HOWELL - Abby Boxman lost her mother in 2008, due to bad health brought on by years of opioid abuse.

Then came Boxman’s son.

After using opioids recreationally, 21-year-old Justin Boxman died of a heroin overdose in 2011.

Abby Boxman didn’t just grieve.

The Howell woman launched a website at justinthebox.org that educates the public on how to dispose of surplus medications properly. Her son may have taken opioids from her and her mother's homes, Boxman said.

Before her son's death, Boxman knew nothing about disposal. Local drug take-back programs were just getting underway.

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Now, a shift has emerged in those take-back efforts. A movement is gaining momentum across the country to have pharmaceutical companies pick up the tab for the programs, seen as a key to closing off an on-ramp to addiction and abuse.

Boxman sees wisdom in it.

“Someone has to be accountable for what’s going on,” Boxman said. “There isn’t ever accountability, there’s just blame."

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Advocates see the pharmaceutical industry — largely responsible for filling the nation's medicine cabinets —  as best suited to keep leftover drugs from getting in the wrong hands.

But Big Pharma has resisted efforts to close the supply loop — notwithstanding the toll that opioid abuse has taken on the nation, claiming more than 33,000 lives in 2015 alone.

Footing the bill

Since 2010, semiannual drug take-back events sponsored by the Drug Enforcement Administration have emptied more than 9 million pounds of unused pharmaceuticals from medicine cabinets.

The collection and incineration of unused medication around the country has also kept drugs out of landfills and from being flushed down the toilet, leading to downstream environmental harm.

Up until recently, taxpayers by and large footed the bill for such collections. Now, the pharmaceutical industry is starting to pay for those programs.

Fourteen counties, two cities and two states have passed laws mandating that the drug makers pay for collection and disposal.

“We think the manufacturers who are making big bucks have a role to play,” said Vivian Fuhrman, senior associate for policies and programs at the Product Stewardship Institute in Boston.

New Jersey has yet to follow. But the trend has already moved to the region.

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Massachusetts and Vermont drafted laws last year requiring pharmaceutical companies to pay for the programs. Rockland County, in the northern suburbs of New York City, adopted a measure in April, making it the first East Coast county to join the trend.

Tires and paint

Such product stewardship is a concept that goes beyond drugs. It places the responsibility for the end of life of products mostly on manufacturers.

That strategy of environmental management is why fewer old tires turn up on the side of the road or alleys.

The rationale behind making the manufacturers pay for drug take-backs has several prongs. The most obvious one is the heroin epidemic.

Some 80 percent of heroin users started on prescription drugs, illicitly or after being prescribed. While the death rate from drug overdoses soared, the opioid makers reaped billions. One company, Purdue Pharma, the maker of Oxycontin, made $2.4 billion on opioids in 2015 alone.

Product stewardship adds a measure of responsibility to the equation.

And it’s not just about opioids.

Pharmaceuticals thrown into the toilet or down the drain pose other health problems.

Amy Goldsmith, state director of Clean Water Action New Jersey, which has an office in Long Branch, said sewage treatment plants dealing with toilet waste cannot remove contaminants like prescription or over-the-counter drugs.

They get recycled back into drinking water with other pollutants. That could potentially harm people with compromised immune systems. 

There are 94 substances that are regulated in New Jersey to keep them out of drinking water and tens of thousands, such as pharmaceuticals, that are not, she said.

“Any opportunity to keep substances out of (the water), we should take,” Goldsmith said.

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Tom Fote, a disabled Vietnam War veteran who serves on the Atlantic States Marine Fisheries Commission, said he’s observed the decline of fishing populations over the last 15 or more years.

It is at least partly tied to pharmaceuticals making their way into the water, especially endocrine disrupters, such as birth control medication, he said. Much of it is from excretion.

Studies, for instance, show a far greater percentage of female fish to male fish below sewerage outflow pipes worldwide, said Fote, also the legislative chairman for the Jersey Coast Anglers Association.

“We’re seeing more females and more infertile males and more males trying to produce eggs,” he said.

In the past 10 years, researchers have discovered more feminized male fish in bodies of water around the world. Pharmaceuticals, particularly those that alter hormones, are suspected as the cause.

 

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While any drug take back program will help, the pharmaceutical industry is set up to do a better job than government, Furhman said. 

“They have expertise in resource distribution,” she said. “They tend to be more efficient and they have a million resources at their disposal.”

They can cut across geographical borders, where as local efforts are slow to form into a network or share costs, she said.

Existing product stewardship programs are too new to see how they’ve performed, she said.

But they typically bring more drop-off boxes to more people while existing law-enforcement-based take-back programs remain intact.

One estimate of unused medicines in the U.S. sets the number at 3 percent to 7 percent of drug dispensed. The total spent on pharmaceuticals in the United States in 2016 was $425 billion. So, at the low end of the estimate, $12 billion worth of medicine in the U.S. is sitting in medicine cabinets, getting flushed or getting thrown out.

California first

Alameda County in California, home to Oakland, became the first place in the country in 2012 to adopt an ordinance requiring pharmaceutical companies to pick up the cost of take-backs.

The industry, through trade groups like Pharmaceutical Researchers and Manufacturers of America (PHRMA), sued the county to stop the effort. It attempted to take the case all the way to the U.S. Supreme Court, which refused to hear the case.

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An estimate that surfaced in the court case — determined by the government — set the annual cost of collection and disposal at about $330,000. The industry countered with a $1.2 million approximation.

A lower court judge found both figures to be minimal in light of the fact that drug makers sold about $965 million in drugs in Alameda County.

Following the law suit, individual pharmaceutical companies operating in Alameda County set up a stewardship organization, the Pharmaceutical Product Stewardship Work Group, which administers the program. It figures the breakdown of cost for each manufacturer, based on detailed industry data.

That organization has so far installed 20 kiosks in pharmacies around the county, said Bill Pollock, who manages Alameda County’s household hazardous waste program. The goal is 100 pharmacy kiosks, he said.

Boxes of the dropped-off drugs are periodically shipped to Indiana and then onward to an incinerator in Ohio, he said. Although Pollock said he has no idea how much the industry spends on the program, but figured the shipping costs of more than 1,000 60-pound boxes of drugs a year could add up.

Pollock, who was involved in the new take-back measure, used a rough estimate that other advocates rely on: a penny a pill.

His household hazardous waste sites take in about 4 million pounds of televisions, hazardous materials, and other debris a year. It costs county taxpayers nearly $4 million a year to run it. Making manufacturers pick up the tab would shift much of that burden, ultimately back to consumers, Pollock said.

Asked if the trade group still objected to being compelled to take-back programs, spokeswoman Caitlin Carroll would not respond directly.

She touts another method for disposing of leftover drugs: putting drugs into a sealable plastic bag, mixing them with water and then cat litter, coffee or sawdust, and then throwing the bag in the garbage. She calls that “an important step" in the process.

The industry has been pushing that idea through a web site, MyOldMeds.com.

The web site includes an endorsement: “…we support community-driven drug disposal programs when they are run and managed by local law enforcement.”

Furhman, from the Product Stewardship Institute, said drug makers would pass the cost of take-backs on to consumers.

Carroll said that’s up to the individual company.

Local efficiency

Ocean County has been aggressive in pursuing drug-take back programs.

The Ocean County Prosecutor’s Office recently sent out 150 letters to senior citizen communities stressing that people should dispose of unused drugs during spring cleaning. Temporary drop-off bins were set up in some of them.

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Nineteen police departments in Ocean County have drop-off boxes. The are available 24 hours a day.

Police officers from those departments transport the drugs to the Prosecutor’s Office when they are there on other business, Ocean County Prosecutor Joseph Coronato said.

Occasionally, two workers  in his office will make pickups and dispose of the collected drugs, sometimes with the help of interns, he said.

 

Over the past two years, the program has collected 23,000 pounds of drugs.

“You want to be effective with minimal cost,” Coronato said.

But Coronato, who gained knowledge of product stewardship early in his career as a state deputy attorney general who went after chemical companies illegally dumping toxins, agrees that having the pharmaceutical industry pick up the cost is a better choice.

“It’s all about accountability,” he said.

Boxman sees urgency in the new legislative trend.

"We’re losing so many kids," she said. "When is somebody going to take responsibility for what’s going on?”