This Saturday is National Prescription Drug Takeback Day - Please Take Advantage of it
by Don Drake, Connelly Law Offices, Ltd. 4.24.24
"National Prescription Drug Takeback Day is scheduled for this Saturday, April 27, 2024, from 10 AM to 2 PM," said professional fiduciary and certified elder law Attorney RJ Connelly III. "These events are conducted twice annually, typically in the spring and fall seasons, to provide a safe, convenient, and responsible way for people to dispose of unused or expired medications."
The first such event was organized in 2010, and four days after it, Congress passed legislation amending the Controlled Substances Act, thereby granting the Drug Enforcement Administration (DEA) the power to make this event a permanent feature. This initiative enables people to dispose of the extra medication safely.
"The presence of unused or expired medicines in home medicine closets has long been a significant safety concern for seniors," said Attorney Connelly. "Consequently, authorized drug take-back locations will be established at various venues, including retail pharmacies, hospital or clinic pharmacies, and law enforcement facilities. At Connelly Law, we have witnessed the adverse effects that too many prescriptions cluttering the cabinet or table can have on seniors, particularly those with eyesight or memory problems or when they fall into the hands of a child or teen. Disposing of them appropriately is the most effective way to protect your loved ones' safety."
Medication Disposal is Important
The current opioid epidemic has brought to light the issue of medication disposal and its potential dangers. However, it's important to acknowledge that many other medications in a senior's medicine cabinet can also be misused. Regrettably, such abuse can often occur without the knowledge of family members, who may only be cognizant of the hazards associated with opioids. Let's examine the types of medications that are likely to be present in the medication cabinet of our senior loved ones that possess abuse potential.
Opioids
It is common knowledge that the use of opioids can pose significant risks. This class of drugs encompasses several medications, such as codeine, hydrocodone (Vicodin), morphine (MS Contin), oxycodone (Oxycontin and Percocet), hydromorphone (Dilaudid), and fentanyl (Duragesic). Opioids are primarily prescribed to alleviate pain. However, with prolonged use, the analgesic effects may diminish as tolerance sets in, resulting in the recurrence of pain. This can lead to dependence and addiction, which could cause withdrawal symptoms that make it challenging to discontinue opioid usage. For seniors, the abuse of opioids can cause other medical problems, further complicating the health situation.
Benzodiazepines
Benzodiazepines are a class of medications commonly prescribed for their sedative and anxiolytic properties. This class of drugs includes alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan). While over 2,000 different benzodiazepines have been produced, only a select few, about fifteen, have been approved by the FDA for use in the United States. These drugs act on the central nervous system to produce sedation, muscle relaxation, and anxiety reduction. The duration of action of benzodiazepines is usually used to classify them.
Benzodiazepine abuse is a growing concern, partly due to the widespread availability of these drugs and their toxic effects. Chronic abuse and overdose, which are commonly seen in hospital emergency departments, are both forms of abuse. Although death and severe reactions are rare with benzodiazepine abuse alone, combining benzodiazepines with alcohol or other medications can result in fatal consequences. Elderly individuals who abuse benzodiazepines may experience symptoms similar to dementia, leading to a misdiagnosis.
Z Drugs
The Z-drugs, including Lunesta, Ambien, and Sonata, belong to the class of benzodiazepine receptor agonists and are commonly prescribed for insomnia. These drugs function similarly to benzodiazepines within the brain and were developed as a non-benzodiazepine alternative with similar therapeutic effects but without the addictive and hazardous properties associated with benzodiazepines. The pharmaceutical companies that produce these drugs market them as a less addictive substitute for benzodiazepines for individuals with acute insomnia.
However, physical dependence on these drugs can develop rapidly within a mere two weeks, regardless of whether the user is strictly adhering to a prescription or abusing the drug. Such dependence is characterized by tolerance, whereby the user requires progressively larger doses of the medication to achieve the same effect, and withdrawal symptoms may occur if the user abruptly ceases taking the drug or decreases their dosage.
Stimulants
Stimulant medications, such as methylphenidate (Ritalin, Concerta, others), amphetamine (Adderall XR, Mydayis), and dextroamphetamine (Dexedrine), are generally not recommended for older adults. These drugs are primarily used to treat attention-deficit/hyperactivity disorder (ADHD) and certain sleep disorders, such as narcolepsy. While amphetamines (like Adderall) and methylphenidates (like Ritalin) differ in their molecular composition, their potential for abuse yields similar effects. Depending on the desired potency and duration of action, patients may be prescribed either amphetamines or methylphenidates.
Gabapentin
Gabapentin, commercially known as Neurontin, is an anticonvulsant medication available in capsule, tablet, and oral solution forms. It is prescribed for the management of certain seizure disorders and the neuropathic pain condition known as post-herpetic neuralgia, which is characterized by lasting nerve and skin pain due to shingles. Additionally, an extended-release version of gabapentin, marketed as Horizant, is used to treat restless leg syndrome (RLS).
When prescribed and taken as directed, gabapentin poses little potential for abuse or addiction. However, when taken in conjunction with other medications, such as opioids, muscle relaxants, or anxiety medications, it can produce a high that is comparable to marijuana.
The rise in the prescription of gabapentin to manage some types of pain has led to an increase in gabapentin overdoses, similar to opiates. Unlike opiates, there is no known antidote to gabapentin overdose. The prolonged half-life of the drug necessitates immediate medical attention to handle the complications related to a toxic quantity of this medication.
Other Abused Drugs
The aforementioned pharmaceuticals have been reported to be the most commonly abused by both elderly individuals as well as adolescents. However, it is crucial to note that these substances are not the only medications that may be abused. Further examination reveals additional medicines that may be found within a senior's medication cabinet that could be subject to abuse.
Muscle Relaxers
Centrally acting skeletal muscle relaxants are a potential class of drugs that may be abused. Although they are rarely used as the primary drug of abuse, they are often consumed along with other central nervous system depressants, such as narcotics or alcohol. The primary toxic effects of these drugs are respiratory depression and coma.
Carisoprodol (Soma) and cyclobenzaprine (Flexeril) are the most widely used drugs in this class. Soma is known to be addictive and is often combined with benzodiazepines and opiates to achieve a heroin-like high. The combination of these drugs is commonly referred to as the Houston Cocktail, as it was prevalent in the Houston area. Flexeril is also addictive and can be abused.
Psychotropics
Psychiatric medications that are primarily used to treat mood disorders can be abused, particularly by individuals who have an existing substance abuse habit. Seroquel is a commonly abused psychiatric medication due to its calming effects, which can alleviate the discomfort of withdrawal or the side effects of illicit drug use. This drug is often referred to by street names such as Susie Q, Squirrel, Quell, and baby heroin. Intravenous injection or inhalation through crushing and snorting are popular methods of abuse. Combining Seroquel with more potent substances like cocaine is also a common practice, known as a “Q-Ball”.
Other antipsychotic medications, such as Olanzapine, Risperidone, Abilify, Thorazine, Zyprexa, Ziprasidone, Haldol, and Clozaril, also have the potential for misuse and abuse. It is essential to be aware of the potential for abuse and misuse of these medications, as they can pose serious health risks and lead to addiction and other adverse outcomes.
Barbiturates
Barbiturates, which belong to a class of drugs known as sedative-hypnotics, are highly addictive substances with sleep-inducing and anxiety-reducing effects. Although high school-aged individuals commonly abuse them, they are more frequently prescribed to older adults and can be found in their medicine cabinets. Some of the barbiturate names that are prescribed include Amytal (amobarbital), Seconal (secobarbital), Butisol (butabarbital), Nembutal (pentobarbital), Donnatal (phenobarbital), Esgic and Fioricet (butalbital/acetaminophen/caffeine combinations), and Fiorinal Ascomp and Fortabs (butalbital/aspirin/caffeine combinations). These drugs can be hazardous as even slight overdoses can lead to coma or death, and a life-threatening withdrawal syndrome can also occur.
Other Medication Concerns
Overusing antibiotics is a significant concern regarding leftover drugs from the medicine cabinet. Prolonged use can lead to infections developing antibiotic resistance, which could result in serious health consequences. Despite being viewed as harmless, taking antibiotics without medical advice is fraught with potential dangers.
Overconsumption of antibiotics can lead to more severe illnesses and antibiotic resistance, resulting in the proliferation of dangerous bacteria that can no longer be treated effectively by many of the most commonly prescribed medications. Moreover, the overuse of antibiotics can eliminate "beneficial bacteria" in the gastrointestinal tract, leading to diarrhea and yeast infections. Seniors or individuals with compromised immune systems are at a higher risk of developing a potentially fatal illness known as C. difficile or C-diff.
This bacterium can cause symptoms ranging from explosive diarrheal episodes to life-threatening colon inflammation. In severe cases, C. difficile infection can also cause enlargement of the colon (toxic megacolon) and sepsis. C. difficile is highly contagious and can spread through hands from person to person. It can be found on surfaces such as cart handles, bedside tables, toilets, sinks, stethoscopes, thermometers, telephones, and remote controls in a hospital or nursing home setting.
Expired Medications
One of the concerns associated with retaining unused medications is the potential loss of drug potency. While several studies suggest that potency may not necessarily deteriorate as rapidly as initially believed, this remains a topic of ongoing debate. A 2012 Journal of the American Medical Association study revealed that many medications, even those that had expired for over four decades, retained their potency.
However, it is generally advisable to avoid saving unused medication for future use, primarily if the medicines are intended to treat different conditions. Many seniors may save unused medication to manage limited financial resources and avoid additional medical visits. This practice is not without risks, as the symptoms presenting at a future time may not be the same illness or condition for which the medications were initially prescribed. Furthermore, the formulation of drugs currently being used could have changed since the original prescription, leading to the possibility of severe and potentially fatal drug interactions.
Cleaning out Cabinets
As previously mentioned, this event occurs biannually, and it is considered good practice to dispose of any medication that is no longer required or may have expired. Previously, flushing medications was deemed acceptable, but this practice has been banned in several municipalities due to environmental concerns. It is crucial to dispose of medications in a safe and environmentally friendly manner.
Here are simple steps to dispose of medications safely and in an eco-friendly way:
Combine the medicines (without crushing tablets or capsules) with an unpalatable substance such as dirt, kitty litter, or used coffee grounds. This helps prevent the diversion of medicines from the trash.
Place the mixture in a container such as a zip-lock or sealable plastic bag and dispose of the container in your household trash.
When disposing of a prescription vial, remove the label and/or scratch off all personal information on the label.
Utilize pharmacy “take-back” programs or solid waste programs to dispose of unused or expired medicines.
A study that investigated accidental child exposure to a grandparent’s medicine found that 45% of cases involved medicines stored in child-resistant containers, so even if seniors are aware of the dangers, their grandchildren are still at risk.
A Final Word
"I cannot stress enough the importance of disposing of medicines after they are no longer needed," said Attorney Connelly. "This creates an unnecessary health risk within the home, particularly when young children or teenagers are present. It is essential to remember that even with child-resistant containers, the term 'resistant' does not equate to 'child-proof,' and issues can and do occur. I urge you to take advantage of this upcoming event and dispose of unused or expired medications for the safety and well-being of all concerned."
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