Proper drug disposal programs
Evidence Ratings
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results. Learn more about our methods
Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Evidence Ratings
Scientifically Supported: Strategies with this rating are most likely to make a difference. These strategies have been tested in many robust studies with consistently positive results.
Some Evidence: Strategies with this rating are likely to work, but further research is needed to confirm effects. These strategies have been tested more than once and results trend positive overall.
Expert Opinion: Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Insufficient Evidence: Strategies with this rating have limited research documenting effects. These strategies need further research, often with stronger designs, to confirm effects.
Mixed Evidence: Strategies with this rating have been tested more than once and results are inconsistent or trend negative; further research is needed to confirm effects.
Evidence of Ineffectiveness: Strategies with this rating are not good investments. These strategies have been tested in many robust studies with consistently negative and sometimes harmful results. Learn more about our methods
Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.
Disparity Ratings
Potential to decrease disparities: Strategies with this rating have the potential to decrease or eliminate disparities between subgroups. Rating is suggested by evidence, expert opinion or strategy design.
Potential for mixed impact on disparities: Strategies with this rating could increase and decrease disparities between subgroups. Rating is suggested by evidence or expert opinion.
Potential to increase disparities: Strategies with this rating have the potential to increase or exacerbate disparities between subgroups. Rating is suggested by evidence, expert opinion or strategy design.
Inconclusive impact on disparities: Strategies with this rating do not have enough evidence to assess potential impact on disparities.
Strategies with this rating do not have enough evidence to assess potential impact on disparities.
Health factors shape the health of individuals and communities. Everything from our education to our environments impacts our health. Modifying these clinical, behavioral, social, economic, and environmental factors can influence how long and how well people live, now and in the future.
Proper drug disposal programs accept expired, unwanted, or unused medicines from designated users and dispose of them responsibly. Programs can use in-person drop-offs, mail-in efforts, permanent secure collection receptacles (e.g. 24-hour drop-boxes), scheduled drug take-back events, or products that deactivate medication (e.g. pouches), as well as education efforts to raise awareness about reasons for proper drug disposal and available options1. Proper drug disposal programs can be administered by state or local governments, municipal trash and recycling services, pharmacies, hospitals, clinics, or community organizations partnered with law enforcement. A 2014 amendment to the federal Controlled Substances Act allows the U.S. Drug Enforcement Administration (DEA) to register authorized collectors of controlled substances, allowing collection of pharmaceutical controlled and non-controlled substances, but not illegal drugs2.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced illicit drug use
Reduced unintentional poisoning
Reduced water pollution
Improved water quality
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased appropriate drug disposal
What does the research say about effectiveness?
Proper drug disposal programs are a suggested strategy to reduce illicit drug use and unintentional poisoning1, 3, 4, 5, 6, reduce pharmaceutical contamination of fresh water, and improve water quality7, 8, 9, 10, 11, 12, 13, 14, 15. Available evidence suggests that drug disposal programs increase collection and proper disposal of unused prescription drugs1, 16, 17, 18, 19, 20, 21 and reduce pharmaceuticals in the environment22. However, additional evidence is needed to confirm effects on drug use and water quality.
Prescription drugs collected. Available evidence from hundreds of drug take-back events and drop-boxes suggests these efforts successfully collect prescription drugs, which reduces their availability for misuse at least by the amounts collected1. Additional evidence is needed to establish effects on overall proper drug disposal rates and amounts of unused opioids that are disposed of compared to amounts that remain in homes1. More information is needed about the outreach efforts of drug take-back campaigns and events, including how and which populations are reached within a community1. A Michigan-based case study suggests take-back events can reduce excess opioids in a community and remove prescription opioids from many homes with youth or children23. A Kentucky-based study suggests increasing parent awareness of drug take-back programs and parents’ perceptions of availability of prescription drugs for adolescent nonmedical use can increase proper drug disposal24. A prescription drug take-back program designed to monitor opioid prescriptions for surgery patients successfully reclaimed excess opioid drugs from patients at post-surgery follow-up visits and reduced the amount of opioids participating surgeons prescribed to subsequent patients25. Drug take-back events may be more inclusive and accessible if organizers are aware that law enforcement participation can reduce participation among many populations that fear police interactions; disposal boxes provide an acceptable alternative to take-back events1.
Drug use effects. Ongoing statewide drug disposal programs with permanent collection receptacles may more effectively prevent drug abuse and accidental poisoning than temporary, one day take-back events5, 13. A Denton, Texas-based study associates drug take-back events with reduced unintentional poisonings and prescription drug misuse26. Surveys suggest that community campaigns to raise awareness about drug take-back events increase use of disposal programs and conversations with children about the dangers of prescription drug abuse27. Patient education about safe opioid handling practices and proper disposal appears to increase knowledge and use of proper opioid disposal methods3. Proper opioid disposal is more likely through take-back programs or drop-boxes that accept any unused drugs and can be incentivized with compensation28. Partially filling prescriptions of opioids initially may also reduce the amount of unused drugs that need disposal28.
Water quality effects. Many federal agencies and experts suggest that individual households, hospitals, and health care facilities avoid flushing any pharmaceuticals to preserve water quality and protect aquatic life and ecosystems9, 29, 30. Active pharmaceutical ingredients (APIs) released into the environment via improper disposal (e.g., flushing or landfill leaching) can adversely affect aquatic life, contaminate freshwater resources, and promote drug resistance in bacteria15, 31, 32. Flushing unused pharmaceuticals can cause spikes in APIs in the environment13; flushed pharmaceuticals may also break down into compounds that have different toxicity levels than the original drug11. Over 80% of sampled U.S. streams have evidence of pharmaceuticals in the water14, 33.
Best practices. Patient and pharmacist education may be needed to reduce improper drug disposal and increase use of proper disposal programs8, 10, 34, 35. Pharmacists can help reduce pharmaceutical waste and educate patients about available proper medication disposal methods and the negative effects of improper medication disposal on the environment and society8, 36. A North Carolina-based study suggests pharmacists working in a pharmacy where a medication drop-box is available are more likely to consistently recommend proper drug disposal methods37. Experts suggest pharmaceutical companies have a shared ethical responsibility for implementing proper medication disposal programs, including providing education, raising awareness, and managing services, with collaboration needed between companies, government agencies, health care providers, and patients to successfully implement programs7. Healthcare providers simply handing out information about proper drug disposal without instruction or discussion does not appear to influence proper drug disposal practices; more active interventions such as personalized teaching about drug disposal kits, discussions about drug take-back opportunities, and reviewing storage and disposal instructions before dispensing medication and/or drug disposal kits are more likely to increase proper drug disposal practices38. Available evidence suggests patients prefer mail-in drug disposal resources provided with prescriptions or traditional drop-off drug take-back programs that have minimal time costs and no monetary costs for patients39. Increased wastewater testing is suggested as a low cost way for communities to quickly monitor changes in drug use along with current testing for pharmaceuticals, pathogens, and pollutants40.
Costs. Benefit cost analysis suggests that establishing a proper drug disposal program would yield positive net social benefits41. Permanent secure drop-box or bin-based programs appear to be more cost-effective than mail-in programs or one day events42.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
It is unclear what impact proper drug disposal programs have on prescription drug misuse rates.
Available evidence suggests that safe storage and disposal of prescription opioids is rare, however, data suggest Black patients have a higher likelihood of locking prescription opioids57. Information and resources for safe storage and proper disposal of drugs is needed for people from all racial and ethnic backgrounds, of all ages, and with diverse education levels57. Data suggests that prior to the 1980s, people who were older, living in urban areas, and people of color had a higher risk for opioid use; available evidence suggests that higher risk for opioid use, especially prescription drug misuse, has shifted to people who are younger, living in suburban areas, and white people58. Inequalities by race, geographic location, and economic status persist in overdose deaths59, 60. Most people who overdose are non-Hispanic whites, about 10% are non-Hispanic Blacks, and 8% are Hispanic61. Experts attribute this demographic breakdown to the unconscious bias and prejudices of health care providers, who are more cautious prescribing opioids to patients of color based on the prejudiced assumption that patients of color are more likely to abuse or sell opioid prescription drugs61. Individuals who exhibit mental health conditions are also more likely to use opioids61.
The diversion and misuse of prescription drugs, especially of opioids, is an epidemic in rural, suburban, and urban communities across the U.S.58. Drug take-back programs are one primary prevention method to reduce the supply of diverted prescription drugs58. Tailoring outreach messages for non-English speakers, providing culturally sensitive, multi-lingual communication, establishing programs led by people of color, and addressing fear of law enforcement can remove barriers to participation in proper drug disposal programs57, 58. Disposal drop-boxes, mail-back programs, and options that allow participation without requiring interaction with law enforcement are more accessible, inclusive, and encourage broader community engagement57, 58. A North Carolina-based study suggests the number of drug disposal boxes are increasing and that drug disposal boxes are more likely to be placed in neighborhoods with lower incomes and higher rates of opioid overdose deaths. Experts suggest that continuing to expand permanent, secure drop-box locations could increase proper drug disposal and reduce prescription opioid diversion and misuse62.
What is the relevant historical background?
Opioid overdose deaths have been increasing since 199963. The rise in opioid overdose deaths began in the 1990s with a substantial increase in the prescription of both natural and semi-synthetic opioids because they were effective at managing chronic pain and falsely marketed to health care providers as non-addictive64, 65, 66, 67. Prescription opioid sales increased fourfold between 1999 and 200868. Many patients who became addicted to prescribed opioids turned to non-prescribed forms of opioids, such as heroin, which lead to a second wave of opioid overdoses in 2010. In 2013, a third wave began when synthetic opioids, such as fentanyl, that are much more potent than other forms of opioids, were combined with other drugs or counterfeit prescription pills, often unknown to the purchaser64. In 2013, the U.S. Department of Health and Human Services declared the misuse of prescription opioids an epidemic. Four years later, in 2017 the opioid epidemic was declared a national public health emergency61. Between 2020 and 2021, the opioid overdose death rate increased by over 15% and the synthetic opioid overdose death rate increased by over 22%64.
The dramatic increase in opioid sales was the result of pharmaceutical companies that overproduced and oversupplied opioid drugs for huge profits, pharmacies that filled the prescriptions, and health care providers who overprescribed the medications68. In rural areas many physicians overprescribed opioids to patients who travel long distances for treatment, do not have the ability to attend frequent appointments, and do not have alternative pain management interventions in their area68. Large quantities of prescription opioids exacerbate the opioid epidemic in the U.S. as 50-75% of non-medical opioid users have diverted drugs from friends or relatives with a prescription1. According to the 2019 National Survey on Drug Use and Health, over 10 million people use prescription opioids for non-medical reasons annually1. Diverted prescription opioids were involved in over 40% of opioid overdose deaths in 20161. In most cases, medical schools do not provide enough training about pain management, especially the relationships between tolerance, physical dependence, and addiction with opioids, best practices for opioid prescriptions, and other pain treatment strategies67.
It was not legal for pharmacies and health care facilities in the U.S. to accept unused prescription drugs for disposal until the Controlled Substances Act was amended with the Secure and Responsible Drug Disposal Act of 201010, 69. The Secure and Responsible Drug Disposal Act of 2010 gives the Drug Enforcement Administration (DEA) authority to create, regulate, and propose new opportunities for proper drug disposal such as take-back programs, mail-back programs, and permanent, secure drop-boxes10. This federal legislation addressed proper medication disposal practices in response to increasing prescription medication misuse, especially among teenagers using prescription opioids, and unintentional overdose deaths10. In October 2014, the DEA implemented Final Rule 9 allowing pharmacies and health care locations to register as designated sites for proper drug disposal programs and as of February 2016, there are 882 locations registered as collectors with the DEA10.
Research studies have detected pharmaceutical drugs in streams across the U.S., including antidepressants, antibiotics, antihypertensives that treat high blood pressure, analgesics or painkillers, and endocrine-disrupting drugs that alter hormones7. Concentrations of pharmaceuticals have been found above detection limits in surface, drinking, and groundwater in many countries in Australia, Africa, Asia, Europe, North America, and South America7, 70. Globally, efforts to improve environmental sustainability in health care are growing and proper drug disposal programs are needed to preserve water and soil quality and to maintain ecological systems7. The U.S. Environmental Protection Agency has labeled many pharmaceuticals and personal care products, especially compounds that change normal hormonal function, as contaminants of emerging concern because of potential effects on aquatic life15.
Equity Considerations
- What proper drug disposal opportunities are available in your community? How are your local proper drug disposal programs addressing barriers to participation, including fear of law enforcement, time and cost constraints, and lack of awareness?
- What educational opportunities are available for pharmacists and health care providers to learn about the need for and availability of proper drug disposal methods?
- What outreach and educational efforts exist in your community to improve public use and awareness of proper drug disposal opportunities?
Implementation Examples
Several states have legislation that authorizes and guides proper drug disposal programs for consumers, such as Maine43, Ohio44, and Washington45. Some states have legislation that prohibits health care institutions from flushing unused medications into public wastewater, as in Illinois46. Other states provide public guidelines and educational materials about proper drug disposal, such as Connecticut47, Florida48, New York49, and New Jersey50. Some states also offer maps for residents to find nearby take-back locations, as in Michigan51. As of 2023, 44 states and Washington, D.C. have laws establishing prescription drug repository programs, which allow unused medications to be donated instead of discarded and avoids improper disposal methods; donated drugs can be used to increase access to affordable medication52.
The DEA has two drug take-back events each year; since 2010, the DEA has collected 4.8 million pounds of prescription drugs on only 9 days53. In 2016, the DEA set a record, collecting about 447 tons at almost 5,400 sites in all 50 states54. Sheriff’s offices also host regularly scheduled drug take-back programs for the public. Operation Medicine Cabinet in Broward County, Florida is one example55.
October 22nd is National Prescription Drug Take-Back Day; in 2016, more than 5,000 collection sites nationwide participated. Private organizations have also established permanent drug disposal receptacles. For example, Walgreen’s pharmacy has over 500 collection kiosks at pharmacies in 35 states and Washington, D.C.56.
Implementation Resources
‡ Resources with a focus on equity.
US DEA-Drug take-back - U.S. Drug Enforcement Agency (U.S. DEA). National prescription drug take-back day.
CDC-Drug take-back - Centers for Disease Control and Prevention (CDC). (2021, October 18). Rx Prep: National prescription drug take-back day. Public Health Matters Blog.
PDFK-Safe drug disposal guide - Partnership for Drug-Free Kids (PDFK). Safe drug disposal: A guide for communities seeking solutions. Washington, D.C.: Office of Community Oriented Policing Services (COPS); 2015.
AMCC-Rx drop - The American Medicine Chest Challenge (AMCC). Use the search tool to find the drop off location closest to you!
Dispose my meds - Dispose My Meds. Safe disposal of medications: Pharmacy locator.
Take back your meds - Take Back Your Meds. Washington needs a statewide medicine take-back program: Protect our kids, families, and environment.
WTC-Disposal tips - WTC Health Program. (n.d.). Your prescription medicine: Tips for safe storage and disposal. Retrieved December 11, 2024.
Footnotes
* Journal subscription may be required for access.
1 Schafer 2021 - Schäfer, W. L. A., Johnson, J. K., Wafford, Q. E., Plummer, S. G., & Stulberg, J. J. (2021). Primary prevention of prescription opioid diversion: A systematic review of medication disposal interventions. The American Journal of Drug and Alcohol Abuse, 47(5), 548–558.
2 US DEA-Disposal regulations 2014 - U.S. Drug Enforcement Administration (U.S. DEA). (2014, September 9). Disposal of controlled substances: A rule by the Drug Enforcement Administration on 09/09/2014. Federal Register.
3 McElyea 2022 - McElyea, J., Sam, B., Hollingsworth, H., Chamberlain, C., & Brown, L. S. (2022). The effect of patient opioid education on opioid use, storage, and disposal patterns. Journal of Pain & Palliative Care Pharmacotherapy, 36(1), 11–17.
4 TFAH-Levi 2013 - Levi J, Segal LM, Miller AF. Prescription drug abuse: strategies to stop the epidemic. Trust for America’s Health (TFAH). 2013.
5 Simons 2010 - Simons TE. Drug take-back programs: Safe disposal of unused, expired, or unwanted medications in North Carolina. Coastal Coalition for Substance Abuse Prevention. 2010:1-17.
6 US FDA-Unused medicines - U.S. Food and Drug Administration (U.S. FDA). Disposal of unused medicines: What you should know.
7 Karim-Nejad 2022 - Karim-Nejad, L., & Pangilinan, K. (2022). How should responsibility for proper medication disposal be shared? America Medical Association Journal of Ethics, 24(10), E971-979.
8 Ehrhart 2020 - Ehrhart, A. L., Granek, E. F., Nielsen-Pincus, M., & Horn, D. A. (2020). Leftover drug disposal: Customer behavior, pharmacist recommendations, and obstacles to drug take-back box implementation. Waste Management, 118, 416–425.
9 Amin Dar 2019 - Maqbool, M., Dar, S. A., Munshi, S. H., & Saleem, F. (2019). Pharmaceutical wastes and their disposal practice in routine. International Journal of Information and Computing Science.
10 Kinrys 2018 - Kinrys, G., Gold, A. K., Worthington, J. J., & Nierenberg, A. A. (2018). Medication disposal practices: Increasing patient and clinician education on safe methods. Journal of International Medical Research, 46(3), 927–939.
11 Lubick 2010 - Lubick N. Drugs in the environment: Do pharmaceutical take-back programs make a difference. Environmental Health Perspectives. 2010;118(5):A210-A214.
12 Glassmeyer 2009 - Glassmeyer ST, Hinchey EK, Boehme SE, et al. Disposal practices for unwanted residential medications in the United States. Environment International. 2009;35(3):566-572.
13 Ruhoy 2008 - Ruhoy IS, Daughton CG. Beyond the medicine cabinet: An analysis of where and why medications accumulate. Environment International. 2008;34:1157-1169.
14 Becker 2010 - Becker J. Minding the gap: Research priorities to address pharmaceuticals in the environment. Health Care Research Collaborative. 2010:1-24.
15 US EPA-PPCPs - U.S. Environmental Protection Agency (U.S. EPA). Contaminants of emerging concern including pharmaceuticals and personal care products (PPCPs).
16 Fleming 2016 - Fleming E, Proescholdbell S, Sachdeva N, et al. North Carolina’s Operation Medicine Drop: Results from one of the nation’s largest drug disposal programs. North Carolina Medical Journal. 2016;77(1):59-62.
17 Gray 2015 - Gray J, Hagemeier N, Brooks B, Alamian A. Prescription disposal practices: A 2-year ecological study of drug drop box donations in Appalachia. American Journal of Public Health. 2015;105(9):e89-e94.
18 Yang 2015a - Yang CHJ, Doshi M, Mason NA. Analysis of medications returned during a medication take-back event. Pharmacy. 2015;3(3):79-88.
19 Stewart 2015 - Stewart H, Malinowski A, Ochs L, et al. Inside Maine’s medicine cabinet: Findings from the Drug Enforcement Administration’s medication take-back events. American Journal of Public Health. 2015;105(1):e65-e71.
20 Perry 2014a - Perry LA, Shinn BW, Stanovich J. Quantification of an ongoing community-based medication take-back program. Journal of the American Pharmacists Association. 2014;54(3):275-279.
21 Welham 2015 - Welham GC, Mount JK, Gilson AM. Type and frequency of opioid pain medications returned for disposal. Drugs - Real World Outcomes. 2015;2(2):129-135.
22 Stoddard 2015 - Stoddard KI, Huggett DB. Wastewater effluent hydrocodone concentrations as an indicator of drug disposal program success. Bulletin of Environmental Contamination and Toxicology. 2015;95(2):139-144.
23 Moustarah 2020 - Moustarah, F., Desai, J. P., & Blebea, J. (2020). Removing abuse-prone prescription medication from fueling the national opioid crisis through community engagement and surgeon leadership: Results of a local drug take-back event. Surgery Open Science, 2(1), 34–41.
24 Egan 2020a - Egan, K. L., Gregory, E., Foster, S. E., & Cox, M. J. (2020). Modifiable risk factors associated with disposal of unused prescription drugs by parents of adolescents. The Journal of Primary Prevention, 41(6), 529–545.
25 Lewis 2023 - Lewis, P. R., Pelzl, C., Benzer, E., Szad, S., Judge, C., Wang, A., & Van Gent, M. (2023). Bringing opiates off the streets and undertaking excess scripts: A novel opiate reclamation and prescription reduction program. Surgery, 174(3), 574–580.
26 Stoddard 2017 - Stoddard, K. I., Hodge, V., Maxey, G., Tiwari, C., Cready, C., & Huggett, D. B. (2017). Investigating research gaps of pharmaceutical take back events: An analysis of take back program participants’ socioeconomic, demographic, and geographic characteristics and the public health benefits of take back programs. Environmental Management, 59(6), 871–884.
27 Yanovitzky 2016 - Yanovitzky I. The American Medicine Chest Challenge: Evaluation of a drug take-back and disposal campaign. Journal of Studies on Alcohol and Drugs. 2016;77(4):549-555.
28 Buffington 2019 - Buffington, D. E., Lozicki, A., Alfieri, T., & Bond, T. C. (2019). Understanding factors that contribute to the disposal of unused opioid medication. Journal of Pain Research, Volume 12, 725–732.
29 Mankes 2013 - Mankes RF, Silver CD. Quantitative study of controlled substance bedside wasting, disposal and evaluation of potential ecologic effects. The Science of the Total Environment. 2013;444:298-310.
30 US EPA-Medicine disposal - U.S. Environmental Protection Agency (U.S. EPA). Dispose of medicines, vitamins and other supplements properly.
31 Kessler 2010 - Kessler R. Pharmaceutical factories as a source of drugs in water. Environmental Health Perspectives. 2010;118(9):382-385.
32 Pal 2010 - Pal A, Gin KYH, Lin AYC, Reinhard M. Impacts of emerging organic contaminants on freshwater resources: Review of recent occurrences, sources, fate and effects. The Science of the Total Environment. 2010;408(24):6062-6069.
33 USGS-Emerging contaminants - U.S. Department of the Interior, U.S. Geological Survey (USGS). (2019, March 2). Emerging contaminants in the environment. Water Resources Mission Area.
34 Seehusen 2006 - Seehusen DA, Edwards J. Patient practices and beliefs concerning disposal of medications. The Journal of the American Board of Family Medicine. 2006;19(6):542-547.
35 Jarvis 2009 - Jarvis CI, Seed SM, Silva M, Sullivan KM. Educational campaign for proper medication disposal. Journal of the American Pharmacists Association (JAPhA). 2009;49(1):65-68.
36 Afanasjeva 2019 - Afanasjeva, J., & Gruenberg, K. (2019). Pharmacists as environmental stewards: Strategies for minimizing and managing drug waste. Sustainable Chemistry and Pharmacy, 13, 100164.
37 Egan 2024 - Egan, K. L., McCallum, L., Matthews, J. C., & Eldridge, L. A. (2024). Elucidating determinants of medication disposal programs at retail pharmacies in North Carolina. Journal of the American Pharmacists Association, 64(1), 111–119.
38 Bicket 2021 - Bicket, M. C., Fu, D., Swarthout, M. D., White, E., Nesbit, S. A., & Monitto, C. L. (2021). Effect of drug disposal kits and fact sheets on elimination of leftover prescription opioids: The DISPOSE multi-arm randomized controlled trial. Pain Medicine, 22(4), 961–969.
39 Varisco 2023 - Varisco, T., Patel, H., Saadi, R. A., Wanat, M., & Thornton, D. (2023). Patients prefer free drug disposal options delivered by pharmacists at the point of care: Results of a decision tree analysis of a national factorial vignette panel survey. International Journal of Drug Policy, 116, 104045.
40 RAND-Pardo 2020 - Pardo, B., & Knopman, D. (2020, March 23). Want to know if a new drug crisis is growing? Check the wastewater. RAND Commentary.
41 Kotchen 2009 - Kotchen M, Kallaos J, Wheeler K, Wong C, Zahller M. Pharmaceuticals in wastewater: Behavior, preferences, and willingness to pay for a disposal program. Journal of Environmental Management. 2009;90(3):1476-1482.
42 Carnevale-Drug takeback 2012 - Research and Policy Analysis Group of Carnevale Associates, LLC. Prescription drug takeback programs and substance abuse prevention: A policy brief. Gaithersburg: Carnevale Associates, LLC; 2012.
43 ME Statutes 22 604 - State of Maine. Disposal of unused pharmaceuticals. Public Laws of Maine: Second Special Session of the 121st; Chapter 679 S.P. 671-L.D. 1926.
44 OH HB 93 - Ohio 129th General Assembly. Revised code to establish and modify laws regarding the prevention of prescription drug abuse. Amended Substitute House Bill Number 93.
45 WA HB 2600 - Washington State 60th Legislature. An act relating to providing safe collection and disposal of unwanted drugs. 2008 Regular Session: House Bill 2600; 2008:1-15.
46 IL-SB 1919 - Illinois 96th General Assembly. Senate Bill (SB) 1919: Safe Pharmaceutical Disposal Act.
47 CT-Medicine disposal - State of Connecticut Department of Energy & Environmental Protection. Disposing of prescription medicines and over-the-counter (OTC) products.
48 FL-Unwanted medications - Florida Department of Environmental Protection. How to dispose of unwanted medications.
49 NY-Proper drug disposal - New York State Department of Environmental Conservation. Safe medication disposal for households.
50 NJ DEP-Medication disposal - State of New Jersey Department of Environmental Protection (NJ DEP). Guidelines for proper disposal of household medication.
51 MI EGLE-Drug disposal - Michigan Department of Environment, Great Lakes, and Energy (MI EGLE). (n.d.). Drug disposal. (Retrieved December 11, 2024).
52 NCSL-Drug repository - National Conference of State Legislatures (NCSL). (n.d.). State prescription drug repository programs. Retrieved December 11, 2024.
53 US DEA Public affairs 2014 - U.S. Drug Enforcement Administration (U.S. DEA). DEA public affairs: DEA and partners collect 309 tons of pills on ninth prescription drug take-back day. 2014.
54 US DEA Public affairs 2016 - U.S. Drug Enforcement Administration (U.S. DEA). DEA public affairs: DEA collects record-setting amount of meds at latest national Rx take-back day. 2016.
55 Broward Sheriff-OMC - Broward County Sheriff's Office. Operation medicine cabinet (OMC).
56 White House-Botticelli 2016 - Botticelli M. October 22nd is national prescription drug take-back day. The White House Blog, President Barack Obama. 2016.
57 Broman 2021 - Broman, M. J., Ellis, J. D., Victor, G. A., Kollin, R., Pasman, E., Lister, J. J., & Resko, S. M. (2021). Predictors of safe prescription opioid storage and participation in drug take-back events: Results from a statewide survey. Journal of Community Health, 46(5), 1000–1007.
58 Kearney 2019 - Kearney, M., Reynolds, L., Blitzstein, S., Chapin, K., & Massey, P. (2019). Primary prevention of prescription drug misuse among culturally and linguistically diverse suburban communities. Journal of Community Health, 44(2), 238–248.
59 CDC-Disparities widen - Centers for Disease Control and Prevention (CDC). Vital signs. Drug overdose deaths rise, disparities widen.
60 Zhang 2018c - Zhang X, Marchand C, Sullivan B, Klass EM, Wagner KD. Naloxone access for Emergency Medical Technicians: An evaluation of a training program in rural communities. Addictive Behaviors. 2018;86:79-85.
61 Salmond 2019 - Salmond S, Allread V. A population health approach to America’s opioid epidemic. Orthopaedic Nursing. 2019;38(2):95-108.
62 Egan 2022 - Egan, K. L., Johnston, C. A., Jackson, J. T., Foster, S. E., & Lee, J. G. L. (2022). Rates and correlates of medicine disposal program implementation at pharmacies in North Carolina: A longitudinal study, 2016-2021. Journal of the American Pharmacists Association, 62(4), 1329–1337.
63 Freeman 2018 - Freeman PR, Hankosky ER, Lofwall MR, Talbert JC. The changing landscape of naloxone availability in the United States, 2011 – 2017. Drug and Alcohol Dependence. 2018;191:361-364.
64 CDC-Understanding the epidemic - Centers for Disease Control and Prevention (CDC). Understanding the opioid overdose epidemic.
65 Bennett 2021 - Bennett AS, Elliott L. Naloxone’s role in the national opioid crisis — past struggles, current efforts, and future opportunities. Translational Research. 2021;234:43-57.
66 Haffajee 2020 - Haffajee RL, Cherney S, Smart R. Legal requirements and recommendations to prescribe naloxone. Drug and Alcohol Dependence. 2020;209:107896.
67 Volkow 2016 - Volkow, N. D., & McLellan, A. T. (2016). Opioid abuse in chronic pain — Misconceptions and mitigation strategies. New England Journal of Medicine, 374(13), 1253–1263.
68 Judd 2023 - Judd D, King CR, Galke C. The opioid epidemic: A review of the contributing factors, negative consequences, and best practices. Cureus. 2023;15(7):e41621.
69 US Congress 111-273 - 111th Congress 2009-2010. Public Law 111-273, 124 Statute 2858: Secure and Responsible Drug Disposal Act of 2010.
70 NCCID-Qadar 2021 - Qadar, S. M. Z., Thane, G., Haworth-Brockman, M., & National Collaborating Centre for Infectious Diseases. (2021). A call to action: An evidence review on pharmaceutical disposal in the context of antimicrobial resistance in Canada. In National Collaborating Centre for Environmental Health. National Collaborating Centre for Infectious Diseases.
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