The definition of population health, as we all think about it, refers to the health status and health outcomes within a group of people rather than considering the health of one person at a time. It often includes an emphasis on primary care, it’s data driven, involves physician leadership, and is focused on disease management. For those of us working in the industry of medications every day, I believe we need to think about this from an additional angle.

Lari Harding

The vantage point we need to look from should focus on the diversion and misuse of prescription medications, the growth of this problem, and the impact it has on population health. The pandemic has exacerbated this threat to our nation’s health, and we need to respond collectively as an industry.

The numbers ­demand attention

According to the National Institutes of Health, death rates related to alcohol have doubled from 1999 to 2017 to more than 70,000 annually. In fact, the pandemic was a catalyst for the “quarantini.” Alcohol sales in 2020 were at their highest levels in 18 years according to the International Wines and Spirits Record (IWSR). IWSR reported a 2% sales increase between 2019 and 2020 — the highest year-over-year increase since 2002.

Already part of the social fabric and an accepted behavior among adults prior to the pandemic, drinking alcohol became a coping tool for many in dealing with the spread of COVID-19 and all its residual effects. Unfortunately, this “coping” brought about negative impacts as well.

According to Express Scripts the number of prescriptions filled per week for antidepression, antianxiety and anti-insomnia medications increased 21% between February 16 and March 15, peaking the week ended March 15, when COVID-19 was declared a pandemic. Overall, there was a 15% jump in the number of people taking antidepressants from 2015 through 2019, and among teens (13 to 19 years old), the use of these medications rose a very significant 38%.

Anxiety among American teenagers is quickly and exponentially on the rise, and with it, a rise in anxiety medication abuse as access to these medications has become much more immediate with their increased presence in homes. Xanax (benzodiazepines) has become a recreational drug of choice among teens in the U.S., and deaths attached to this category of drug have increased by 500% since 2000. Xanax is often easy to access, renders immediate effects and is highly addictive.

In fact, 30% of teens report that they gained access to prescription drugs from a medicine cabinet at home. The National Institute on Drug Abuse (NIDA) trend report explains that “one in three students in 12th grade say that prescription opioids are easy to obtain. In the NIDA study, 70% of the teens said that they have multiple sources for drugs. When their source exists in their own home, easy access can be a gateway to addiction.”

The opioid epidemic spiked during the pandemic. Latest reporting from the Centers for Disease Control and Prevention cites 90,722 overdose deaths in the U.S. between November 2019 and November 2020.

There have been 600,000 deaths from COVID-19 in the United States. Think about our response. Every American was aware of the preventative measures that masks offer. The life sciences industry produced three vaccines and a new set of instructions and biology processes for vaccines in mRNA. Goals and incentives are active across the country to get more Americans vaccinated. We have all come together to solve this public health crisis.

The problems demand action

There is another public health crisis that needs this kind of focused and committed response and should be a part of our everyday thinking about population health. It is the need to have every American understand their role in the proper disposition of unused medicines that are in their homes. Unused medicines are medicines taken home by the patient but, for appropriate reasons, are not all consumed by the patient.

Unused anxiety medicines get in the hands of teenagers. Unused opioids get in the hands of family members. Unsecure, prolonged storage of unneeded medications is a key contributor to the improper use of medicines and the resulting addiction and death.

The longer-term health issue created by the unsafe disposition of unused medicines is the damage done to our water supply. The water we drink and rely on every day to maintain our health is also a source for unknown amounts of pharmaceutical waste. Some of this we cannot control, like how individuals metabolize the drugs and that some of it comes out in our waste. However, discarding drugs into toilets, the trash and landfills is something we can and should control.

Studies conducted by the United States Geological Survey over the last two decades found measurable amounts of medication in 80% of the water samples taken from streams across the country. This essentially means that nearly every water source is polluted, to some extent, with pharmaceutical waste. The long-term population health impact of this is still being studied.

A time line of progress

10 years ago, jurisdictions across the country began mandating the creation of drug take-back programs in their communities, with the costs of these programs to be underwritten by pharmaceutical manufacturers. This movement started in California, and now there are various drug take-back regulations in place in six states, with others moving in that direction.

Five years ago, Inmar began providing DEA-compliant, self-serve consumer drug take-back receptacles to our retail and hospital pharmacy clients. These were funded by the pharmacies as a service to their communities, and there are now more than 4,000 receptacles in place in pharmacies, hospitals and law enforcement locations throughout the country. Current plans call for a total of 6,000 receptacles to be in place by the end of next year.

Inmar keeps Google Maps updated with all active take-back locations — searchable with 25 different keywords. Inmar uses its social influencer network to blog about the importance of proper disposition and share receptacle locations with their followers. And, as part of Inmar’s service to take-back program partners, it offers comprehensive marketing assistance to help build awareness of consumer drug take-back and encourage program participation.

Two and a half years ago, when we were all present at NACDS Annual, the pharmaceutical manufacturers asked Inmar to help them with Extended Producer Responsibility as it pertains to pharmaceuticals. For pharma, the costs were growing significantly, as were the nuances in the regulations for each jurisdiction.

Today Inmar assists our pharmaceutical manufacturer clients with maintaining compliance with a host of disparate state regulations related to drug stewardship. This is a business solution, and Inmar is applying the same economies of scale and scope of capabilities that we bring to our other work in health care, the supply chain, and consumer engagement to drive better outcomes for all parties. More importantly, it is also a passion for our company. Inmar is committed to making the world a better place with its consumer drug take-back programs.

Tomorrow I want to be a part of an industrywide movement that addresses the problem of improper disposition of unused medicines with the same energy given to fighting COVID-19. All prescription revenue stakeholders should be involved, as no single segment within the industry should have to carry the burden alone. What’s more, this should be a voluntary initiative — led by our own industry experts — rather than one mandated by the government. Together, we can change the trajectory of prescription drug abuse and environmental damage through consumer education, greater and more equitable access to take-back receptacles, access to mail-back envelope kiosk locations, and collaboration.

We have all been impacted by this problem. We all know a friend or family member who has struggled. We can make a difference. As we virtually gather at NACDS Total Store Expo let’s challenge ourselves to do more for this vantage point on population health.

Lari Harding is vice president of client development at Inmar ­Intelligence.