Problem

Problematic Behavior Or Activity

In 2009, it was reported that second to marijuana, prescription drugs were the illicit substances most abused by teenagers. Teenagers were gaining access to the drugs in the medicine cabinets of their own homes. Likewise, these substances were becoming easily accessible in schools. A belief that doctor-prescribed medications were safe to experiment with perpetuated abuse of these drugs.

Until 2014, pharmacies could not legally take back any unused medications and options for safe disposal did not exist. Portland residents were being advised to dispose of unused and expired prescription medications by flushing them into the water supply or putting them in the trash. Ultimately, many people simply let the medications pile up in their homes.

Impact On The Community

According to the U.S. Centers for Disease Control and Prevention, the number of people ages 15-19 who died from accidental poisoning increased by 91 percent from 2000 to 2009. It was also clear that prescription painkillers were becoming a gateway drug for heroin use.

According to the Oregon Association of Clean Water Agencies, there is also a great environmental concern about disposing of prescription drugs by flushing them into the water supply.

Solution

Program Description

After learning about prescription-drug collection efforts in other Oregon communities and across the country, a drug turn-in program was created to serve the City of Portland.

Part I

Collect prescription medications during a one-day event. Collection is free and anonymous, and disposal is environmentally safe.

The Prescription Drug Turn-In Program was piloted in August 2009. The Crime Prevention Program at the Office of Neighborhood Involvement coordinated the event and partnered with the Portland Police Bureau (PPB) for legal handling and disposal of the prescription drugs. PPB’s mobile precinct was strategically placed in the parking lot of a popular shopping mall. The mobile precinct provided safe storage of the medication, as well as facilities for the event staff.

For six hours, Crime Prevention staff and PPB officers accepted the drop-off of unused and expired medications, including over-the-counter medications and pet medications. The event was anonymous, free to the community, and medications were safely disposed of through incineration after the event. Incentives in terms of gift cards or coupons were not provided, just free, safe medication disposal.

Part II

Although the prescription drug turn-in events were well attended, there was a need for regular disposal options. By 2011, pharmacies were still unable to take back medications. Following a nationwide trend, Crime Prevention and PPB invested in MedReturn drug-collection units for the precincts.

The MedReturn units, also known as drop boxes, were installed in the lobbies of four precincts for the purpose of collecting unused and expired medications. The boxes were accessible by the community year-round, during the lobby hours of each precinct house, and placed within view of the front-desk staff, per local Drug Enforcement Administration (DEA) requirements. Use of the first drop box was piloted at East Precinct. The response was overwhelming. The box was filled to capacity and needed to be emptied multiple times per week. A standard operating procedure (SOP) was drafted and used at each precinct when emptying a box full of prescription medications.

The drug drop boxes were decommissioned in 2016 due to a lack of staffing to manage the boxes. There was also misuse of the boxes, with people depositing inappropriate material such as needles and trash. Officers were also exposed to an unidentified powder when emptying a box. The drop boxes added a great service to the community, but they were not viewed as a permanent solution.

Effective October 9, 2014, regulations allowed for pharmacies to register with the DEA to take back medications. The Crime Prevention Program is seeking a pharmacy to which it could donate unused drug drop boxes.

Based On Research

Teens and Prescription Drugs: An Analysis of Recent Trends on the Emerging Drug Threat, Office of National Drug Control Policy, Executive Office of the President, February 2007

Funding

For the single-day event, costs included staffing for two Crime Prevention coordinators, a sergeant, two police officers and one precinct staff member. The medications were incinerated on schedule with other police evidence and any additional cost was minimal. The mobile precinct was used on loan with the understanding that it could be pulled for a priority situation.

The four MedReturn Units cost a total of $1,600. The cost of the MedReturn units was split between the Crime Prevention Program and PPB; the latter, through its maintenance department, absorbed the cost of installing the boxes. Officers emptied the box during their regular shifts and the boxes did not require extra hours worked. Drug disposal was included in the disposal costs of other police evidence.

Outcome

Program Impact

During the pilot event, more than 40 pounds of prescription medications were collected. This included more than 4,100 tablets of the most-abused medications at the time (codeine, oxycodone (OxyContin), Vicodin, lorazepam (Ativan), morphine, and fentanyl). The estimated street value of the drugs turned in was well above $102,000. A total of 120 people turned in medications at the pilot event.

Since 2009, the Crime Prevention Program has held 12 Prescription Drug Turn-In events throughout Portland. ONI continues to participate in DEA nationwide drug turn-in days. To preclude event staff handling the drugs, medication is no longer removed from its containers and is incinerated in the containers in which it was deposited. The Crime Prevention Program stopped tracking the amounts and types of medications turned in. The need for the disposal service was abundantly clear and people have continued to take advantage of it.

As a result of the program, the Crime Prevention Program formed a partnership with the High Intensity Drug Trafficking Areas Program. The office also designed a brochure for parents of teens to advise them about opioid abuse and its signs.

Critical Success Factors

• Publicity helped raise awareness and promote the events, including PPB press releases and public service announcements; neighborhood newsletters; the Crime Prevention website; local news coverage; speakers at neighborhood association and business association meetings; flyer distributed at area pharmacies and by the Oregon Association of Clean Water Agencies; promotion on Nextdoor.com, Facebook, and Twitter; participation in DEA Rx Drug Turn-In events; and a press conference with U.S. Senator Ron Wyden.

• Partnerships legitimized the event and helped with publicity, including DEA, Fred Meyer, Eastport Plaza, Mirabella Retirement Community, neighborhood clean-up days, and community document-shredding events.

• The event was based on best practices: Drawing on research and reaching out to other police agencies to learn about their programs and best practices were key.

• The events were also bolstered by sharing best practices with area police agencies, providing guidance on standard operating procedures for disposal, and offering advice.

Lessons Learned

• It was difficult to get local news stations to provide advance coverage of the events because of requests for exclusivity. Exclusive story rights could not be granted for a City of Portland–sponsored event. When the DEA started holding nationwide drug turn-in days, the promotion and media coverage became easier.

• Some retailers would not partner with PPB due to misconceptions about the events. They had negative reactions to the idea of police taking back prescription drugs in their parking lot.

• A number of people who have prescription medications to dispose of also have used sharps and needles. For staff safety, objects such as sharps, needles, and medical waste are not accepted at events. PPB hast been unable to identify any free disposal services for needles.

• Although pharmacies could legally register to take back medications on-site effective October 2014, to date very few in Oregon have registered.