Washington’s program to collect medication so it doesn’t end up in the wrong hands has brought in over 1 million pounds of drugs since 2020, according to a state audit.

But it’s still beset with some challenges, like a lack of sites to return unused pills in rural areas, a limited sense of the program’s effectiveness and the recent withdrawal of one of the two companies collecting the drugs in the state, according to the report from Washington’s Joint Legislative Audit and Review Committee released this month.

Under this program, drug manufacturers pay companies to collect unused medication, including prescription and over-the-counter drugs, for incineration free of charge to patients. Those two companies have been MED-Project and Inmar, but the latter pulled out at the end of June. 

The state Department of Health collects fees from MED-Project, and previously Inmar, to oversee the program. Inmar’s absence means fewer sites for members of the public to bring in medication and less funding for state oversight. 

The company decided to bow out of Washington “after evaluating the long-term sustainability of the program and determining that the current model was not viable going forward,” said Brian Nightengale, the president of the company’s healthcare division.

Inmar also stopped doing this work in other states, according to auditors. 

Seven counties had similar programs before the statewide version launched six years ago. The goals are to avoid medication misuse, and stop the unused or expired drugs from polluting waterways.

The report comes as the state inches closer to sunsetting the program in 2029, a date the Legislature could extend.

Washington now has more than 400 drug collection sites with secure dropboxes to return unused medication. The number has gone down significantly in recent years with the closures of numerous Bartell Drugs and Rite Aid locations. 

Not everywhere in Washington has these kiosks. Over 100 cities and towns don’t meet requirements to have one per 50,000 residents, according to data from February. These are mostly small towns with just a few thousand residents or less. For example, in places with under 1,000 people, 91% don’t meet the kiosk requirement. In Seattle, on the other hand, there are more than 40 kiosks.

The average driving time from the city center to the nearest kiosk in places that have them is five minutes, according to the audit. But it’s 25 minutes in many of these small communities.

Only Washington’s two smallest counties, Columbia and Garfield counties, don’t have any drop-off sites. All counties have a mail option to allow residents to send medication directly to a disposal site with prepaid envelopes. Almost all of the drugs have been returned via kiosk. This is common across states with similar programs, said Carly Bartz-Overman, who runs the office in the Department of Health that oversees this initiative.

State lawmakers suggested increasing mail medication returns to get more drugs collected.

“With so many of our communities facing pharmacy deserts,” said Rep. Gerry Pollet, D-Seattle, “it seems like the likelihood of improving performance from kiosks is pretty low compared to the potential for improving performance through mailers.”

Bartz-Overman said she was also surprised the mail isn’t used more often to return pills but doesn’t believe people will start using that option more.

State law requires some smaller communities to have a dropbox even if there isn’t an eligible site for one. Federal law only allows them in places like pharmacies, hospitals and police stations, but eligible sites don’t have to participate under state law.

“Overall, the current program requirements may not be achievable,” Sydney Romero, a research analyst with the committee, said in a hearing on the audit last week. She noted similar programs elsewhere have less restrictive mandates.

Washington’s requirement makes it hard for state officials to provide oversight, as they don’t have a way to recognize progress toward complying with an unreachable benchmark, according to the audit.

It’s also been difficult for the Department of Health to measure the program’s efficiency and cost effectiveness, and the lack of data makes it harder to know what to prioritize.

No data is collected on which types of drugs are collected.

To assess the program’s success, the Legislature required three separate evaluations, but all are incomplete, according to auditors.

The audit recommends the Legislature continue the program past 2029 with changes to address these challenges.

“We look forward to working with the Legislature and operator on determining what measures and goals the department should put in place to ensure the program continues to serve Washington residents,” Bartz-Overman said.

Earlier this year, auditors recommended lawmakers amend how the program is funded, because otherwise, health officials warn, the program may not have the money to support its two full-time staffers. Almost every year, expenditures have surpassed revenue. The Department of Health has needed to use other money and an infusion from the Legislature to close that gap, according to the audit.

But last fiscal year, the program’s revenue was $533,000 from the operators. The Department of Health spent $405,000. Estimated revenue this year is expected to be under $300,000 with Inmar’s departure.

Bartz-Overman said she hopes the state will revamp the fee structure to “keep our program whole.”