[Pharmwaste] FW: Regarding flushing of pharmaceuticals in households...

Thu, 21 Jul 2005 08:13:13 -0700

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A key point to keep in mind is that, at least in California and =
presumably in Minnesota, we want to get pharmaceuticals out of sewers =
NOW.  We want to take action that will let us do that in the most =
cost-effective and timely manner possible.  We CANNOT wait until we have =
solved all problems regarding waste assessment, patient compliance, =
pharmacoeconomic policy projections, sources of payment, counterfeit =
medication, etc. We can not wait until a national pharmaceutical =
take-back program has been set up. We can not wait until some fancy =
device is invented that cleverly destroys controlled substances.  We =
need to move forward, let me say it again, NOW, to get pharmaceuticals =
out of sewers. People moving forward with these efforts should not be =
critized for imperfect efforts; they are actually taking action rather =
than remaining paralyzed because they can't come up with the perfect =
solution.  And, FWIW, I disagree that incinerating waste pharmaceuticals =
is automatically better than landfilling them. Waste pharmaceuticals are =
often left in their plastic containers, and incinerating plastics makes =
dioxin.  Incinerators "leak" via air emissions, maybe not of the =
original substance but of other toxics.=20
=20
Ann Heil
LACSD
=20
=20

-----Original Message-----
From: pharmwaste-admin@lists.dep.state.fl.us =
[mailto:pharmwaste-admin@lists.dep.state.fl.us]On Behalf Of Stevan =
Gressitt
Sent: Wednesday, July 20, 2005 6:52 PM
To: 'Tenace, Laurie'; pharmwaste@lists.dep.state.fl.us
Subject: RE: [Pharmwaste] FW: Regarding flushing of pharmaceuticals in =
households...

This process would ensure that no assessment of waste, patient =
compliance, pharmacoeconomic policy projections, or sources of payment =
for potential for identification of unidentified counterfeit medication =
would occur. Quite successfully. No ability to determine whether one =
drug of a class has a lower compliance or patient dissatisfaction rate =
than another, and no ability to use non-compliance to address side =
effects or public health educational campaigns. From Hush and Flush, the =
process will become Hush and Hide.=20

=20

This will take the entire unused medication issue and hide it. What is =
needed is a godd assessment of policies that ever urge greater access, =
greater price control and work toward more profligate prescribing =
regardless of use rates. With 60% of the population non-compliant with =
medications now, we will hide that and continue the process. Smarter =
prescribing, less waste at the front ned should be the goal and that =
will entail using numbers to educate prescribers, insurance companies, =
and perhaps manufacturers. Certainly policies as currently followed have =
led us to this situation where the problem exists, but hiding it will =
not solve it and frankly will contribute to the old policies continuing =
to churn out more and more waste.

=20

Do I have an answer for all the problems, no, but setting in motion a =
public education campaign that starts a process of sweeping the problem =
into the landfill which may or may not leak today tomorrow or the next =
is not one I would think has universal support. I continue to hear =
incineration as the preferred method for pharmaceutical destruction, =
diversion control, or simple inactivation of ingredients.=20

=20

If 60% of patient can't follow the instruction such as "Take one a day" =
accurately, I also fear that the steps involved will simply not be met =
by the majority of the public. Or that is how I read the evidence.

=20

Once a public has the attached message in their "daily exposure" then =
when a better system or systems, which I do believe is ahead of us, is =
found the whole educational process will need to start up again and  =
redirect a public starting down one path. It is not a process that =
engenders trust as the medical community can vouch for given the history =
of say Thalidomide, or more recently Vioxx.

=20

Just some thoughts.

=20

Stevan Gressitt, M.D.

 =20

=20

  _____ =20

From: pharmwaste-admin@lists.dep.state.fl.us =
[mailto:pharmwaste-admin@lists.dep.state.fl.us] On Behalf Of Tenace, =
Laurie
Sent: Monday, July 18, 2005 9:10 AM
To: pharmwaste@lists.dep.state.fl.us
Subject: [Pharmwaste] FW: Regarding flushing of pharmaceuticals in =
households...

=20

=20

Minnesota is always on top of things -=20

=20

  _____ =20

From: pharmwaste-owner@lists.dep.state.fl.us =
[mailto:pharmwaste-owner@lists.dep.state.fl.us] On Behalf Of Walter, =
Rebecca
Sent: Friday, July 15, 2005 4:48 PM
To: pharmwaste-owner@lists.dep.state.fl.us
Subject: Regarding flushing of pharmaceuticals in households...

=20

Here is a flyer that the Office of Environmental Assistance (OEA) in =
Minnesota developed to educate citizens how to dispose of their unwanted =
pharmaceuticals.  The OEA is currently working on printing copies to =
distribute state wide.=20

http://www.moea.state.mn.us/hhw/pharmaceuticals.cfm=20

Rebecca Walter, PCS=20
Minnesota Pollution Control Agency=20
(651) 296-3552=20

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<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN =
class=3D000410115-21072005>A key=20
point to keep in mind is that, at least in California and presumably in=20
Minnesota, we want to get pharmaceuticals out of sewers NOW.&nbsp; We =
want to=20
take action that will let us do that in the most cost-effective and =
timely=20
manner possible.&nbsp; We&nbsp;CANNOT wait until we have solved all =
problems=20
regarding waste assessment, patient compliance, pharmacoeconomic policy=20
projections, sources of payment, counterfeit medication, etc. We can not =
wait=20
until a national pharmaceutical take-back program has been set up. We =
can not=20
wait until some fancy device is invented that cleverly destroys =
controlled=20
substances.&nbsp; We need to move forward, let me say it again, NOW, to =
get=20
pharmaceuticals out of sewers.&nbsp;People moving forward with these =
efforts=20
should not be critized for imperfect efforts; they are actually taking =
action=20
rather than remaining paralyzed because they can't come up with the =
perfect=20
solution.&nbsp; And, FWIW, I disagree that incinerating waste =
pharmaceuticals is=20
automatically better than landfilling them. Waste pharmaceuticals are =
often left=20
in their plastic containers, and incinerating plastics makes =
dioxin.&nbsp;=20
Incinerators "leak" via air emissions, maybe not of the original =
substance but=20
of other toxics. </SPAN></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D000410115-21072005></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN =
class=3D000410115-21072005>Ann=20
Heil</SPAN></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D000410115-21072005>LACSD</SPAN></FONT></DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D000410115-21072005></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT face=3DArial color=3D#0000ff size=3D2><SPAN=20
class=3D000410115-21072005></SPAN></FONT>&nbsp;</DIV>
<BLOCKQUOTE dir=3Dltr style=3D"MARGIN-RIGHT: 0px">
  <DIV class=3DOutlookMessageHeader dir=3Dltr align=3Dleft><FONT =
face=3DTahoma=20
  size=3D2>-----Original Message-----<BR><B>From:</B>=20
  pharmwaste-admin@lists.dep.state.fl.us=20
  [mailto:pharmwaste-admin@lists.dep.state.fl.us]<B>On Behalf Of =
</B>Stevan=20
  Gressitt<BR><B>Sent:</B> Wednesday, July 20, 2005 6:52 =
PM<BR><B>To:</B>=20
  'Tenace, Laurie'; pharmwaste@lists.dep.state.fl.us<BR><B>Subject:</B> =
RE:=20
  [Pharmwaste] FW: Regarding flushing of pharmaceuticals in=20
  households...<BR><BR></FONT></DIV>
  <DIV class=3DSection1>
  <P class=3DMsoNormal><FONT face=3DArial color=3Dnavy size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">This =
process would=20
  ensure that no assessment of waste, patient compliance, =
pharmacoeconomic=20
  policy projections, or sources of payment for potential for =
identification of=20
  unidentified counterfeit medication would occur. Quite successfully. =
No=20
  ability to determine whether one drug of a class has a lower =
compliance or=20
  patient dissatisfaction rate than another, and no ability to use=20
  non-compliance to address side effects or public health educational =
campaigns.=20
  From Hush and Flush, the process will become Hush and Hide.=20
  <o:p></o:p></SPAN></FONT></P>
  <P class=3DMsoNormal><FONT face=3DArial color=3Dnavy size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial"><o:p>&nbsp;</o:p></SPAN></FONT></P>
  <P class=3DMsoNormal><FONT face=3DArial color=3Dnavy size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">This will =
take the=20
  entire unused medication issue and hide it. What is needed is a godd=20
  assessment of policies that ever urge greater access, greater price =
control=20
  and work toward more profligate prescribing regardless of use rates. =
With 60%=20
  of the population non-compliant with medications now, we will hide =
that and=20
  continue the process. Smarter prescribing, less waste at the front ned =
should=20
  be the goal and that will entail using numbers to educate prescribers, =

insurance companies, and perhaps manufacturers. Certainly policies as=20
 currently followed have led us to this situation where the problem =
exists, but=20
 hiding it will not solve it and frankly will contribute to the old =
policies=20
 continuing to churn out more and more =
waste.<o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial"><o:p>&nbsp;</o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Do I have =
an answer=20
 for all the problems, no, but setting in motion a public education =
campaign=20
 that starts a process of sweeping the problem into the landfill which =
may or=20
 may not leak today tomorrow or the next is not one I would think has =
universal=20
 support. I continue to hear incineration as the preferred method for=20
 pharmaceutical destruction, diversion control, or simple inactivation =
of=20
 ingredients. <o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial"><o:p>&nbsp;</o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">If 60% of =
patient=20
 can&#8217;t follow the instruction such as &#8220;Take one a =
day&#8221; accurately, I also fear=20
 that the steps involved will simply not be met by the majority of the =
public.=20
 Or that is how I read the evidence.<o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial"><o:p>&nbsp;</o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Once a =
public has the=20
 attached message in their &#8220;daily exposure&#8221; then when a =
better system or=20
 systems, which I do believe is ahead of us, is found the whole =
educational=20
 process will need to start up again and &nbsp;redirect a public =
starting down=20
 one path. It is not a process that engenders trust as the medical =
community=20
 can vouch for given the history of say Thalidomide, or more recently=20
 Vioxx.<o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial"><o:p>&nbsp;</o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Just some=20
 thoughts.<o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial"><o:p>&nbsp;</o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Stevan =
Gressitt,=20
 M.D.<o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial">&nbsp;&nbsp;<o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial"><o:p>&nbsp;</o:p>
 <DIV>
 <DIV class=3DMsoNormal style=3D"TEXT-ALIGN: center" =
align=3Dcenter><FONT=20
 face=3D"Times New Roman" size=3D3>
 <HR tabIndex=3D-1 align=3Dcenter width=3D"100%" SIZE=3D2>
 </DIV>
 <SPAN=20
 style=3D"FONT-WEIGHT: bold; FONT-SIZE: 10pt; FONT-FAMILY: =
Tahoma">From:<FONT=20
 face=3DTahoma size=3D2>=20
 pharmwaste-admin@lists.dep.state.fl.us=20
 [mailto:pharmwaste-admin@lists.dep.state.fl.us] <SPAN=20
 style=3D"FONT-WEIGHT: bold">On Behalf Of Tenace, =
Laurie <SPAN=20
 style=3D"FONT-WEIGHT: bold">Sent: Monday, July 18, 2005 =
9:10=20
 AM To:=20
 pharmwaste@lists.dep.state.fl.us <SPAN=20
 style=3D"FONT-WEIGHT: bold">Subject: [Pharmwaste] FW: =
Regarding=20
 flushing of pharmaceuticals in=20
households...<o:p></o:p></DIV>
 <SPAN=20
 style=3D"FONT-SIZE: 12pt"><o:p>&nbsp;</o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial">&nbsp;<o:p></o:p>
 <DIV>
 <st1:State w:st=3D"on"><st1:place =
w:st=3D"on"><SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: =
Arial">Minnesota</st1:place></st1:State><FONT=20
 face=3DArial color=3Dnavy size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> is always =
on top of=20
 things -<SPAN=20
 style=3D"COLOR: navy">&nbsp;<o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: =
navy">&nbsp;<o:p></o:p></DIV>
 <DIV>
 <DIV class=3DMsoNormal style=3D"TEXT-ALIGN: center" =
align=3Dcenter><FONT=20
 face=3D"Times New Roman" size=3D3>
 <HR tabIndex=3D-1 align=3Dcenter width=3D"100%" SIZE=3D3>
 </DIV>
 <SPAN=20
 style=3D"FONT-WEIGHT: bold; FONT-SIZE: 10pt; FONT-FAMILY: =
Tahoma">From:<FONT=20
 face=3DTahoma size=3D2>=20
 pharmwaste-owner@lists.dep.state.fl.us=20
 [mailto:pharmwaste-owner@lists.dep.state.fl.us] <SPAN=20
 style=3D"FONT-WEIGHT: bold">On Behalf Of Walter, =
Rebecca <SPAN=20
 style=3D"FONT-WEIGHT: bold">Sent: Friday, July 15, 2005 =
4:48=20
 PM To:=20
 pharmwaste-owner@lists.dep.state.fl.us <SPAN=20
 style=3D"FONT-WEIGHT: bold">Subject: Regarding flushing of=20
 pharmaceuticals in households...<o:p></o:p></DIV>
 <SPAN=20
 style=3D"FONT-SIZE: 12pt">&nbsp;<o:p></o:p>
 Here is a=20
 flyer that the Office of Environmental Assistance (OEA) in <st1:State=20
 w:st=3D"on"><st1:place w:st=3D"on">Minnesota</st1:place></st1:State> =
developed to=20
 educate citizens how to dispose of their unwanted =
pharmaceuticals.&nbsp; The=20
 OEA is currently working on printing copies to distribute state wide.=20
 <o:p></o:p>
 <A=20
 =
href=3D"http://www.moea.state.mn.us/hhw/pharmaceuticals.cfm">http://www.m=
oea.state.mn.us/hhw/pharmaceuticals.cfm</A>=20
 <o:p></o:p>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Arial">Rebecca Walter, =
PCS=20
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Arial">Minnesota Pollution =
Control=20
 Agency <SPAN=20
 style=3D"FONT-SIZE: 10pt; FONT-FAMILY: Arial">(651) 296-3552=20
 <o:p></o:p></DIV></BLOCKQUOTE></BODY></HTML>

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