EPISODE 141: INTERVIEW WITH ANGEL BIVENS, BS PHARM, MBA, CSPI FROM THE MARYLAND POISON CENTER ABOUT BEST PRACTICES FOR MEDICATION STORAGE AND DISPOSAL

Happy Poison Prevention Week! National Poison Prevention Week is March 20-26, 2022. Second-time guest Angel Bivens (Pharmacist and Certified Specialist in Poison Information) shares best practices for medication storage and disposal. Plus, the Maryland Poison Center is celebrating 50 years of service! Congrats! 🎉 What has changed between 1972 and 2022? Listen, and find out!

Listener discretion is advised. Some of the topics in this episode include children putting weird things in their mouths, applying patches, poisonings, injuries, and other sensitive topics. If you have small children or sensitive individuals listening with you today, please use your judgement. Some of the information in this episode is not intended for individuals who may be influenced by the topics we discuss today.

Thank you for listening to episode 141 of The Pharmacist’s Voice ® Podcast!

Angel is a pharmacist by training with experience in retail, hospital, home infusion, and mail order pharmacy, but her true passion is working at the Maryland Poison Center (MPC). She has been with the MPC for over 25 years, spending the first 8 years as a specialist in poison information managing poisoning and overdose cases from the public and healthcare professionals. She then spent the next 17 years in the role of public education coordinator, ensuring the more than 4 million Marylanders in the MPC service area know about their services and learn ways to keep their families safe from poison dangers in an around their home. Angel rose to her current role as assistant director, overseeing operations and public education in 2018. In this role she combines her love for educating the public with responsibilities that ensure there is always someone there to help with a poisoning or overdose 24/7/365.

Angel completed her BS in Pharmacy at Duquesne University (Pittsburgh PA) and her MBA at University of Baltimore (Baltimore MD). She also holds the designation of Certified Specialist in Poison Information (CSPI) after successfully completing the American Association of Poison Control Centers certification examination in 1990, 1998, 2005, 2012, and 2019.

Mentioned in this episode

☎️ Poison Help Line 1-800-222-1222 (Program this in your phone today, and share with others!)

LinkedIn for Angel Bivens https://www.linkedin.com/in/angelbivens/

The Pharmacist’s Voice Podcast Episode 87 featuring Angel Bivens (March 2021)

DEA Drug Take-Back events (spring and fall)

Maryland Poison Center website: www.mdpoison.com

To find your local poison center: www.aapcc.org

Resources for pharmacists and their patients:

Safe Storage: PROTECT Up and Away Campaign: www.upandaway.org

FDA: Disposal of Unused Medicines Includes link to “flush list”: https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know

FDA and EPA home medication disposal tips https://www.fda.gov/consumers/consumer-updates/where-and-how-dispose-unused-medicines

Poison Prevention Press: http://bit.ly/PoisonPrevPress
One-page, plain language e-newsletter published every other month on varying topics; all current and previous issues available

Poison Prevention Press sign up: http://bit.ly/MPCSignUp

eAntidote Blog: blog.mdpoison.com

Facebook: MarylandPoisonCenter

Twitter: @MDPoisonCtr

Instagram: @MDPoisonCenter

YouTube: Maryland Poison Center

Resources with clinical information for pharmacists:

ToxTidbits: http://bit.ly/ToxTidbits
One-page clinical e-newsletter published monthly on various toxicologic topics; all current and previous issues available

ToxTidbits sign up: http://bit.ly/TTBSignUp

Twitter: @MPCToxtidbits

To see MPC’s one-minute, time-lapse video of a button battery cooking a hot dog, click here.

Duquesne University

University of Baltimore

Subscribe to or Follow The Pharmacist’s Voice Podcast!

Highlights from the interview

👉 Medications need to be accessible, but storing medications up, away, and out of sight can help children, visitors, and other vulnerable individuals stay safe. This is also good advice for household cleaners. For more tips, visit https://upandaway.org.

👉 Store non-food items away from food items to avoid confusing products that look alike.

👉 Store non-food items in original containers. Do not use food containers for non-food items. Example: Cleaning products in soda bottles.

👉 Store medications in their original, labeled containers.

👉 Injuries from poison exposures can last a lifetime! Example: an exposure from an ingested liquid could burn the esophagus.

👉 Can child-resistant packaging make a difference? Child-resistant does not equal childproof. Although child-resistant packaging and cabinet latches are not guaranteed to prevent access completely, they can slow kids down. Having time to “catch someone in the act” can safe a life.

What should you lock up?

👉 Chemicals, paints, automotive products, and pesticides.

Button battery poisonings

👉 Button battery poisonings happen when a battery gets stuck in the esophagus. It may burn a hole in the esophagus. To see MPC’s one-minute, time-lapse video of a button battery cooking a hot dog, click here. It’s important to get to an emergency room with an X-ray machine right away (in less than 2 hours). Safe disposal of button batteries is important. Watch out for pets who eat trash!

👉 7-day pill organizers are not child-resistant, and identifying pills in each compartment can be confusing, especially when pill colors change due to manufacturer changes. However, pill organizers hold multiple medications and save time for those who have multiple bottles. From a poison center’s point of view, if someone gets a hold of a 7-day pill organizer, determining how many pills they took can be easy. Then, the threat to the child can be determined. 7 days of medicine is a finite number compared to a bottle, which may be partially filled and hold an unknown quantity.

👉 If more than one person in the home uses a 7-day pill organizer, get more than one color (so you can tell them apart).

👉 Blister packs contain a finite number of pills. Telling the Poison Help Line how many pills were taken can be simple.

👉 Store 7-day pill minders, blister packs, and other medications up and away and out of sight.

👉 Visitors to your home should be offered a safe place to store their medicine. On the flip side, when you visit someone, ask if there’s a safe place to store your medicine.

👉 Travel times and holidays provide good opportunities to have conversations about safe medication storage.

👉 Don’t store medicines in baggies. From a kid’s point of view, treats come in baggies. There are more appropriate containers available to hold small quantities of medicine.

👉 Don’t leave meds sitting on a countertop in a small dish. The wrong person could take the medication, a small child may find it, or a pet may eat it.

👉 Don’t use old bottles, which may be mislabeled or unlabeled. You may even accidentally take medicine that does not belong to you!

👉 As pharmacists, we need to counsel patients on safe storage and best practices for remembering to take their medications at the right time. Start a “safe storage initiative” in your pharmacy, reach out to patients, and offer tips. Have a conversation with your local Poison Center Educator to learn tips you can share with your patients.

👉 Don’t keep meds in a backpack or purse if you’re visiting a home with small kids or pets. Kids are nosy, and pets can find things.

Drug disposal and household products

👉 Dispose of household products according to local ordinances.

Best practices for disposing of medicine

Disposal boxes at police stations (usually available 24/7/365, No questions asked)
DEA Drug Take-Back events (spring and fall).
FDA Flush list (may be ok to flush). Ex: Opioids due to the risk of diversion.
Home disposal: FDA + FDA agree on this method: https://www.fda.gov/consumers/consumer-updates/where-and-how-dispose-unused-medicines
Double check with local ordinances or Poison Center Educators about other ways to safely dispose of medicines. ☎️ Call 1-800-222-1222.

👉 Poisons act fast! So do children! Dispose of patches carefully. Kids love stickers! The medicine in the patch is for an adult. It may not take long for a child to present with symptoms of drug exposure. Ex: nicotine or fentanyl patches.

👉 Remove prescription labels from bottles or cross out personal information with a Sharpe® marker.

👉 When a medication is discontinued by a prescriber, that’s a good time to dispose of a medication. Don’t keep it around “just in case,” which can lead to self-medicating and confusion.

👉 When talking to medication hoarders, be empathetic. They have a hard time throwing away something that cost money. Be sure to express concerns about product safety too.

🎉 Maryland Poison Center (MPC) is celebrating 50 years of service (1972-2022). Over the last 50 years, MPC is proud to have provided an excellent level of care and expert service.

🌟 What has changed over the last 50 years? Among other things, documentation and data collection methods, search tools (computers vs microfiche), the phone system, databases, references, and the number of cases managed per year (5,700 cases in 1972 vs >31,000 cases in 2021).

👉 Finding accurate information right away in a crisis is critical with potential poisonings. There are 55 poison centers in the US, and all 50 states have service from a poison center. Poison Centers are faster and friendlier than the internet, and have experts with accurate advice! ☎️ Pharmacists can help people help themselves by promoting the Poison Help Line phone number 1-800-222-1222.

💥 It’s ok for a pharmacist to call the Poison Help Line for their own child. I have called the Poison Help Line several times. In a crisis, I feel stressed. I need someone to talk me down, reassure me that everything’s going to be ok, and give me a plan to get help.

💊 Information is detailed and personalized for individual situations, not generalized for a broad (internet) audience. Poison Centers may check up/follow up after a call, and callers are welcome to call back.

How can pharmacists get involved with poisoning prevention education? Most poison centers can share brochures, stickers, magnets, etc. Use a landline, and call 1-800-222-1222 to connect with your local Poison Center Educator. They should have ideas for engaging your patients or audience and may provide materials to help you. Having a relationship with the educator will be helpful for future efforts too. The educator will help you even if you just want materials at your store to hand out to promote the poison center services and the Poison Help Line, which will help you keep your patients safe.

Below is a picture of me volunteering in my younger son’s 5th grade elementary school class. 10-year-olds are smart and make a great audience for poison prevention messages. They can keep themselves and younger siblings/family members safe. It took a team to make this talk happen:

1. A school willing to allow speakers like me to visit the school.
2. Teachers who believe in the value of prevention education.
3. Injury prevention organizations like Safe Kids Worldwide and American Association of Poison Control Centers (AAPCC) to support and educate me about the messages that need to be shared.
4. Children, parents, caregivers, and communities who are willing to listen, learn, and take action!