[Pharmwaste] FW: Version 3 N3D Postcard

Stevan Gressitt gressitt@uninets.net
Fri, 24 Jun 2005 23:30:24 -0400


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  _____  

From: Stevan Gressitt [mailto:gressitt@uninets.net] 
Sent: Friday, June 24, 2005 6:43 PM
To: 'Hill, Penny'; 'Ann Heil (E-mail)'; 'Barbara Sharatz (E-mail)'; 'Brian
Fung (E-mail)'; 'Jane Tran (E-mail)'; 'Jeff Stone (E-mail)'; 'Jennifer
Cabral (E-mail)'; 'Jennifer Greenlief (E-mail)'; 'Kevin H. Kondru (E-mail)';
'Lisa Young (E-mail)'; 'Loudmilla Vertanessian (E-mail)'; 'Mac McLaughlin
(E-mail)'; 'Mahin Talebi (E-mail)'; 'Mark Kawamoto (E-mail)'; 'Mary Misemer
(E-mail)'; 'Michael Simpson (E-mail)'; 'Nira Yamachika (E-mail)'; 'Nora
Varner (E-mail)'; 'Olga Krel (E-mail)'; 'Pascal Roubineau (E-mail)'; 'Rich
Berman (E-mail)'; 'Ron Pilorin (E-mail)'; 'Steve Gray (E-mail)'; 'Steve Kubo
(E-mail)'; 'Terry Musil (E-mail)'; 'Tim Dafeta (E-mail)'; 'Tim Grogan
(E-mail)'
Cc: 'Christian Daughton (E-mail)'; 'Eileen Sheehan (E-mail)'; 'John Katz
(E-mail)'; 'Luisa Valiela (E-mail)'
Subject: RE: Version 3 N3D Postcard

 

Penny, and list recipients, 

 

Safe disposal of unwanted medications has been discussed widely in Maine,
and elsewhere in the U.S. It is now an option only in limited areas of the
country, but one that has the potential for diversion and significant
bio-environmental impact, as well as dangers at home.  The following
postulates, based on current legal and safety constraints, are only for your
cautionary consideration.

 

1. Sanitation and Hazardous Materials centers operated by cities and
counties, at the moment, are not sufficiently equipped to safely and collect
expired or unused medications.  Some are qualified only by exception if they
are operated under the auspices of law enforcement, such as the Drug
Enforcement Agency. Expansion of this coverage is under discussion now. 

 

2. Classification of medications as hazardous materials may not only confuse
the average citizen, it may require special handling and documentation, such
as an MSDS. Additionally, most people seldom distinguish, and are unable to
distinguish,  controlled substances from non-controlled, when they are
trying to get rid of unwanted medications. Though labeling of prescriptions
has some standardization it is currently under further review with
standardized patient information packages ( that we are trying to get to
contain disposal instructions along the lines that Charlotte Smith wrote
about years ago to USP.) Your proposed flyer instructs that no controlled
substances are allowed, but your website
(http://www.lacsd.org/HHW/HHWFLIER.ht) did not mention this in the Household
Hazardous Waste Program.  Is your facility certified to handle such items as
narcotics and other federally controlled pharmaceuticals?

 

3. Based on discussion with environment experts, typical landfills do not
meet "inactivation" expectations regarding safe disposal of most
medications, especially antineoplastics and psychotropic drugs.
Radionuclides are generally not dispensed for any home use but procedures
for the unforeseen are prudent. Some chemically active ingredients in
medications, such as hormone replacement drugs and antibiotics, remain
active in the environment. They are as likely to potentiate each other in
the environment as they are in human use.  The latter is causing grave
concern for introduction of multiple-drug-resistant bacteria.  These
chemicals eventually seep into the water that may end up at the faucets.   

 

4. The potential for drugs diversion at collection sites is quite serious
and can invite unanticipated problems to any well-intended community
program. Diversion has already occurred and even in police custody there has
been diversion. Without proper supervision and authority, unscrupulous
collectors may, and likely shall, clandestinely sort out controlled drugs
and use (abuse) or sell them on the streets.  Such programs inadvertently
may create an opportune scheme for a channel for illegal drugs trafficking
and trade.

 

We commend you on your successful Household Hazardous Waster Program and
this campaign to remove unwanted medications from the home.  We also are
aware that every prescription drug that is not used appropriately for its
intended therapeutic purpose means wasted healthcare dollars.  We are
sensitive to the fact that unused and expired medications translate into
likely adverse events, including harm to a patient through non-adherence to
a prescription and unintentional overdose or interaction.  Children and
elderly, of course, are prone to accidental poisoning.  

 

My colleagues and I are particularly concerned about all these issues and
working diligently to build a coalition and national strategies to address
them.  While we focus on the current situation, we are most interested in
ways to prevent the problem in the first place.  For instance, the
over-abundance of unwanted medications at home is one indication of
over-prescription by doctors.  Through education and better policies, we may
be able to stem this practice.  Non-compliance rates of 30-60% are not
unheard of and this rate of failure has significant health-care system
ramifications as well as volume considerations for all of our efforts.

 

We are racing to create a national registry for unwanted medications, so we
can study the magnitude of this problem and characterize the types and
quantity of household medications that are unused or expired. In draft form
it is now available at www.communityofcompetence.com
<http://www.communityofcompetence.com/>  at "Registries." The registry will
be used to help set monitored and safe systems to collect and dispose of
these medications. Informally it has already collected as much as we know
about and invite further contributions so that what we all are trying to
accomplish can have the numbers with which we all can approach the relevant
authorities or funding sources. An international registry of programs is
being compiled currently along with their mechanisms and contact personnel.
Shortly it is hoped a listing of the unusable donations at Banda Aceh will
also be available to help focus attention on this problem. 

 

Sending medications to dumpsters or landfills without assessing what they
are only add to the growing crisis of environmental contamination.  We all
will miss the opportunity to learn about what medications are unused, and
why.  Several Canadian studies have looked into this very same problem, and
there is one US data set publicly available at
www.noemaine.org/benzo/benzo.htm in the 2004 Conference report. This was
released so that reporting might become standardized and that this common
data set in the public domain could be used to develop different reporting
formats for consideration by us all.  From one important study in Sudbury,
Ontario, health and public officials have made great strides in reducing
unwanted drugs by lowering the initial size (number of pills or amount) of a
prescription, monitoring for adherence, and calculating the pharmacoeconomic
projections on cost savings of various prescription policies. US studies
exist but we have not found any with the necessary detail of the Sudbury
study.

 

I realize unwanted medications and the disposal of them are a major problem
for your community.  It should be a concern for all communities, locally and
internationally. With prudence, determination, and collaboration, we
together shall find a solution.  Again, I commend you for your effort and
for drawing attention to this problem. However, I encourage you to exercise
caution with your Household Hazardous Waste Program, particularly dealing
with unwanted medications.  I am more than glad to discuss this further.
Regarding your flyer, I am happy to refer you to those who have expertise in
risk communication and health promotion. There is a public health component
as well as a waste reduction component.  

 

Stevan Gressitt, M.D.

207-441-0291

www.noemaine.org/benzo/benzo.htm 

 

 

  _____  

From: Hill, Penny [mailto:PHill@lacsd.org] 
Sent: Tuesday, June 21, 2005 12:44 PM
To: Ann Heil (E-mail); Barbara Sharatz (E-mail); Brian Fung (E-mail); Jane
Tran (E-mail); Jeff Stone (E-mail); Jennifer Cabral (E-mail); Jennifer
Greenlief (E-mail); Kevin H. Kondru (E-mail); Lisa Young (E-mail); Loudmilla
Vertanessian (E-mail); Mac McLaughlin (E-mail); Mahin Talebi (E-mail); Mark
Kawamoto (E-mail); Mary Misemer (E-mail); Michael Simpson (E-mail); Nira
Yamachika (E-mail); Nora Varner (E-mail); Olga Krel (E-mail); Pascal
Roubineau (E-mail); Rich Berman (E-mail); Ron Pilorin (E-mail); Steve Gray
(E-mail); Steve Kubo (E-mail); Terry Musil (E-mail); Tim Dafeta (E-mail);
Tim Grogan (E-mail)
Cc: Christian Daughton (E-mail); Eileen Sheehan (E-mail); John Katz
(E-mail); Luisa Valiela (E-mail); Stevan Gressitt (E-mail)
Subject: Version 3 N3D Postcard

 

Hello all,

Attached is a new (third) version of the "No Drugs Down the Drain" postcard.
After opening it go to "View" then "Fit Page".

 

We received different views on various aspects of the previous two versions
of the card.  These were not ignored but rather, were evaluated based on all
comments received.  So, to clarify the card's evolution, I would like to
take some time to explain why we did certain things and not others. 

*	 Remember that you are viewing a pdf file which is easy for you to
download but it does not have the resolution of the file that will go to the
printer.  The colors in the final printed card will be more vibrant and the
images (including text) will be much sharper. 
*	The card will be 4" x 6" and, as such, is size-constrained with
respect to how much information it can contain (and effectively convey).
Keep in mind that there will be an associated web site with more detailed
information and links.  The card recipient also has the avenue of asking the
pharmacist for further information.  
*	There were some suggestions to use line drawings on the card.  We
discussed this but felt that photographs are more professional looking and
striking. 
*	We have been trying  to use a visual that is eye catching and
thought provoking (thus, the fish in the gas mask in the first version) with
a contemporary feel (this is somewhat hard to do with a toilet).  After the
fish, there were suggestions that the graphics should be more literal and it
appears that we got a little too literal in the second version with the
shoes standing in front of the toilet!  In this version we use a toilet
picture that is engaging both because it's an active picture of disposal but
especially because of the disapproving looks on the children's faces.  
*	We played around with putting the text in other colors (e.g. "NO
DRUGS DOWN THE DRAIN" in red) but the result is that the card starts to look
garish. 
*	There were concerns regarding the potential for the card to be
interpreted as referring to illegal drugs  because of the title "No Drugs
Down the Drain".  Please put the card in context when viewing it: it will be
stapled on a bag containing your prescription that you are picking up from a
pharmacist in a pharmacy or drug store (e.g. Sav-On Drugs, Thrifty Drug
Store, etc.).  Therefore, we think that the illegal drug connection is
unlikely.  We tried a test run with several of our Public Information staff
and stapled it on a mock prescription bag while pretending to be a
pharmacist.  There was no confusion in their minds regarding what drugs the
card was referring to.  Also, the text on the card refers to "unused
medications" and "unused prescription and over-the-counter medications".
Therefore, we stayed with "No Drugs ...' rather than "No Medications..."
because it is much more dynamic and forceful (i.e. catchy). 
*	I didn't mention it previously but the card will be a two sided,
bilingual card.

Please send feedback to me by July 5 at the latest.  Thanks so much for your
participation.

Penny

 

 

 

 

Penny Hill
Recycling Coordinator
L.A. County Sanitation Districts 
1955 Workman Mill Road 
P.O. Box 4998 
Whittier, CA  90607 
(562) 699-7411 (voice) x1781 
(562) 699-6358 (fax) 
phill@lacsd.org 

 


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style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>

<div>

<div class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><font =
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face=3D"Times New Roman"><span style=3D'font-size:12.0pt'>

<hr size=3D2 width=3D"100%" align=3Dcenter tabindex=3D-1>

</span></font></div>

<p class=3DMsoNormal><b><font size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'> =
Stevan Gressitt
[mailto:gressitt@uninets.net] <br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> Friday, June 24, =
2005 6:43
PM<br>
<b><span style=3D'font-weight:bold'>To:</span></b> 'Hill, Penny'; 'Ann =
Heil
(E-mail)'; 'Barbara Sharatz (E-mail)'; 'Brian Fung (E-mail)'; 'Jane Tran
(E-mail)'; 'Jeff Stone (E-mail)'; 'Jennifer Cabral (E-mail)'; 'Jennifer
Greenlief (E-mail)'; 'Kevin H. Kondru (E-mail)'; 'Lisa Young (E-mail)';
'Loudmilla Vertanessian (E-mail)'; 'Mac McLaughlin (E-mail)'; 'Mahin =
Talebi
(E-mail)'; 'Mark Kawamoto (E-mail)'; 'Mary Misemer (E-mail)'; 'Michael =
Simpson
(E-mail)'; 'Nira Yamachika (E-mail)'; 'Nora Varner (E-mail)'; 'Olga Krel
(E-mail)'; 'Pascal Roubineau (E-mail)'; 'Rich Berman (E-mail)'; 'Ron =
Pilorin
(E-mail)'; 'Steve Gray (E-mail)'; 'Steve Kubo (E-mail)'; 'Terry Musil
(E-mail)'; 'Tim Dafeta (E-mail)'; 'Tim Grogan (E-mail)'<br>
<b><span style=3D'font-weight:bold'>Cc:</span></b> 'Christian Daughton =
(E-mail)';
'Eileen Sheehan (E-mail)'; 'John Katz (E-mail)'; 'Luisa Valiela =
(E-mail)'<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> RE: Version 3 =
N3D
Postcard</span></font><o:p></o:p></p>

</div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>Penny, and list =
recipients, <o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>Safe disposal of =
unwanted
medications has been discussed widely in <st1:State =
w:st=3D"on">Maine</st1:State>,
and elsewhere in the <st1:place w:st=3D"on"><st1:country-region =
w:st=3D"on">U.S.</st1:country-region></st1:place>
It is now an option only in limited areas of the country, but one that =
has the
potential for diversion and significant bio-environmental impact, as =
well as
dangers at home.&nbsp; The following postulates, based on current legal =
and
safety constraints, are only for your cautionary =
consideration.<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>1. Sanitation and =
Hazardous
Materials centers operated by cities and counties, at the moment, are =
not
sufficiently equipped to safely and collect expired or unused
medications.&nbsp; Some are qualified only by exception if they are =
operated
under the auspices of law enforcement, such as the Drug Enforcement =
Agency.
Expansion of this coverage is under discussion now. =
<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>2. Classification =
of
medications as hazardous materials may not only confuse the average =
citizen, it
may require special handling and documentation, such as an MSDS. =
Additionally,
most people seldom distinguish, and are unable to distinguish, =
&nbsp;controlled
substances from non-controlled, when they are trying to get rid of =
unwanted
medications. Though labeling of prescriptions has some standardization =
it is
currently under further review with standardized patient information =
packages (
that we are trying to get to contain disposal instructions along the =
lines that
Charlotte Smith wrote about years ago to USP.) Your proposed flyer =
instructs
that no controlled substances are allowed, but your website (<a
href=3D"http://www.lacsd.org/HHW/HHWFLIER.ht">http://www.lacsd.org/HHW/HH=
WFLIER.ht</a>)
did not mention this in the Household Hazardous Waste Program.&nbsp; Is =
your
facility certified to handle such items as narcotics and other federally
controlled pharmaceuticals?<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>3. Based on =
discussion with
environment experts, typical landfills do not meet =
&quot;inactivation&quot;
expectations regarding safe disposal of most medications, especially =
antineoplastics
and psychotropic drugs. &nbsp;Radionuclides are generally not dispensed =
for any
home use but procedures for the unforeseen are prudent. Some chemically =
active
ingredients in medications, such as hormone replacement drugs and =
antibiotics, remain
active in the environment. They are as likely to potentiate each other =
in the
environment as they are in human use. &nbsp;The latter is causing grave =
concern
for introduction of multiple-drug-resistant bacteria.&nbsp; These =
chemicals
eventually seep into the water that may end up at the faucets. =
&nbsp;&nbsp;<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>4. The potential =
for drugs
diversion at collection sites is quite serious and can invite =
unanticipated
problems to any well-intended community program. Diversion has already =
occurred
and even in police custody there has been diversion. Without proper =
supervision
and authority, unscrupulous collectors may, and likely shall, =
clandestinely
sort out controlled drugs and use (abuse) or sell them on the =
streets.&nbsp;
Such programs inadvertently may create an opportune scheme for a channel =
for
illegal drugs trafficking and trade.<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>We commend you on =
your
successful Household Hazardous Waster Program and this campaign to =
remove
unwanted medications from the home.&nbsp; We also are aware that every
prescription drug that is not used appropriately for its intended =
therapeutic
purpose means wasted healthcare dollars.&nbsp; We are sensitive to the =
fact
that unused and expired medications translate into likely adverse =
events,
including harm to a patient through non-adherence to a prescription and =
unintentional
overdose or interaction. &nbsp;Children and elderly, of course, are =
prone to
accidental poisoning.&nbsp; <o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>My colleagues and I =
are
particularly concerned about all these issues and working diligently to =
build a
coalition and national strategies to address them.&nbsp; While we focus =
on the
current situation, we are most interested in ways to prevent the problem =
in the
first place.&nbsp; For instance, the over-abundance of unwanted =
medications at
home is one indication of over-prescription by doctors.&nbsp; Through =
education
and better policies, we may be able to stem this practice.&nbsp; =
Non-compliance
rates of 30-60% are not unheard of and this rate of failure has =
significant
health-care system ramifications as well as volume considerations for =
all of
our efforts.<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>We are racing to =
create a
national registry for unwanted medications, so we can study the =
magnitude of
this problem and characterize the types and quantity of household =
medications
that are unused or expired. In draft form it is now available at <a
href=3D"http://www.communityofcompetence.com/">www.communityofcompetence.=
com</a>
at &#8220;Registries.&#8221; The registry will be used to help set =
monitored
and safe systems to collect and dispose of these medications. Informally =
it has
already collected as much as we know about and invite further =
contributions so
that what we all are trying to accomplish can have the numbers with =
which we
all can approach the relevant authorities or funding sources. An =
international
registry of programs is being compiled currently along with their =
mechanisms
and contact personnel. Shortly it is hoped a listing of the unusable =
donations
at Banda Aceh will also be available to help focus attention on this =
problem. <o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>Sending medications =
to
dumpsters or landfills without assessing what they are only add to the =
growing
crisis of environmental contamination.&nbsp; We all will miss the =
opportunity
to learn about what medications are unused, and why.&nbsp; Several =
Canadian
studies have looked into this very same problem, and there is one =
<st1:place
w:st=3D"on"><st1:country-region =
w:st=3D"on">US</st1:country-region></st1:place>
data set publicly available at <a =
href=3D"http://www.noemaine.org/benzo/benzo.htm">www.noemaine.org/benzo/b=
enzo.htm</a>
in the 2004 Conference report. This was released so that reporting might =
become
standardized and that this common data set in the public domain could be =
used
to develop different reporting formats for consideration by us all. =
&nbsp;From
one important study in <st1:place w:st=3D"on"><st1:City =
w:st=3D"on">Sudbury</st1:City>,
 <st1:State w:st=3D"on">Ontario</st1:State></st1:place>, health and =
public
officials have made great strides in reducing unwanted drugs by lowering =
the
initial size (number of pills or amount) of a prescription, monitoring =
for
adherence, and calculating the pharmacoeconomic projections on cost =
savings of
various prescription policies. <st1:country-region =
w:st=3D"on">US</st1:country-region>
studies exist but we have not found any with the necessary detail of the =
<st1:place
w:st=3D"on"><st1:City w:st=3D"on">Sudbury</st1:City></st1:place> =
study.<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>I realize unwanted
medications and the disposal of them are a major problem for your
community.&nbsp; It should be a concern for all communities, locally and
internationally. With prudence, determination, and collaboration, we =
together
shall find a solution.&nbsp; Again, I commend you for your effort and =
for
drawing attention to this problem. However, I encourage you to exercise =
caution
with your Household Hazardous Waste Program, particularly dealing with =
unwanted
medications.&nbsp; I am more than glad to discuss this further. =
Regarding your
flyer, I am happy to refer you to those who have expertise in risk
communication and health promotion. There is a public health component =
as well
as a waste reduction component. &nbsp;<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'>Stevan Gressitt, =
M.D.<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier =
New"'>207-441-0291<o:p></o:p></span></font></p>

<p class=3DMsoNormal style=3D'text-autospace:none'><font size=3D2 =
face=3D"Courier New"><span
style=3D'font-size:10.0pt;font-family:"Courier New"'><a
href=3D"http://www.noemaine.org/benzo/benzo.htm">www.noemaine.org/benzo/b=
enzo.htm</a>
<o:p></o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>

<p class=3DMsoNormal><font size=3D2 color=3Dnavy face=3DArial><span =
style=3D'font-size:
10.0pt;font-family:Arial;color:navy'><o:p>&nbsp;</o:p></span></font></p>

<div>

<div class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><font =
size=3D3
face=3D"Times New Roman"><span style=3D'font-size:12.0pt'>

<hr size=3D2 width=3D"100%" align=3Dcenter tabindex=3D-1>

</span></font></div>

<p class=3DMsoNormal><b><font size=3D2 face=3DTahoma><span =
style=3D'font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font =
size=3D2
face=3DTahoma><span style=3D'font-size:10.0pt;font-family:Tahoma'> Hill, =
Penny
[mailto:PHill@lacsd.org] <br>
<b><span style=3D'font-weight:bold'>Sent:</span></b> Tuesday, June 21, =
2005 12:44
PM<br>
<b><span style=3D'font-weight:bold'>To:</span></b> Ann Heil (E-mail); =
Barbara
Sharatz (E-mail); Brian Fung (E-mail); Jane Tran (E-mail); Jeff Stone =
(E-mail);
Jennifer Cabral (E-mail); Jennifer Greenlief (E-mail); Kevin H. Kondru
(E-mail); Lisa Young (E-mail); Loudmilla Vertanessian (E-mail); Mac =
McLaughlin
(E-mail); Mahin Talebi (E-mail); Mark Kawamoto (E-mail); Mary Misemer =
(E-mail);
Michael Simpson (E-mail); Nira Yamachika (E-mail); Nora Varner (E-mail); =
Olga
Krel (E-mail); Pascal Roubineau (E-mail); Rich Berman (E-mail); Ron =
Pilorin
(E-mail); Steve Gray (E-mail); Steve Kubo (E-mail); Terry Musil =
(E-mail); Tim
Dafeta (E-mail); Tim Grogan (E-mail)<br>
<b><span style=3D'font-weight:bold'>Cc:</span></b> Christian Daughton =
(E-mail);
Eileen Sheehan (E-mail); John Katz (E-mail); Luisa Valiela (E-mail); =
Stevan
Gressitt (E-mail)<br>
<b><span style=3D'font-weight:bold'>Subject:</span></b> Version 3 N3D =
Postcard</span></font><o:p></o:p></p>

</div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'><o:p>&nbsp;</o:p></span></font></p>

<div>

<div>

<p class=3DMsoNormal><font size=3D2 face=3D"Comic Sans MS"><span =
style=3D'font-size:
10.0pt;font-family:"Comic Sans MS"'>Hello all,</span></font><font =
size=3D1
face=3D"Comic Sans MS"><span style=3D'font-size:7.5pt;font-family:"Comic =
Sans MS"'><o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D2 face=3D"Comic Sans MS"><span =
style=3D'font-size:
10.0pt;font-family:"Comic Sans MS"'>Attached&nbsp;is a new&nbsp;(third) =
version
of the &quot;No Drugs Down the Drain&quot; postcard.&nbsp;&nbsp;After =
opening
it&nbsp;go to &quot;View&quot; then &quot;Fit =
Page&quot;.</span></font><font
size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:7.5pt;font-family:"Comic Sans =
MS"'><o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:
7.5pt;font-family:"Comic Sans MS"'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D2 face=3D"Comic Sans MS"><span =
style=3D'font-size:
10.0pt;font-family:"Comic Sans MS"'>We received&nbsp;different views on =
various
aspects of the previous two versions of the card.&nbsp; These were not =
ignored
but rather, were evaluated based on all comments received.&nbsp; So, to =
clarify
the card's evolution, I would like to take some time&nbsp;to explain why =
we did
certain things and not others.&nbsp;</span></font><font size=3D1
face=3D"Comic Sans MS"><span style=3D'font-size:7.5pt;font-family:"Comic =
Sans MS"'><o:p></o:p></span></font></p>

</div>

<ul type=3Ddisc>
 <li class=3DMsoNormal =
style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
     mso-list:l1 level1 lfo3'><font size=3D2 face=3D"Comic Sans =
MS"><span
     style=3D'font-size:10.0pt;font-family:"Comic Sans =
MS"'>&nbsp;Remember that
     you are viewing a pdf file which is easy for you to download but it =
does
     not have the resolution of the file that will go to the =
printer.&nbsp; The
     colors in the&nbsp;final printed card will be more vibrant and the =
images
     (including text)&nbsp;will be&nbsp;much sharper.</span></font><font
     size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:7.5pt;font-family:"Comic Sans MS"'>
     <o:p></o:p></span></font></li>
 <li class=3DMsoNormal =
style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
     mso-list:l1 level1 lfo3'><font size=3D2 face=3D"Comic Sans =
MS"><span
     style=3D'font-size:10.0pt;font-family:"Comic Sans MS"'>The card =
will be
     4&quot; x 6&quot; and, as such, is size-constrained with respect to =
how
     much information it can contain (and effectively =
convey).&nbsp;&nbsp;Keep
     in mind&nbsp;that there will be an associated web site with more =
detailed
     information and links.&nbsp; The card recipient also has the avenue =
of
     asking the pharmacist for further information.&nbsp; =
</span></font><font
     size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:7.5pt;font-family:"Comic Sans =
MS"'><o:p></o:p></span></font></li>
 <li class=3DMsoNormal =
style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
     mso-list:l1 level1 lfo3'><font size=3D2 face=3D"Comic Sans =
MS"><span
     style=3D'font-size:10.0pt;font-family:"Comic Sans MS"'>There were =
some
     suggestions to use line drawings on the card.&nbsp; We discussed =
this but
     felt that&nbsp;photographs are&nbsp;more professional =
looking&nbsp;and
     striking. </span></font><font size=3D1 face=3D"Comic Sans MS"><span
     style=3D'font-size:7.5pt;font-family:"Comic Sans =
MS"'><o:p></o:p></span></font></li>
 <li class=3DMsoNormal =
style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
     mso-list:l1 level1 lfo3'><font size=3D2 face=3D"Comic Sans =
MS"><span
     style=3D'font-size:10.0pt;font-family:"Comic Sans MS"'>We have been =
trying
     &nbsp;to use a visual that is&nbsp;eye catching and thought =
provoking
     (thus, the fish in the gas mask in the first version) with a =
contemporary
     feel (this is somewhat hard to do with a toilet).&nbsp; After the =
fish,
     there were suggestions that&nbsp;the graphics should be more
     literal&nbsp;and&nbsp;it appears that we got a little too literal =
in the
     second version with the shoes standing in front of the =
toilet!&nbsp;
     In&nbsp;this version we&nbsp;use a&nbsp;toilet =
picture&nbsp;that&nbsp;is
     engaging&nbsp;both because it's an active picture of disposal but
     especially&nbsp;because of the disapproving looks on the children's
     faces.&nbsp; </span></font><font size=3D1 face=3D"Comic Sans =
MS"><span
     style=3D'font-size:7.5pt;font-family:"Comic Sans =
MS"'><o:p></o:p></span></font></li>
 <li class=3DMsoNormal =
style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
     mso-list:l1 level1 lfo3'><font size=3D2 face=3D"Comic Sans =
MS"><span
     style=3D'font-size:10.0pt;font-family:"Comic Sans =
MS"'>We&nbsp;played around
     with putting the text in other colors (e.g. &quot;NO DRUGS DOWN THE
     DRAIN&quot; in red) but&nbsp;the result&nbsp;is that the =
card&nbsp;starts
     to&nbsp;look garish.</span></font> <font size=3D1 face=3D"Comic =
Sans MS"><span
     style=3D'font-size:7.5pt;font-family:"Comic Sans =
MS"'><o:p></o:p></span></font></li>
 <li class=3DMsoNormal =
style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
     mso-list:l1 level1 lfo3'><font size=3D2 face=3D"Comic Sans =
MS"><span
     style=3D'font-size:10.0pt;font-family:"Comic Sans MS"'>There were =
concerns
     regarding the potential for the card to be interpreted as referring =
to
     illegal drugs&nbsp; because of the title &quot;No Drugs Down the
     Drain&quot;.&nbsp; Please put the card in context when viewing it: =
it will
     be stapled on a bag containing your prescription that you are =
picking up
     from a pharmacist&nbsp;in a pharmacy or drug store (e.g. Sav-On =
Drugs,
     Thrifty Drug Store, etc.).&nbsp; Therefore, we think that the =
illegal drug
     connection&nbsp;is unlikely.&nbsp; We tried a test run with several =
of our
     Public Information staff and stapled it on a mock prescription
     bag&nbsp;while pretending to be a pharmacist.&nbsp; There was no =
confusion
     in their minds regarding what drugs the card was referring =
to.&nbsp; Also,
     the&nbsp;text&nbsp;on the card refers to&nbsp;&quot;unused =
medications&quot;
     and &quot;unused prescription and over-the-counter
     medications&quot;.&nbsp; Therefore, we stayed with &quot;No Drugs =
...'
     rather than &quot;No Medications...&quot; because it
     is&nbsp;much&nbsp;more dynamic and forceful (i.e. =
catchy).</span></font><font
     size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:7.5pt;font-family:"Comic Sans MS"'>
     <o:p></o:p></span></font></li>
 <li class=3DMsoNormal =
style=3D'mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
     mso-list:l1 level1 lfo3'><font size=3D2 face=3D"Comic Sans =
MS"><span
     style=3D'font-size:10.0pt;font-family:"Comic Sans MS"'>I didn't =
mention it
     previously but the card will be a two sided, bilingual =
card.</span></font><font
     size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:7.5pt;font-family:"Comic Sans =
MS"'><o:p></o:p></span></font></li>
</ul>

<div>

<p class=3DMsoNormal><font size=3D2 face=3D"Comic Sans MS"><span =
style=3D'font-size:
10.0pt;font-family:"Comic Sans MS"'>Please&nbsp;send feedback&nbsp;to me =
by
July 5 at the latest.&nbsp; Thanks so much for your =
participation.</span></font><font
size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:7.5pt;font-family:"Comic Sans =
MS"'><o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D2 face=3D"Comic Sans MS"><span =
style=3D'font-size:
10.0pt;font-family:"Comic Sans MS"'>Penny</span></font><font size=3D1
face=3D"Comic Sans MS"><span style=3D'font-size:7.5pt;font-family:"Comic =
Sans MS"'><o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:
7.5pt;font-family:"Comic Sans MS"'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:
7.5pt;font-family:"Comic Sans MS"'>&nbsp;<o:p></o:p></span></font></p>

</div>

</div>

<div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:
7.5pt;font-family:"Comic Sans MS"'>Penny Hill</span></font><font =
size=3D1><span
style=3D'font-size:7.5pt'><br>
</span></font><font size=3D1 face=3D"Comic Sans MS"><span =
style=3D'font-size:7.5pt;
font-family:"Comic Sans MS"'>Recycling Coordinator<br>
<st1:place w:st=3D"on"><st1:City w:st=3D"on">L.A.</st1:City></st1:place> =
County
Sanitation Districts <br>
<st1:address w:st=3D"on"><st1:Street w:st=3D"on">1955 Workman Mill Road =
<br>
  P.O. Box 4998</st1:Street> <br>
<st1:City w:st=3D"on">Whittier</st1:City>, <st1:State =
w:st=3D"on">CA</st1:State>&nbsp;
 <st1:PostalCode w:st=3D"on">90607</st1:PostalCode></st1:address> <br>
(562) 699-7411 (voice) x1781 <br>
(562) 699-6358 (fax) <br>
phill@lacsd.org </span></font><o:p></o:p></p>

</div>

<div>

<p class=3DMsoNormal><font size=3D3 face=3D"Times New Roman"><span =
style=3D'font-size:
12.0pt'>&nbsp;<o:p></o:p></span></font></p>

</div>

</div>

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