The potential of prescription drug take backs

In the United States, October 24 represents National Prescription Drug Take Back Day. Twice a year, the US Drug Enforcement Agency (DEA) holds the event in order to allow the public to submit unwanted, unused, or expired medication for proper disposal. The idea behind this is to prevent misuse and abuse of medication, especially of prescription narcotics and controlled substances. اضافة اعلان

According to a 2012 study by the Jordan Anti-Narcotics Department (AND), it is believed that prescription sedatives and stimulants are the most commonly abused drug in Jordan. The possible implementation of a drug take back program might reduce abuse in Jordan, but first it is important to understand the severity of the issue.

Prescription drug abuse in Jordan

A 2010 study assessed the most frequently reported drugs sold without a prescription and labeled as “drugs of abuse/misuse by Jordanian pharmacists working in community pharmacies. Among commonly abused prescription medication, number one was sedative hypnotics, particularly benzodiazepines (BDZ), with 53.2 percent of pharmacists claiming them as the main drug of abuse.

Second were antibiotics at 28.8 percent, followed by anticholinergic/anti-Parkinson’s drugs (14 percent), and lastly misoprostol (7.1 percent). More interestingly is the gender divide among abusers for each drug. For BDZ and anticholinergic drugs, males were significantly more likely to abuse these drugs, whereas misoprostol is predominately abused by women. Antibiotics were abused in equal proportions by both genders. 

Another study in 2016 conducted a similar assessment and found similar results. BDZ (42.5 percent) was the most abused followed by antibiotics (26.9 percent), anti-Parkinson’s drugs (12.4 percent), and misoprostol (1.08 percent). The differences of abuse among genders was identical to that of the original study.

What are these drugs and why are they being abused?

Benzodiazepines are a class of sedative hypnotic agents that have been in clinical use since the 1960s. Pharmacologically, BDZs are indicated for sedation and to treat anxiety, seizures, withdrawal states, insomnia, and agitation. Common BDZs include lorazepam (brand name: Lorans, and Ativan), alprazolam (Xanax and Zolam), midazolam (Dormicum and Dormixal), and diazepam (Valium and Stesolid). In BDZ abuse, the reported pleasurable effects include lightheadedness, a loose grip on reality, a feeling of detachment, emotional numbness, and increased libido. 

Due to the sought after effects and its inherent addictive qualities, BDZ has a high risk of abuse. Withdrawal from BDZ can be difficult to endure as well. Symptoms include tremors, anxiety, perceptual disturbances (lack of awareness), dysphoria (unhappiness), psychosis (loss of reality), seizures, and autonomic instability (difficulty with involuntary processes).

Causes of antibiotic abuse are completely different than that of BDZs. Antibiotic abuse comes from ignorance and poor patient compliance. Antibiotics are used to treat only bacterial infections. Bacteria are micro-sized organisms that have the potential to enter our body and make us sick. Being sick alone is not an indication of having a bacterial infection. 

Within our lifetime, we are far more likely to be infected by viruses than we are by bacteria. Viral infections like the flu and common cold cannot be treated with antibiotics. Furthermore, most coughs and sore throats cannot be treated with antibiotics. Self-diagnosing between bacterial and viral infections is nearly impossible and even doctors — more often than not — cannot tell the difference just from a quick examination. 

Tests must be conducted in order to confirm and identify which bacteria is infecting your body. These tests are crucial because not every bacterium can be treated with the same antibiotic. Bacteria range in complexity and structure, and each antibiotic works in a specific manner to help your body fight off the infection. Poor patient compliance includes not completing a course of antibiotics due to a resolution of symptoms, taking left-over antibiotics the next time you feel sick, whether or not it is indicated, or simply getting antibiotics without a prescription.

Anticholinergic anti-Parkinson’s drugs are a group of drugs that can be used in the treatment of Parkinson’s. Anticholinergic drugs include trihexyphenidyl (Akisol), benztropine, biperiden, orphenadrine (found in myogesic), and procyclidine (Kemadrin). When abused, the effects are said to be mood altering and psychedelic and include a broad range of symptoms from mild euphoria and increased sociability to hallucinations and toxic psychosis. 

Misoprostol is a prescription prostaglandin originally used to reduce stomach acid and help protect the stomach and small intestine from ulcers caused by nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen. The main concern is the administration of this medication without a prescription. Accurate dosing and monitoring are important when taking misoprostol and may result in complications. 

Potentials of a drug take back

Starting in 2018, the US’s DEA held the Take Back Day every April and October. Each month, on average, the campaign collects 459 tonnes of medication including controlled and narcotic medication. A drug take back program would stand to benefit Jordan in its fight against medication abuse, especially for antibiotics. The benefits are not only in physically disposing but also in spreading awareness. 

The campaign is used to inform the public on the dangers of unused or expired prescription medication being a potential public safety issue, leading to potential accidental poisoning, misuse, and overdose. Furthermore, this campaign can be tailored to the Jordanian demographic and emphasize the importance of consulting a doctor and taking the extra steps for getting a prescription. Emphasis should also be placed on educating the public on the role of pharmacists and that they are not qualified to prescribe medication that is not over-the-counter and requires patients to provide prescriptions. 

How to dispose of medication at home

There are simple steps to dispose of medication safely in your own home. Firstly, remove the medication from its original container and mix it in with something like cat litter or coffee grounds. Next, place the mixture in a sealable bag, empty bag, or other container to prevent the medicine from leaking or breaking out the garbage. Additionally, rip, tear, or shred any personal information that may be on receipts or packaging and do not share any medication prescribed to you. If the original disposal method is difficult to do, medication can be flushed down the sink or toilet although this practice is not preferred as it may leave trace amounts in the surrounding environment.


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