Statement of purpose The accumulation of unused medications has sparked a prescription drug abuse epidemic in this country. In 2012 health care providers wrote 259 million prescriptions for painkillers; enough for every American adult to have a bottle of pills. 7 Unused, these medications have the potential for negative consequences; including harm to the environment, drug diversion and unintended poisonings, and wasted healthcare resources. Medication may accumulate as a result of a myriad of factors such as patient non-adherence, expiration dates that occur too soon to enable use of the entire quantity, over-purchase by the consumer, and over-prescribing.

Methods/Approach The Erie Country Department of Health (ECDH) purchased and placed twelve MedReturn Drug Collection Units at various law enforcement locations throughout Erie County between 2012 and 2014. After the units were placed, ECDH in collaboration with the LECOM School of Pharmacy audited the units a total of 33 times between August 2012 and September 2014. For medications that were returned and not identifiable through prescription labels, an electronic pill identifier was utilised. Prior to data collection, returned prescription bottles were de-identified, and after data collection, medications returned were placed in tamper-proof packaging, labelled and securely locked in evidence rooms.

Results Hydrocodone combinations had the highest average percent returned among drug classes per audit (31.68%). The difference in average percentage returned per audit between hydrocodone and other medications was statistically significant.

53,530 units of drugs of concern were returned between August 2012 until September 2014. The “non-control drugs of concern” which included skeletal muscle relaxants with the exception of carisoprodol, which is a Schedule IV medication, made up the highest percentage with 39%. While Schedule V medications made up only 2% of returned medications.

Conclusions The accumulation of unused medications is a large factor as to why prescription drug abuse is an epidemic. One approach to help minimise the abuse of prescription drugs is proper disposal of unused or expired medications. Multiple MedReturn Drug Collection Units placed throughout Erie County have been useful in removing tens of thousands of units of potentially addictive and deadly drugs from circulation. Erie’s medication return program has proven to be an important and successful public health initiative.

Significance and contribution to the field Hydrocodone is the most prescribed opioid with the highest rate of diversion and our results are consistent with this finding. Hydrocodone combination products have been rescheduled by the DEA from a CIII to a CII medication. Prescriber, dispenser education, and enhanced monitoring at the state level, helped address these concerns. Medicine cabinets of family and friends are a major source of access for abused prescription drugs. Between 8/12 and 9/14, Erie County’s MRU’s collected and removed over 50,000 units of drugs from local medicine cabinets. These collection efforts are supported by federal, state, and local agencies as an essential approach to minimising the abuse of prescription drugs.