Multnomah County Commissioners want lawmakers to pass a bill requiring drug manufacturers to provide free and safe disposal for unused medications. And if lawmakers don’t, the Commissioners said during a hearing Thursday, they’ll work to create a take-back program of their own.
The Oregon Legislature is conducting hearings on House Bill 3273, which would direct manufacturers of prescription drugs sold in the state to develop, implement and fund a drug take-back program that the Oregon Department of Environmental Quality would oversee.
“I hope the Legislature acts on the House bill this session and implements this policy statewide,” Commissioner Sharon Meieran said Thursday during a County Board briefing on safe drug disposal. “But I want us to be poised to act if the Legislature fails.”
In 2018, Oregonians filled more than 41 million prescriptions through pharmacies and by mail, including millions for opioid medications. When those prescriptions go unused, they create a risk of accidental poisoning and drug misuse.
Public Health Director Rachael Banks on Thursday pointed to data from the Centers for Disease Control and Prevention that shows emergency departments log 60,000 visits by children younger than 5 who have accidentally overdosed on medication. In 90 percent of those cases, the children consumed those drugs while a caregiver wasn’t looking.
And when three-fourths of heroin users report having started with prescription opioids, Banks said, “drug take-back is one prong to tackle opioid addiction and overdose deaths.”
Multnomah County launched a pilot program in 2016 to take back unused medications from clients at its downtown Portland pharmacy. The program expanded last year to three additional pharmacies, but it remains accessible only to County clients. The program has collected nearly 500 pounds of drugs at a cost of just $8,586 — a significant value for a public agency operating on a tight budget.
“We have not advertised the service,” said Adrienne Daniels, deputy director of Integrated Clinical Services. “It’s a good thing to do, but the one concern is that if there were much more demand, we couldn’t support it.”
Ritchie Longoria, director of Lab and Pharmacy Services for Multnomah County, told the Board on Thursday that the project sought to ease concerns about drug abuse, considering two-thirds of teens report having abused prescription drugs in their home. There is also a risk when patients hold on to medications and take them later for an unrelated health concern. When those medications are antibiotics, that can lead to antibiotic resistance.
Without acceptable opportunities to dispose of unused drugs, people often flush or simply discard the drugs, which raises concerns over environmental contamination. The Portland Water Bureau tests for trace drugs in the water and reports the local drinking water supply is safe. But trace amounts of prescription drugs have been found in Oregon waterways.
Five states and 23 local governments have passed what are called “product stewardship” laws to force drug manufacturers to provide free and safe disposal options for consumers. In Oregon, Washington County is considering a product stewardship ordinance this spring. The movement began in 2012, when the Alameda County Board of Supervisors in California passed an ordinance requiring pharmaceutical companies to pay for and operate a drug take-back program.
Industry trade groups took Alameda County to court, but lost first in federal district court, then at the 9th Circuit Court of Appeals and finally, in 2015, when the U.S. Supreme Court declined to hear the case.
One of those trade groups, the Pharmaceutical Research and Manufacturers of America, is lobbying Oregon legislators against the pending take-back Bill.
Eric Lohnes, senior director of state policy for the trade group, told the House Committee on Health during a March 21 hearing that the industry opposes the concept of an industry-funded statewide disposal program, citing a lack of research that such programs reduce trace pharmaceutical waste in waterways.
Instead, Lohnes said, the industry recommends communities go to the web sites of the FDA and industry groups to learn methods of in-home disposal such as crushing pills and mixing the powder with cat litter.
Rep. Teresa Alonso León, D-Woodburn, scoffed at the industry’s recommendation.
“You’re assuming everyone has internet. You’re assuming everyone can read and write English. You’re making a lot of assumptions,” she said during the hearing. “To me, that’s disturbing. That’s not you being part of the conversation. That’s you making excuses.”
Multnomah County Commissioners said Thursday they want state officials to include syringes — or sharps — in any take-back law. And commissioners said the County would consider its own ordinance if necessary.
“We hear a lot of concern around sharps,” said Commissioner Susheela Jayapal. “In the state legislation, is there a possibility of preemption?”
Jeston Black, director of government relations for the County, said the industry has pushed for an amendment that would preempt local governments from passing regulations stricter than the state law. But, he said, “I don’t think they'll get what they want.”
The County has led the state toward stronger clean air, nutrition and tobacco regulations by stepping forward first with local laws. Multnomah County would be joining Washington County if it passed its own product stewardship ordinance, said Chair Deborah Kafoury.
“Once again, Multnomah County is sending the message to the State that, ‘If you’re not going to do it, we will do it here,’” she said Thursday. “And eventually you’re going to have to do it.”