The New England Journal of Medicine last week carries a wonderful Perspective piece (Shrank WH. Our Bulging Medicine Cabinets – the other side of medication nonadherence. N Engl J Med 2011 Apr 28;364(17):1591-3) that should be compulsory reading for all of those involved in the in the prescription, dispensing, administration and disposal of pharmaceuticals, and all of those involved in the regulation of any of these stages.

Shrank discusses, in a wonderfully clear and unambiguous way, the impact of unclear and unnecessary prescribing on the accumulation of waste pharmaceuticals in the home. Focusing mainly on the risk of inappropriate drug administration and medication errors, ‘sharing’ of stockpiled medications among family members, and disposal – mainly to sewer – the driver for Shrank’s writing is yet another community collection event. We have discussed many times before on the Clinical Waste Discussion Forum the US approach to collection of household hazardous wastes, including waste pharmaceuticals. Shrank reports a recent “National Prescription Drug Take-Back Day” managed by the Drug Enforcement Agency in partnership with local police departments throughout the country. More than 4000 police departments participated, and in Orange County, Florida alone (Shrank’s home) more than 1.5 tons of prescription medications were returned.

In the UK, Local Authorities might act instead of the police, and the environment Agency in place of the Drug Enforcement Agency. This works best with a powerful educational drive to manage prescribers and their over-prescribing habits as Shrank describes. But disposal cannot be ignored and such a move, whether local, regional or national can have a dramatic and hugely positive environmental impact. Fewer medication errors and reduced risk of accidental poisoning, together with a vast body of invaluable information on prescribing habits etc that will used to shape future prescribing is well worth the effort.

All it needs is the impetus to get it off the ground, and someone to get the ball rolling. Logically, this should be one of the major beneficiaries, either the Department of Health or the Environment Agency. A fully multi-agency approach is key to success, and sadly that will be the main reason why such a collection and disposal drive will remain a distant hope.

But one day, perhaps on day, someone will get another bee in their bonnet about pharmaceutical waste disposal, this time of community pharmaceutical waste disposal, and announce such an initiaive here in the UK. No doubt there will be much fanfare and PR backing for “their” wonderful idea.

But remember, you heard it hear first, several years ago!!

The New England Journal of Medicine paper is behind a paywall. If anyone is struggling to gain access, please do get in touch ian@ianblenkharn.com