[Pharmwaste] RE: Sewered Pharms

Mon Mar 5 21:22:45 EST 2007

Can that 50,000 pounds be translated into patient hospital bed days? Stevan
Gressitt, M.D.

-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Charlotte
Smith
Sent: Monday, March 05, 2007 7:26 PM
To: gressitt; Volkman, Jennifer; zimme053 at umn.edu; Heil, Ann
Cc: pharmwaste at lists.dep.state.fl.us; Jenna.Duwenhoegger at house.mn; Gibbons,
Mary
Subject: RE: [Pharmwaste] RE: Sewered Pharms

Reverse distribution only handles expired meds in original containers.
Hospitals generate considerable amounts of waste pharmaceuticals through
their daily operations that are not eligible for reverse distribution,
such as unused IVs, partial vials, partially used inhalers, ointments,
insulin, repackaged tablets/ capsules, etc. 

Charlotte A. Smith, R. Ph., M.S., HEM
President
PharmEcology Associates, LLC
200 S. Executive Drive, Suite 101
Brookfield, WI 53005
262-814-2635
csmith at pharmecology.com
www.pharmecology.com 

-----Original Message-----
From: pharmwaste-bounces at lists.dep.state.fl.us
[mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of gressitt
Sent: Saturday, March 03, 2007 3:45 PM
To: 'Volkman, Jennifer'; zimme053 at umn.edu; 'Heil, Ann'
Cc: pharmwaste at lists.dep.state.fl.us; Jenna.Duwenhoegger at house.mn;
'Gibbons, Mary'
Subject: [Pharmwaste] RE: Sewered Pharms

I'm puzzled by this. That 50,000 pounds was not handled by the current
reverse distribution system? Meaning that the actual waste count would
be
increased by that commercial stream as well?
Is there a document that summarizes those 50,000 and is there any
breakout
of what specific drugs were handled?

Stevan Gressitt, M.D.
207-441-0291
www.mainebenzo.org 

-----Original Message-----
From: Volkman, Jennifer [mailto:Jennifer.Volkman at state.mn.us] 
Sent: Tuesday, February 27, 2007 12:39 PM
To: zimme053 at umn.edu; Heil, Ann
Cc: gressitt; Volkman, Jennifer; pharmwaste at lists.dep.state.fl.us;
Jenna.Duwenhoegger at house.mn; Gibbons, Mary
Subject: RE: Sewered Pharms

Thanks everyone, the responses have been great!  I didn't expect to be
able
to generate hard numbers, but I feel I've learned more about how to go
about
getting at that.  It would be great to find out the quantity of non-haz
pharms that are still being sewered by health care facilities in MN.  I
am
hopeful that our revised guidance for households has generated some
behavior
change and that we have far less sewering from that sector.  The fact
sheets
have been widely distributed, several local press releases have been
issued
and I've seen the guidance featured prominently in many annual county
guidance documents.  

It is also very exciting to see that several household collection
programs
are going well and are providing good models for others to build
from--thanks for taking that big step all you brave people!

________________________________

From: Catherine Zimmer [mailto:zimme053 at umn.edu]
Sent: Tue 2/27/2007 10:12 AM
To: Heil, Ann
Cc: gressitt; Volkman, Jennifer; pharmwaste at lists.dep.state.fl.us;
Jenna.Duwenhoegger at house.mn
Subject: Sewered Pharms

Hi all,
As you know, in MN there has been a deliberate regulatory effort to
ensure healthcare facilities properly manage their hazardous waste,
including many pharmaceuticals.  According to summary data collected by
the seven counties in the Mpls St Paul area, in 2005 close to 50,000 lbs
of waste pharmaceuticals (not including chemotherapeutics) were
collected and managed as hazardous waste.  This is data from 28
hospitals.  Prior to the hazardous waste initiative, no pharmaceuticals
were being reported to regulatory authorities as hazardous waste.  So,
we assume these drugs were either being disposed of down the sewer--all
the controlled substances of course, which in many cases still are, and
to infectious waste--probably sewered with condensate.

Ann, thank you for the very interesting excretion data.

Catherine Zimmer
Health Care Specialist

Minnesota Technical Assistance Program
University of Minnesota
612/624-4635, 800/247-0015
http://www.mntap.umn.edu <http://www.mntap.umn.edu/> 

Helping Minnesota businesses maximize resource efficiency, prevent
pollution
and reduce costs.

Heil, Ann wrote:
> I hope that everyone is aware that there is no *one* answer for all
pharmaceuticals regarding the relative amounts arriving the wastewater
from
human waste and direct disposal. Each pharmaceutical is different,
particularly in terms of how they behave in the human body. Some are
used up
almost entirely in the body; some are passed through unchanged. There
are
also differences regarding disposal practices. One would not expect much
vicodin to be disposed of directly, but we all know that people tend to
not
take all of their antibiotics. That said, I did a little exercise a few
years ago to look at the amount of drugs metabolized and excreted in
human
waste.
>
> I started with the top ten drugs by sales for 2003 (latest year
available
when I did the analysis)from www.rxlist.com.  This site also has the top
ten
drugs by number of prescriptions.  The information on percent excreted I
generally took from the patient package inserts, which can be found
online
using google searches. The percent excreted was usually listed as
percent in
urine.  There isn't much data on percent in feces.  In some cases an
isotope
study is done to determine overall percent excreted (unused drug and
metabolites), but I was interested in actual amounts of drug excreted
since
we usually see actual drug amounts in water bodies.
>
> Excretion Percentages - Top 10 US Pharmaceuticals in 2003 by Sales
> Lipitor  - cholesterol reduction - < 2% excreted
> Zocor - cholesterol reduction - < 0.5% excreted
> Prevacid - ulcers - < 1% excreted
> Procrit - anemia - < 5% excreted
> Zyprexa - antipsychotic - 7% excreted
> Epogen - anemia -  < 5% excreted
> Nexium - acid reflux - < 1% excreted
> Zoloft - antidepressant - 14% excreted
> Celebrex - anti-inflammatory - < 3% excreted
> Neurontin - antiseizure - 100% excreted
> Leading OTC drug: Ibuprofen - 10% excreted
>
> Ann Heil, P.E.
> Supervising Engineer
> Sanitation Districts of Los Angeles County
> 1955 Workman Mill Road
> Whittier, CA 90601
> 562/908-4288, x2803
> fax 562/908-4293
> aheil at lacsd.org
>
> -----Original Message-----
> From: pharmwaste-bounces at lists.dep.state.fl.us
> [mailto:pharmwaste-bounces at lists.dep.state.fl.us]On Behalf Of gressitt
> Sent: Saturday, February 24, 2007 1:28 PM
> To: 'Volkman, Jennifer'; pharmwaste at lists.dep.state.fl.us
> Cc: Jenna.Duwenhoegger at house.mn
> Subject: RE: [Pharmwaste] Measuring the amount of pharms reaching
> surface water
>
>
> The San Francisco report gave an estimate, though I think it is high (
> estimate of family size was not included.) I don't recall a reference
for
> the 5-20% directly from sewering but I do know someone in PHARMA was
> offering a 3% number that was not documented at all and would seem to
fly
in
> the face of patient compliance rates that hover 20-80%. American
Society
of
> Consulting Pharmacists estimated about 12-14% as I recall as wastage
but
> only in long term care facilities and that was about 2-3 years ago.
And
> unfortunately the information is proprietary and I had only limited
access
> to it at one point. I believe it might have been Anne Heil? Who
exquisitely
> took a list of the top 10 drugs and made a chart ( which I have lost
but
> love to have it again if anyone could forward it) showing rates of
> metabolism and demonstrating a nice wide range. One of the purposes of
the
> various pilots is to simply collect benchmark data from all of our
various
> efforts and  address the exact question you have been asked as I think
the
> best answer is a cautious " I don't know." It is more than 1 pound, it
is
> more than 10, or a hundred, but I feel at this point many of our
> measurements need to be accepted as labor intensive, unfunded efforts
we
all
> have made that will likely pale when something does get up and
running. At
> this point, I fear at times that some of what we are doing is more
akin
to:
> http://www.mousetrapcontraptions.com/rube-cartoons-2.html and in need
of a
> very healthy dose of self-humor. We are working in a particularly
> frustration inducing area otherwise. And that contraption I keep in
mind
as
> something we definitely do not want to have as a final
solution/product.
>
> Stevan Gressitt, M.D.
> 207-441-0291
> www.mainebenzo.org
>
> -----Original Message-----
> From: pharmwaste-bounces at lists.dep.state.fl.us
> [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of
Volkman,
> Jennifer
> Sent: Wednesday, February 21, 2007 1:41 PM
> To: pharmwaste at lists.dep.state.fl.us
> Cc: Jenna.Duwenhoegger at house.mn
> Subject: [Pharmwaste] Measuring the amount of pharms reaching surface
water
>
> Hello list serv friends,
> 
> A MN legislator is possibly proposing some legislation related to
> pharmaceutical collection.  She is very concerned about the impacts to
fish,
> etc. 
> 
> In attempting to provide information on the regulatory and other
barriers
to
> collection of household pharms, I threw out a number, based on what I
could
> recall from several previous messages, that from 5 to 20% of pharms in
> surface water are there due to direct sewering of waste pharms by
households
> and hospitals and that the rest is what passes through our bodies and
so
> can't be diverted (not easily anyway), from sewering.
> 
> The staff from her office would like to know what 5-20% would be in
pounds
> per year.  I said it was a pretty elusive number and that I have not
seen
> anything close to an actual estimate of pounds.  The more I think
about
it,
> I wonder if the 5-20% numbers are even good.  We can certainly guess
that
> for households some percent is taken and expelled, some is in storage
(for
> years), some is disposed of through sewering and some is disposed of
in
the
> trash.  For hospitals, it would be a similar mix of the same. 
> 
> I thought maybe the State Pharmacy Board might track the number of
> prescriptions written or filled and from that we could extrapolate,
but I
> wouldn't have much confidence in the numbers.
> 
> Does anyone have any other ideas or has anyone tackled this question
in
> another state?
> 
> I thought it might make more sense to ban hospitals from sewereing any
> pharms and/or require manufacturers and pharmacies to get involved in
a
> solution, rather than to try to establish a collection system that
puts
all
> of the weight on the already overloaded HHW collection system.  I had
a
nice
> discussion with the people from Washington State on their drop off
system
> which still isn't approved by DEA, but seems to be going well
otherwise.
> 
> Please let me know your thoughts,
> Thanks!
> Jnifr
>
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