Mary Leigh Meyer: Howdy everybody! Welcome to Sounds Like Health. This is Mary Leigh Meyer
Sam Craft: And I’m her trustworthy cohost, Sam Craft.
Mary Leigh Meyer: And we are here with another trustworthy person, Dr. Eric Grayson. He’s a clinical assistant professor of pharmacy practice at the Texas A&M Irma Lerma Rangel College of Pharmacy. And we are going to talk today about proper medication storage and safety. Medication’s supposed to keep us safe, but if we don’t keep it safe, then it can’t do its job.
Sam Craft: Keep us safe.
Mary Leigh Meyer: Keep us safe?
Sam Craft: Yes, that’s its job, to keep us safe.
Mary Leigh Meyer: Yes. Yes. Okay. So, Dr. Grayson, what are some basic storage and safety tips?
Eric Grayson: Well, generally when I think of storage and safety, I think of three big kind of domains of topic: That’s security, safety, integrity and then disposal. So would you like me to start off with security?
Mary Leigh Meyer: Sure. What does that mean in terms of medication?
Eric Grayson: Well, most of the medications that we deal with and are prescribed to us are actually pretty potent items. And so, security to try to keep it out of the wrong hands, like little children or older people who maybe don’t have the best of judgment, maybe have Alzheimer’s, that sort of thing. So proper security becomes important because these medications can be quite potent. And so, keeping them in kind of a secure place that we can feel comfortable that they’re not readily accessible, by especially children. I think is probably the person that’s taking the medications, it’s their responsibility to make sure of security. But you’ve also got to think about visitors and strangers in the home, because a lot of times we have other people in the home that have friends that come over. The last thing you need is them picking through and finding medications, and people tend to be overly curious sometimes.
Mary Leigh Meyer: You think kind of keeping it on the top shelf versus the bottom shelf? Or what are some everyday…
Sam Craft: Yeah. It’s like in your medicine cabinet, so I always think of you just go in your bathroom, and it’s just right there. That’s where I keep my most of my drugs. It’s just out of habit.
Eric Grayson: Yeah, I think higher up, any place that you feel like younger children who really don’t understand the seriousness of it don’t have access to the prescription drugs.
Mary Leigh Meyer: Okay.
Eric Grayson: One last point I think I would make is are prescription containers. When we’ve used them, there’s a lot of personal information on those containers. And so what I try to do, in the world of identity theft and scam artists, that sort of thing, is to encourage people to either scratch off or tear off the name from the label before the old, wasted bottles go into the trash.
Mary Leigh Meyer: Oh yeah. My mom used to do that. We used to recycle our prescription bottles, and she would always make us scratch it off.
Eric Grayson: I think that’s a good idea, I really do.
Mary Leigh Meyer: Okay. So what else did you … So that was security, medication security and safety.
Eric Grayson: Well, let’s focus in on safety for just a second then. I would encourage everybody to store their medications in the original containers that they came in whenever possible. A small supply in like a weekly organizer, that sort of thing is okay, as long as it’s kept in a safe place. But for the bulk of the medication storage, it needs to be in the original container. Some medications don’t react well to plastic. Others … And those would typically require glass containers. Others have to be without cotton, otherwise the drug will migrate into the cotton, and it will be less potent. So original containers is probably the best idea. And then not having them or moving them to odd containers without the label. Otherwise, you end up with containers of mystery pills that nobody really knows what’s in there.
Sam Craft: Mystery pills, sounds terrifying.
Eric Grayson: It is terrifying, especially if you’re an EMS person responding to an overdose.
Sam Craft: Oh, that’s true.
Eric Grayson: They took a whole bottle of these and there’s no label on it.
Sam Craft: Yeah, and they have no idea what it is.
Eric Grayson: It’s very troubling.
Sam Craft: So, thinking about traveling, I’m really bad about throwing medications in a bag, whether it be prescription or something I bought at the store. It’s just some … whatever. It’s just, “I might need this. I might get a cold. I might get…”
Mary Leigh Meyer: Mm-hmm. You have a little baggie of just in case.
Sam Craft: Yeah. And I think it’s scary to me to think about it. We don’t think about just throwing some pills in a bottle that you know exactly what those are. But then what if you’re going through customs or you’re going through airport security and they stop and say, “Hey, what are these pills?”
Eric Grayson: Exactly.
Sam Craft: Yeah. So then, now you’re talking about a security issue with somebody else, not just you.
Eric Grayson: I’ll tell you what I do, is I saved back some containers, old containers, and then just put a small supply in those older containers, especially if I just got a small supply from the pharmacy in the smaller bottles, but still labeled correctly. I save those back and then use those for travel is what I do.
Mary Leigh Meyer: Oh, that’s a good idea, because you don’t want to bring your whole supply in case your bag gets lost or…
Eric Grayson: Exactly. The smaller supply probably goes in a carry-on, would be the best practice on that.
Mary Leigh Meyer: And even if you … Yeah, and a carry-on’s a good point because if you check your bag, you don’t know how long it’s been sitting out waiting to get loaded onto the plane. You can’t control where it is.
Eric Grayson: That’s true, and bags do get lost. Carry-ons seldom get lost.
Sam Craft: So, what about keeping medication in your car? I know I will sometimes on a road trip, I’ll throw some in my glove box or whatever, just some headache medicine, whatever, just in case. I’ve heard that hot temperatures can really effect drugs. Is that true to that?
Eric Grayson: Absolutely. Most medications have fairly narrow ranges within which they can stay chemically stable. And so in Arizona, right on top of the dash of the car, it can become 190 degrees. There’s not a lot of chemical compounds that’ll stay stable at that kind of temperature, especially medications.
Mary Leigh Meyer: So, what happens if it doesn’t stay stable? Does that make it…
Sam Craft: Yeah, stable’s a scary word.
Eric Grayson: Different things can happen. Mostly, most of the time it’ll just lose potency. The drugs will change into something that’s more inert or possibly not as active, which means you can take the medication and nothing’s going to happen. That’s a bad thing because you’re taking the medication for a reason, correct? And so you want them to work for their intended purpose, and so heat can destroy that.
There’s also a couple of medications that we won’t get into too much today, but there’s a couple of them that will actually turn into something more toxic. I’ll give you one example. Tetracycline products can turn into a compound that can damage the kidneys and cause something called Fanconi syndrome. There are consequences to storing medications inappropriately as far as temperature, humidity, too much moisture, that sort of thing, and then letting them become degraded into something else.
Mary Leigh Meyer: Does that apply to bathrooms? Everyone has their medicine cabinet in their bathroom. Is that bad because all the moisture?
Sam Craft: It’s steamy and all that kind of stuff.
Mary Leigh Meyer: And even heat.
Eric Grayson: Exactly. That’s not the best place to keep your medicine because what to do typically is just avoid heat, moisture, humidity and, believe it or not, even light, especially UV light can break down medications. And so the bathroom is probably the wrong place to put medications.
Sam Craft: It’s just always think about your bathroom, like your medicine cabinet.
Eric Grayson: Cool and dry is typically the best storage advice.
Mary Leigh Meyer: So maybe not even in the kitchen, unless it’s far away from the oven or the range.
Eric Grayson: Yeah, I’ve seen people store them over the oven and over the range, and there’s a lot of heat there, maybe not a lot of moisture … Well, come to think of it, you can boil water on there, so heat and moisture would definitely be a problem, even over the range. Now, if you’ve got a cool spot in the kitchen, that’s fine, as long as it’s out of reach and not within the reach of children. As long as it’s cool and dry, that’s fine.
Mary Leigh Meyer: I feel like I’ve been doing everything wrong.
Sam Craft: You have, all the time, Mary Leigh.
Mary Leigh Meyer: What about those medications that need to be refrigerated? I’m thinking, what if you need to take it with you?
Eric Grayson: Coolers generally work, ice packs, such as blue ice, that can hold the temperature. Most refrigerated items can take excursions to close to room temperature without much harm, as long as it doesn’t happen on a regular basis. The problem though is if it goes higher than proper storage temperature, then the expiration date will be shortened. And the difficulty is we really don’t know how much shorter the expiration date would be. The cooler, the better. And the fewer excursions out of the refrigerator, the better.
Mary Leigh Meyer: And if you think you’ve exposed your medications to high heat and if you go back to your pharmacist, are they likely to replace it? How would that work with insurance?
Eric Grayson: Typically, the pharmacist would probably call your benefits manager on your insurance plan, explain to them what happened. And they almost always will agree to go ahead and, provided you’ve got the container that was exposed to the heat, that you can turn that in because that would be harmful. Turn that in, and get a fresh supply from the pharmacy, typically. I can’t speak for every insurance system, but I’ve never called a benefits manager that didn’t understand the problem and authorize a re-refill. Now, sometimes that requires another copay. That depends on the benefits manager.
Sam Craft: Are there any drugs that are not affected from the heat? And I say that because my work with the Opioid Task Force. We talk a lot about Naloxone and where they store it and how they keep it in cars. And the cops, that’s one of law enforcement‘s big hang-ups was like, “How do we store this in our cars because we’re always in our cars. Is the heat going to degrade the potency of this drug?”
Eric Grayson: Most of the opioid and opioid receptor active drugs are actually chemically pretty stable. It would take someone that’s got a little bit of experience with medications and structural properties to be able to make that kind of determination.
Sam Craft: Oh, like fully. Okay. What what you said is fine. I was just curious. That was always one of their big points, in talking with that train of thought. Just knowing that it can make some unstable, the response that our pharmacists had was, Joy Alonzo, she said it wouldn’t matter to her, do it anyway because it’s not going to hurt them regardless. I was just curious if you can do anything…
Mary Leigh Meyer: And that’s life and death at that point.
Sam Craft: Yeah. I mean, it’s not going to hurt them, so why not just go ahead and give it to them?
Eric Grayson: Right. And none of those products are the type of products that will degrade into something harmful.
Sam Craft: Okay. Maybe that’s a better way of putting it, towards the end there.
Eric Grayson: But to be honest with you, they are chemically pretty stable. My expectation is that the expiration date might be affected somewhat, but probably not too much.
Mary Leigh Meyer: What comes to mind for me is, what about things like inhalers? If people bring them to the sports field, they throw them on the sidelines during practice. Are inhalers or different types of, I don’t want to use the phrase physical medicine because all medicine is physical, but tools like medication tools, are they impacted by temperatures also?
Eric Grayson: That’s honestly pretty difficult to answer, for instance, inhalers. Inhalers come as both liquid and powder. The powder inhalers probably will be affected less, and I would say those excursions into the heat probably aren’t going to be too problematic, as long as it’s used within a reasonable period of time and you’re not using the same inhaler for two years, something like that, it’s probably all right. If it’s the liquid inhalers, over time will probably degrade pretty quickly, especially some of the bronchodilators. So I’m thinking those probably need to be used within a month or two for those to be good.
Mary Leigh Meyer: And if they degrade, that means that they’re not as potent, you said?
Eric Grayson: Correct.
Mary Leigh Meyer: Let’s talk a little bit about your third point, integrity.
Eric Grayson: Correct. Potency is definitely something that can be effected because of storage. In fact, that’s probably one of the big … One of the biggest things that I think we probably need to be aware of is the integrity of the medication, whether it be tablets crumbling or whatever. Temperature and proper storage, and especially moisture, those are enemies to medications lasting their full shelf life.
Sam Craft: Dr. Grayson, talking about disposal, I know probably eight to nine years ago I saw … I was at a police station, and I actually saw a bin where you could come down and bring your expired medications or your … anything that was empty, you could return it to this bin and dispose of it safely. Is there a safe way to dispose of your medication like that, that’s readily available? I know a lot of people just throw it down the drain or throw it in the trashcan.
Mary Leigh Meyer: I heard it gets into the water.
Sam Craft: I can imagine.
Eric Grayson: I think we’ve got to be careful about what we dump into our water system, especially when it comes to antibiotics or hormones. Those things can have quite an impact on our environment. Disposal down the toilet is probably not my favorite way to dispose of things. What you saw at the police department is what I would call a drug take-back program. Those programs are actually quite the public service because you really don’t have to worry about de-identifying the containers, scratching your name off, because those are all shredded and taken care of appropriately.
The problem is there’s so few of those around. So what I would recommend is going to the FDA website, which is www.fda.gov. And go to that website and do a search on drug take-back, and you will find a list of those places. And if you live in a place that has one close by, by all means, avail yourself of that because it’s much more convenient. If you’re not in one of those places, and the vast majority of us in Texas aren’t close to a drug take-back program, then generally what you want to do is dispose of the medications in something that’s rather unpalatable. By way of example, I mean used coffee grounds in a container, and then throw it in. Throw all the stuff that you want to get rid of in there, and mix it all up. Make it undesirable and difficult to recover those medications. And then you just throw it into regular trash.
Mary Leigh Meyer: So, you crush up the pills and mix it with another…
Eric Grayson: Actually, crushing it up is what you don’t want to do. Just throw everything in whole, even capsules. Leave them all whole, mix it all up, and then throw it into regular trash. Some medications crushed up can volatilize into a powder and then breathing those may not be the best thing for you.
Mary Leigh Meyer: Oh goodness. Okay. I’m doing everything wrong with this one. And what about syringes or needles, how do you dispose of those?
Eric Grayson: There are containers that you can get that are FDA approved for what we call medical sharps, needles, lancets, auto-injectors, that sort of thing. But really there’s no need to spend a lot of money on those. You can pull out hard, heavily constructed plastic containers. Giving an example, would be like a tub that a detergent comes in. It’s got a fairly wide mouth. Drop everything in there, seal it up, and throw that into regular trash.
Mary Leigh Meyer: Okay. To kind of protect it from piercing the bag or-
Eric Grayson: Exactly. That’s what we’re trying to avoid with sharps, is needles poking through. I’ve seen some terrible gashes from people picking up a bag of trash, and then a needle come out, and then the bag swings against somebody’s leg … I’ve seen some terrible injuries because of that.
Mary Leigh Meyer: Oh no.
Sam Craft: That sounds terrifying.
Eric Grayson: It can be, yes.
Sam Craft: And then we’re having to worry about what was on said needle.
Mary Leigh Meyer: Mm-hmm. Okay listeners, if you’ve taken anything away, put your needles in the empty laundry detergent box.
Sam Craft: Safe disposal, yes.
Eric Grayson: There is a circumstance when you would want to flush things down the toilet. There are some medications that are so toxic to humans and pets and children, and the drugs on that list probably should be disposed of through the toilet, and dilution is probably not an issue with these drugs. It will dilute them and not cause too much of an environmental concern. Most of those medications are opiates and sedatives. And if you’re interested or if you have any of those medications you need to destroy, again, the FDA website’s very easy to use. You just go on and put in there Flush List or Medication Flush List, and it’ll take you right to the page that says which medications are considered to be those things that need to be basically flushed immediately, as soon as you determine that there’s no longer a need for them. The list isn’t very long, and it’s mostly opiates and sedatives. Everything else, the ground coffee. Kitty litter is my favorite; nobody wants to mess with anything in kitty litter, even dirt. Soil will work just fine, but basically dilute it with something that’s kind of unpalatable and people don’t want to mess with.
Mary Leigh Meyer: Well, you’re not wrong about the kitty litter.
Sam Craft: I hate emptying the cat litter box. I hate it. Every Wednesday, I do it. It’s awful.
Mary Leigh Meyer: I think that’s all the time we have. We need to start to wrap up. Is there anything else you think, Dr. Grayson, we should…
Eric Grayson: Yeah. I would like to kind of leave you with … Anytime we’re talking about medication safety, we want to talk about Poison Control Center. I’ve used it twice in the last six months. I guess maybe my life is a little more exposed to medications and people taking more than they should, but I think it’s a good number everybody should probably have in their cell phone. So that’s 1-800-222-1222. We feel like that is so important we make our students memorize that number, and we actually put it on exams.
Mary Leigh Meyer: And is that for the state of Texas?
Eric Grayson: Yes, it is. Any place in the state of Texas. I think the final home of the toxicologist is probably in San Antonio, if I’m not mistaken, but there’s poison control centers in El Paso and Galveston, several locations in the state. And if something needs to be escalated to the toxicologist, they are available to them.
Mary Leigh Meyer: Okay. And in an acute emergency, 9-1-1 would do the trick, correct?
Eric Grayson: Absolutely. Absolutely.
Mary Leigh Meyer: And if it’s one of those questions about, “I don’t know. Did I take too much?”
Eric Grayson: Call anyway.
Mary Leigh Meyer: Well, thank you for your time, Dr. Grayson. We all learned a lot. I learned exactly to stop doing exactly what I’ve been doing.
Sam Craft: All your life.
Mary Leigh Meyer: … all my life. Well, thank you for your time.
Eric Grayson: Mary Leigh, it’s been a pleasure. Thank you for inviting me.
Mary Leigh Meyer: Oh, of course, of course. And thank you all for listening. This has been another episode of Sounds Like Health.