On the Lonely Drop Box’s website, eight red dots mark where Southwest Virginia residents can find pharmacies with permanent drug drop-off boxes.
Those dots — along with 17 blue dots representing law enforcement agencies with drop-off sites — are surrounded by gray markers showing pharmacies that don’t collect unwanted or expired prescription medication. Out of 217 pharmacies in a 26 county area, only eight offer a permanent box where customers can safely get rid of medicine, according to the project’s website.
That’s a statistic the project is hoping to change. The Lonely Drop Box project is part of the Urgent Love Initiative, a strategy started by The Prevention Council of Roanoke County that aims to tackle the opioid epidemic and drug addiction more broadly.
In January, the Lonely Drop Box project started sending out postcards to the largest chain pharmacies in the area: Kroger, CVS, Walgreens and Walmart, urging them to install drop boxes. The idea was to flood CEO offices with 4,000 total postcards, each bearing the Lonely Drop Box — a cartoon mascot meant to remind executives of the only drug drop box provided through a chain store, which is at a Walgreens in Roanoke.
The group also began conducting research on which locations already provide drop boxes. Besides that Walgreens, they found one other drop box provided through a franchise pharmacy and six provided by independent pharmacies.
“We contacted every pharmacy in our area, which was not a small feat,” Urgent Love Initiative strategist Walt Boyle said.
The project’s goal is to give more residents the opportunity to drop off expired medication at the same place where they pick up new prescriptions. That gets unwanted medication out of people’s cabinets and out of reach of anyone who might want to use those drugs for recreational purposes, Boyle said.
“Holding on to them creates its own problems,” Boyle said. “Children, contractors, relatives, housekeepers get into these stashes and pick up a few pills and they can slowly drain away magically.”
Since 2010, the U.S. Drug Enforcement Administration has hosted national drug take back days in communities across the nation as a method of fighting prescription drug abuse. Every six months, residents can take their unused or unwanted medication to a designated location — usually a law enforcement agency — so it can be incinerated. On Oct. 14, 2017, the DEA collected 912,305 pounds of medication from 5,321 collection sites through the program, according to the department’s website. Nearly three tons of that were collected in the 26- county area that the Lonely Drop Box project is focusing on, Boyle said.
After the DEA’s program was introduced, some law enforcement agencies created permanent drop-off sites. In the Roanoke, Roanoke County and Salem area, there’s just two such sites: one at the Roanoke County Sheriff’s Office and one recently installed at the Vinton Police Department.
Roanoke County Sheriff’s Office Deputy Chad Beheler, who works as the department’s Community Outreach Coordinator, said a deputy empties 60-70 pounds out of the department’s drop box about every two weeks. Sometimes, if he sends a reminder about the drop box’s availability through social media, the box fills up in a single day.
But the presence of drop boxes in a few law enforcement agencies is not enough, Boyle said. With only 17 departments participating, residents in some counties like Craig, Amherst and Appomattox either have to wait for the next take-back day or just not donate the medication at all.
Boyle argues that the companies selling the drugs should do more to make sure they don’t fall into the wrong hands.
“Is it the responsibility of tax payers or law enforcement or the non-profit community to be working so hard to take these medications back?” he said.
The group’s idea has merit, according to Jeffrey Gray, an associate professor with East Tennessee State University’s Bill Gatton College of Pharmacy. He co-authored a 2015 study published in the American Journal of Public Health that analyzed eight permanent drug drop box locations in Northeast Tennessee over the course of two years. The results: 4,841 pounds of pharmaceutical waste, almost 240 pounds of which were controlled substances. While that accounts for less than 5 percent of the collected materials, it adds up to 106,464 dosages. Hydrocodone, tramadol and oxycodone were the top three controlled substances collected, according to the study.
Gray said there’s “no question” that drug drop boxes serve as a good method for removing medications that can be abused from communities.
“I’m an advocate for patient options. The more options that patients have, the better, and the less likely that the medications will be used non-medically,” Gray said.
When Gray first began studying the drop off sites in 2009, collection of unwanted medication was limited to sporadically held law enforcement events. Now, Gray said, communities have more disposal options. Using a five-year National Institutes of Health grant, he and other researchers have continued their work. He said the group has discovered that the period between when a patient receives the medication and when they donate it has decreased during the time that the drop boxes have been in place. Researchers have also discovered that very few people are willing to go more than 10 miles to get to drop-off site.
“How far are you willing to travel to a pharmacy to pick up a medication?” Gray said. “It would make sense that they’re willing to donate it at an equal distance.”
Many people living in the Lonely Drop Box project’s 26-county focus area already have to travel a long distance before reaching a pharmacy, much less a drop off site, according to the data the group has collected. In Grayson County, two independent pharmacies are clustered near Independence, Virginia. The next closest pharmacy is near Galax, about 16 miles away. The group’s map also shows few pharmacies in Carroll, Floyd and Craig counties.
That lack of access is demonstrative of larger trends in Appalachia. According to a 2012 study prepared for the Appalachian Regional Commission, Appalachian counties have higher health care costs on average, as well as more coverage and access disparities, than other U.S. counties.
So far, Gray said the independent pharmacies in his research area seemed most receptive to the idea of installing drop boxes.
“They’re able to see the need in their community, and they don’t have to go through red tape and corporate policy to make those steps,” he said.
Boyle said the Lonely Drop Box project has also had more success engaging with independents. The group is currently working on ways to guide independents through the process of acquiring a drop off box.
But Boyle still hopes to convince chain pharmacies to “do the right thing” and join the fight as well.
“We’ve been in touch with some of the folks inside a couple of the companies, but it has turned out to be more of a PR conversation,” he said. “This is a marathon, not a sprint for them. For us, it needs to be a sprint. There needs to be a sense of urgency.”