[Pharmwaste] RE: Pharmwaste Digest, Vol 15, Issue 30
Andria Ventura
aventura at cleanwater.org
Mon Jan 29 20:24:30 EST 2007
It's not clear to me what we mean by non-adherence and what impact does an
unfilled prescription have?
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
pharmwaste-request at lists.dep.state.fl.us
Sent: Monday, January 29, 2007 2:34 PM
To: pharmwaste at lists.dep.state.fl.us
Subject: Pharmwaste Digest, Vol 15, Issue 30
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Today's Topics:
1. Fixing The Pharmawaste Problem - Requires Cultural & Socio
Politic Change (Bill Lewry)
2. RE: mail order prescription waste (Volkman, Jennifer)
3. RE: Non-adherence (Volkman, Jennifer)
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Message: 1
Date: Mon, 29 Jan 2007 11:00:49 -0600
From: Bill Lewry <Bill_Lewry at kcmo.org>
Subject: [Pharmwaste] Fixing The Pharmawaste Problem - Requires
Cultural & Socio Politic Change
To: "gressitt" <gressitt at uninets.net>
Cc: pharmwaste-bounces at lists.dep.state.fl.us,
pharmwaste at lists.dep.state.fl.us
Message-ID:
<OFECD33883.1077D480-ON86257272.005BFDEE-86257272.005D5A5F at kcmo.org>
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Message: 2
Date: Mon, 29 Jan 2007 14:29:24 -0600
From: "Volkman, Jennifer" <Jennifer.Volkman at state.mn.us>
Subject: RE: [Pharmwaste] mail order prescription waste
To: <pharmwaste at lists.dep.state.fl.us>
Message-ID:
<6246727221874A4FB8D3F9BBC37D9BD5020D1D47 at s-sp22.pca.state.mn.us>
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Why thank you all for this string. I don't know why I didn't think of
it before. I am going to box up my left-overs and mail them back to the
pharm company. what if we all just add that to our fact sheets for
awhile....
oh, drat, I suppose they'll just flush them...what if it was like a big
ol' moving box full..maybe they'd have to do something more with it...
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Matthew
Mireles
Sent: Sunday, January 28, 2007 6:36 PM
To: 'Michele Berger'; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] mail order prescription waste
What a brilliant idea! Unfortunately, not everybody understands
or believe in stewardship or the precautionary principle.
________________________________
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Michele
Berger
Sent: Sunday, January 28, 2007 8:20 AM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] mail order prescription waste
Hi ya'll,
Why can't we lobby the insurance companies to take care of
(destroy) the waste drugs? They are the ones with the formularies and
their preffered drug lists that cause all this drug waste to begin with.
The patient jumps through all their hoops, tries all their ineffectual
drugs that they want to pay for and in the end the patient has a
cupboard of unused drugs. Let the insurance companies provide a return
mail voucher and let them be responsible for destroying the drugs! Let
them take responsibility for their ideas of "affordable and effectual
drug regimens." And it just doesn't have to be mail order drug
companies either this goes for everyone Medicaid, Medicare, Medicare
Part D, Private Pays everyone. They can send them to the drug companies
that pay them and the originators can destroy their own product. You
can't tell me that these drug companies don't have incinerators for
their waste.
Michele Berger
Mediserv Pharmacy
Sarasota, Fl.
________________________________
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Message: 3
Date: Mon, 29 Jan 2007 14:33:21 -0600
From: "Volkman, Jennifer" <Jennifer.Volkman at state.mn.us>
Subject: RE: [Pharmwaste] Non-adherence
To: <gressitt at uninets.net>, "Gilliam, Allen"
<GILLIAM at adeq.state.ar.us>
Cc: pharmwaste at lists.dep.state.fl.us
Message-ID:
<6246727221874A4FB8D3F9BBC37D9BD5020D1D48 at s-sp22.pca.state.mn.us>
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I didn't realize that non-filled or non-refilled scripts were counted
toward non-adherrance. How would that be tracked if a person never
presented a script to a pharmacy? Do I need to actively cancel the
scripts I thought were a waste of paper to prescribe, or that didn't
work so I didn't refill them?
-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
gressitt at uninets.net
Sent: Monday, January 29, 2007 8:27 AM
To: Gilliam, Allen
Cc: pharmwaste at lists.dep.state.fl.us
Subject: Re: [Pharmwaste] Non-adherence
Allen, the Registry site is at www.communityofcompetence.com Howeveer
it will measure what is returned rather than actual compliance. That
would be a deriviative conclusion that Matthew Mirelles has attempted
and with some interesting results. What is necessary for his work to
continnue howeveer is more actual reporting from as broad an array of
sites as possible. The best information I have seen on actual compliance
comes from within the Pharmaceutical Industry but is "proprietary."
Stevan Gressitt, M.D. 207-441-0291
> I was reminded that non-adherence also includes those scripts that are
> not refilled. I've been using 50% kind of as a national overall
> average in my presentations since the numerous reports I've perused
> range from 20% to 80% (for psychotrophics). Regardless of which study
> and what %, our nations' waters are in deep doo. The boulder/denver
> study REALLY opened some eyes over here.
>
> Slap me if I'm wrong but, didn't Dr. Gressitt (or somebody "out
> there") start a national registry to try and get some handle on this
> non-adherence rate? If so, what's that website again please? The only
> questionnaire I've got doesn't address "not refilled".
>
> Allen Gilliam
> ADEQ state pretreatment coordinator
>
> -----Original Message-----
> From: pharmwaste-bounces at lists.dep.state.fl.us
> [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Matthew
> Mireles
> Sent: Saturday, January 27, 2007 8:30 AM
> To: 'Jackson, Jennifer'; pharmwaste at lists.dep.state.fl.us
> Subject: RE: [Pharmwaste] RE: question on wastewater
> characterizationofpharmaceuticals
>
>
> Jen, thanks so much for your thoughtful and informative reply. I
> agree that prevention has to be the key. Do you have an idea on what
> drugs are most frequently showing up at your site? If we can address
> the issues of over-prescription, non-adherence of medications, and
> proper disposal (this is the most challenging), then everyone should
> be happy. Thanks for the reference.
>
> Matthew Mireles
>
> -----Original Message-----
> From: pharmwaste-bounces at lists.dep.state.fl.us
> [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
> Jackson, Jennifer
> Sent: Friday, January 26, 2007 5:01 PM
> To: pharmwaste at lists.dep.state.fl.us
> Subject: [Pharmwaste] RE: question on wastewater characterization
> ofpharmaceuticals
>
> Hi Matthew,
>
> Your observation is a good one and there is a plethora of studies done
> on what pharmaceuticals are entering waterways through wastewater
> effluent. Check out the USGS 2002 Reconnaissance on Pharmaceuticals
> and Personal Care Products. Boulder Creek, Potomac and San Francisco
> Bay have some studies as well. Google Scholar will give you lots of
> hits. To begin, look at:
> http://toxics.usgs.gov/highlights/DM_top100.html as well as the
> archives of this listserv.
>
> Lots of pharmaceuticals are coming to our treatment plants, and yes,
> many wastewater agencies are concerned. Some pharms are broken down,
> some adsorb to biosolids and some come out the end pipe. Every
> treatment plant is different, with various kinds of technology.
> Reverse osmosis, UV, ozonation, carbon filtration and now ultrasound
> are all possible treatments that may break down or remove the
> pharmaceuticals. Unfortunately, some pharms respond better to certain
> treatments than others, meaning that a mix of treatments would be
> necessary to get 'em all. Also unfortunately, the burden of bringing
> this technology to our plants falls on our ratepayers -- real people,
> rather than the true
> culprits: over-prescription, formulations that don't break down and a
> lack of EPA and FDA collaboration in ensuring pharmaceuticals are
tested
> for their environmental impacts.
>
> So pollution prevention is key for the portion of pharmaceuticals that
> are unused by hospitals, hospice, or residents, because that's much
> less expensive than, say reverse osmosis. Some people on this list are
> working toward a solution for disposal that will comply with DEA
> regulations as well as state and other federal law. The red tape is
> unbelievable.
>
> For pharms that we take and pass through our bodies, I believe some
> folks are looking at whether reformulation may be possible.
>
> Best,
> Jen Jackson
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