American Psychiatric Association. http://www.psychiatry.org/mental-health/more-topics/warning-signs-of-mental-illness. Accessed November 12, 2013.

Epilepsy Awareness Month

What is epilepsy?

Epilepsy is a disorder that is best described as disturbed electrical activity in the brain. This activity usually appears as a seizure. Seizures can also be caused by other conditions or by seizure-inducing activities. To be considered to have epilepsy a person has to have 2 or more seizures that are not caused by illness or any other provoking event. Seizures from epilepsy can vary in their appearance, severity, and cause. Although seizures are the main symptom of the disease, patients’ lives can be affected in many other ways by epilepsy.

How many people are affected by epilepsy?

There are 120 per 100,000 people in the United States that go to the emergency room or doctor because of a seizure, and approximately 125,000 new cases of epilepsy occur every year. It estimated that about 2 million people in the United States have epilepsy, and 50 million people throughout the world have epilepsy as estimated by the World Health Organization (WHO). Epilepsy occurs more frequently in younger children less than 2 years old and adults older than 65 years old. Epilepsy has an estimated annual cost of $15.5 billion in medical costs and lost or reduced earnings and productivity.

What are the types of epilepsy?

Epilepsy can be classified into 2 different groups by seizure type or as an epileptic syndrome. The seizures type is generally determined by an electrical study of the brain (an electroencephalogram or EEG) and the behavior of a person during and after a seizure. There are 2 major types of seizures, generalized seizures and partial seizures (see Table below).

Table. Types of seizures associated with epilepsy.

Seizure types		Description
Generalized seizures	Tonic, clonic, tonic-clonic, atonic, myoclonic, absence	Involve a large, widespread part of the brain
Partial seizures	Simple (no loss of consciousness) or complex (loss of consciousness)	Affect a smaller area of the brain and are more localized

Epileptic syndromes differ from epilepsy in that they are associated with more signs and symptoms than just seizures, including slow mental development. Epileptic syndromes are defined by a cluster of factors including seizure types, age when seizures begin, EEG findings, brain structure, family history of epilepsy, genetic disorder, and prognosis or future outlook. The epilepsy syndromes can be classified into 4 categories. These include familial, symptomatic, idiopathic, and reflex. Some syndromes and seizure types may not fall under any of the categories and be classified as unknown.

What are the signs and symptoms of epilepsy?

The symptoms a person experiences will depend largely on the type of seizure they have. They can present very noticeably such as a generalized tonic-clonic seizure where the patient will fall to the ground with muscle jerking or can be hardly noticeable with an absence seizure where a person just seems to be staring off into space for a moment. Between seizures there are usually no outright signs of epilepsy. Patients are unable to predict when another seizure will occur.

What can cause epilepsy?

Epilepsy may develop early in life or at any point when an event occurs that alters the connection between the nerve cells of the brain. Conditions or events that can cause this include:

• oxygen deprivation (eg, during childbirth)
• brain infections (meningitis, encephalitis)
• traumatic head or brain injuries
• stroke
• brain tumors
• other neurological diseases (eg, Huntington's disease, Alzheimer's disease)

In some cases epilepsy can be inherited as part of certain syndromes, but in most cases of epilepsy the cause is unknown.

Can epilepsy be prevented?

Depending on the cause of epilepsy there are some actions that can be taken to prevent it. Some of these include:

• prenatal care to avoid complications associated with pregnancy
• immunizations to lessen the likelihood of certain infections that can be linked with epilepsy
• reduce your risk of falls and motor vehicle accidents that are often causes of epilepsy
• reduce your risk for stroke by treating obesity, physical inactivity, diabetes, high blood pressure, and high cholesterol, and quit smoking

How is epilepsy diagnosed?

Epilepsy should be diagnosed by a specialist with training and expertise in epilepsy. A person would be evaluated for epilepsy when they have had more than one seizure of an unknown cause. The official diagnosis of epilepsy is a combination of 2 more seizures not caused by illness. There are 3 major areas of testing that will be done to help diagnosis epilepsy.

• Laboratory or blood tests:  none specifically diagnosis epilepsy but will be used to help rule out other conditions that may cause a seizure
• An EEG can be used to show abnormal brain activity
• Magnetic resonance imaging (MRI): will be used to look for any abnormalities in the brain to help determine a cause of seizures or epilepsy

Finally other conditions and precipitating factors need to be ruled out to diagnose epilepsy. These include seizures from alcohol or drugs, chemically-induced seizures, migraines, panic attacks, transient ischemic attacks, and several others.

After a patient is diagnosed with epilepsy doctors will want to determine the seizure type to help guide treatment decisions. There are multiple factors that go into diagnosing the seizure type. These include the EEG findings, duration of seizure, patient’s behavior during and after the seizure, and whether the patient loses consciousness during the seizure.

How is epilepsy treated?

Once a person’s diagnosis of epilepsy has been confirmed and their seizure type determined their treatment will be begin. Epilepsy treatment can include a variety of options.

• Antiseizure medications are the backbone of treatment for epilepsy. There are several available and choosing which one will be used is based on a variety of factors. These include seizure type, other health condition and medications, patient age, and side effects of the medication. Usually 50% to 70% of patients will be controlled with one antiseizure medication. For 30% to 35% of patients, medication will not be able to control their seizures and they will have to seek other treatment options.²
• Surgery is an option for epilepsy that cannot be controlled with medication alone. This is especially true when the abnormal electrical activity that causes the seizure mostly starts from the same portion of the brain. In some cases, surgeons can remove this area, stopping seizure activity.
• Vagus nerve stimulators are sometimes used if surgery cannot be done. This is an electrical device that is implanted into the head and intermittently releases an electrical shock. This is reported to reduce seizure frequency in epilepsy.
• A ketogenic diet is reported to be associated with seizure reduction. This diet is high in fat and low in carbohydrate. The diet typically has a 3:1 ratio of fats to carbohydrates. It is said to be most effective in generalized and partial epilepsy.

Finding the right treatment for epilepsy takes careful review of a patient’s symptoms and side effects of therapy, working closely with their doctor.

How can I prevent complications if I already have epilepsy?

People with epilepsy should avoid factors or activities that may precipitate or cause a seizure, such as sleep deprivation, fever, alcohol intake, and certain light stimulation. Families, caregivers, and patients should also be educated about road and driving safety, first aid, and prevention of injury at home, work, and school.

Where can I find more information at?

There are several resources online where you can find more information about epilepsy. You can also talk to your doctor or pharmacist for more information.

·      Epilepsy Foundation

http://www.epilepsyfoundation.org/

·      Centers for Disease Prevention and Control

http://www.cdc.gov/Features/EpilepsyAwareness/

·      Managing Epilepsy Well Network

http://web1.sph.emory.edu/ManagingEpilepsyWell/

Written by:    Katy Skowronski

Doctor of Pharmacy Candidate

College of Pharmacy, University of Illinois at Chicago

UIC Pharmacy

August 2013