[Pharmwaste] inconsistent message

[Volkman, Jennifer (MPCA)]

Hello everyone,
I sent emails on the inconsistent messaging and received a reply today from FDA. I attached the content, so you can see whether you want to copy something and send a similar message. FDA stated: "We strive to make our web pages as consistent as possible. We will be considering the recent changes by DEA and revising our web pages as appropriate."

I've seen a bit of change, so they are working on it, but I think they are missing the point: 1) Use collection programs or 2) sewer if there is a chance someone will be poisoned and 3) make clear it is guidance, not required. I think we can live with that. I noticed they now refer to the DEA's collection events. That's new...and DEA is no longer doing those, so...I will write back to them to let them know that, because, clearly, they are not communicating with DEA, unless DEA is going to still do events, but I believe we've heard a no on that.  :/

I am thrilled some hospitals/clinics are becoming more concerned about environmental impacts and are switching to other disposal methods when it is clearly more expensive than sewering!

There are various links to disposal guidance from FDA, here's the one that goes from ONDCP to FDA:
http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm

I also ended up somewhere on a NIH website and tried to download prescription labels to see if sewering was "mandated" on those and it wouldn't let me download them. Probably a good thing. Changing the labeling and instructions that go home with the patient is another area that needs work. I am hopeful things will really change when pharmacies start collecting and making the changes needed to printed materials so customers use their bins.

JV


From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Lotzer Donna M
Sent: Thursday, November 13, 2014 10:23 AM
To: 'Hauser, Deborah'; 'pharmwaste at lists.dep.state.fl.us'
Subject: RE: [Pharmwaste] inconsistent message

Diazepam may be Schedule IV but if you look down this list they are the heavy hitters with a high high potential for abuse and are Schedule II in most cases. Do I agree with flushing them? No...our hospital has recently gone to Cactus Sink instead of flushing or putting stuff in the sharps containers (!!) which is an improvement, albeit expensive. As a pharmacist with 25 years answering poison phones the more inaccessible these products are the safer everyone is. Donna
Donna Lotzer, Senior Clinical Pharmacist
Poison Education Coordinator
University of WI Hospital & Clinics Poison Prevention Center
600 Highland Avenue, MC # 9475, Madison, WI 53792
dlotzer at uwhealth.org<mailto:dlotzer at uwhealth.org>     Phone: 608-265-8160
Please encourage others to save 800-222-1222 in both cell and home phones.
This number will connect callers anywhere in the U.S. to a poison center.
Calls are free, confidential and answered 24/7/365.
Please help me educate your community about poison prevention.
Call or email me for materials or program opportunities.

From: Hauser, Deborah [mailto:Deborah.Hauser at epa.ohio.gov]
Sent: Thursday, November 13, 2014 6:56 AM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] inconsistent message

Good morning,

I've gotten the occasional question from hospital workers here in Ohio about policies to rinse Schedule IV drugs down the drain.  As I generally work with the residential side of things, I'm not as well-versed on hospital practices.  However, it seems to me there is a serious disconnect between the message from the environmental folks (like my agency, Ohio EPA) and the FDA.  The FDA's most recent guidance still suggests flushing a lengthy list of pharms (see below).   Has anyone had any experience with hospitals making it a policy to NOT flush pharmaceuticals?  As far as I know, it is still legal to flush the pharmaceuticals that FDA advises.  But I guess I'd like to see some sort of solution that involves incinerating ALL pharms, even the ones that have historically been flushed.  Do any of you have any suggestions I could pass on to Ohio hospitals?


Thanks,
Deb


Medicine

Active Ingredient

Abstral (PDF - 1M)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM239930.pdf>, tablets (sublingual)

Fentanyl

Actiq (PDF - 251KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM085817.pdf>, oral transmucosal lozenge *

Fentanyl Citrate

Avinza (PDF - 51KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311346.pdf>, capsules (extended release)

Morphine Sulfate

Buprenorphine Hydrochloride, tablets (sublingual) *

Buprenorphine Hydrochloride

Buprenorphine Hydrochloride; Naloxone Hydrochloride, tablets (sublingual) *

Buprenorphine Hydrochloride; Naloxone Hydrochloride

Butrans (PDF - 388KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM219146.pdf>, transdermal patch system

Buprenorphine

Daytrana (PDF - 281KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088581.pdf>, transdermal patch system

Methylphenidate

Demerol, tablets *

Meperidine Hydrochloride

Demerol, oral solution *

Meperidine Hydrochloride

Diastat/Diastat AcuDial<http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Overview&DrugName=DIASTAT>, rectal gel [for disposal
instructions: click on link, then go to "Label information"
and view current label]

Diazepam

Dilaudid, tablets *

Hydromorphone Hydrochloride

Dilaudid, oral liquid *

Hydromorphone Hydrochloride

Dolophine Hydrochloride (PDF - 48KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311370.pdf>, tablets *

Methadone Hydrochloride

Duragesic (PDF - 179KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088584.pdf>, patch (extended release) *

Fentanyl

Embeda (PDF - 39KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM179172.pdf>, capsules (extended release)

Morphine Sulfate; Naltrexone Hydrochloride

Exalgo (PDF - 83KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM204267.pdf>, tablets (extended release)

Hydromorphone Hydrochloride

Fentora (PDF - 338KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM088597.pdf>, tablets (buccal)

Fentanyl Citrate

Kadian (PDF - 135KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311373.pdf>, capsules (extended release)

Morphine Sulfate

Methadone Hydrochloride, oral solution *

Methadone Hydrochloride

Methadose, tablets *

Methadone Hydrochloride

Morphine Sulfate, tablets (immediate release) *

Morphine Sulfate

Morphine Sulfate (PDF - 282KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM199333.pdf>, oral solution *

Morphine Sulfate

MS Contin (PDF - 433KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM311374.pdf>, tablets (extended release) *

Morphine Sulfate

Nucynta ER (PDF - 38KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM270268.pdf>, tablets (extended release)

Tapentadol

Onsolis (PDF - 297KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM285397.pdf>, soluble film (buccal)

Fentanyl Citrate

Opana, tablets (immediate release)

Oxymorphone Hydrochloride

Opana ER (PDF - 56KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM283820.pdf>, tablets (extended release)

Oxymorphone Hydrochloride

Oxecta, tablets (immediate release)

Oxycodone Hydrochloride

Oxycodone Hydrochloride, capsules

Oxycodone Hydrochloride

Oxycodone Hydrochloride (PDF - 100KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM289880.pdf>, oral solution

Oxycodone Hydrochloride

Oxycontin (PDF - 417KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM208530.pdf>, tablets (extended release)

Oxycodone Hydrochloride

Percocet, tablets *

Acetaminophen; Oxycodone Hydrochloride

Percodan, tablets *

Aspirin; Oxycodone Hydrochloride

Suboxone<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf> (PDF - 83KB<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf>)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM225677.pdf>, film (sublingual)

Buprenorphine Hydrochloride; Naloxone Hydrochloride

Xyrem (PDF - 185KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM089830.pdf>, oral solution

Sodium Oxybate

Zubsolv (PDF - 354KB)<http://www.fda.gov/downloads/Drugs/DrugSafety/UCM362203.pdf>, tablets (sublingual)

Buprenorphine Hydrochloride; Naloxone Hydrochloride


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