[Pharmwaste] FDA's proposed mail-back requirement for opioid prescriptions - comments due June 21st!

[Aldred Cheek, Kristin]

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Good morning all - Stericycle is a reverse distributor with a DEA-registered incinerator where we have been receiving and destroying mail back envelopes for several years.

Materials for the workshop at Duke that Margaret mentioned are here: https://secure-web.cisco.com/1wcVbcU6ixuwsPkR--oGA5rN1vWnAtkGA-HUW2EzKfFLYbJC9H2ihmJ_ooP0zb1TlfMjO6lO1qRW8SgeIc9-nrlvttXOL_uw8TSMZLN-ZOnKJQMutCcQWBuyv2zrlQEx6agUXQEmYJKcpb09QahhSH0wfBclE5vPoNs6pyT5RsV4-XqFqMZiMjl_ca0Kt-PFbMtlnuHenQOXYbFbwXHDhnDG2zSU8aGerYdu1fihloSJoJc4baOb-t65lIeASNRrTlZFXP-We0EWkrtpEFf120ElX8TDT8Bp-SzFIq7PJ7gn8B419_nZa--e2vzkMMm9hR6bfaFR25ync2dVZDzJ9Thnmf5lo3-b93VQmViY2GKU/https%3A%2F%2Fhealthpolicy.duke.edu%2Fevents%2Fexploring-options-safe-and-effective-home-opioid-disposal (I wasn't in attendance, just read the notes).

Best,
Kristin


Kristin Aldred Cheek, PhD (she/her)
Director Government Affairs
M 603.519.1086   |  kristin.aldred at stericycle.com<mailto:kristin.aldred at stericycle.com>
stericycle.com <https://secure-web.cisco.com/1fUkVt67KbPSWtjzbQNYnFh-9PUQjppuRGFZiXba3MTQM66QFU37LQb67knq4qYWIOlduZfmIU9eHINy7fm_kphNWTgFk85HGx9tGqkRx0D1YnXKp4W8mi02H8_niY2Oyxh_wSgtbPZNiNd27_zCqVp1ozmXoNwXudcRgVW4QXATNdrqB1_yoSU18XozamePAVXiV6czComPnsOC-0pfU9MRnN-RHpKNP4-KoSy29NIdhHDrrmLbACi2pNHKSL19ELPg6hmh_zbc99uBrVWToiYSWb3_W9PZgnm6Te818zC4QI045d_i64Fk9zf6LAbRcQV7-K53O8YQifo71GSqO90B4DswzAFJyFni6tQulY6U/https%3A%2F%2Fwww.stericycle.com%2F>
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From: Pharmwaste <pharmwaste-bounces at lists.dep.state.fl.us> On Behalf Of Margaret Shield
Sent: Friday, June 3, 2022 6:57 PM
To: 'Smith, Charlotte' <csmith32 at wm.com>; 'Volkman, Jennifer (MPCA)' <jennifer.volkman at state.mn.us>; pharmwaste at lists.dep.state.fl.us
Subject: Re: [Pharmwaste] FDA's proposed mail-back requirement for opioid prescriptions - comments due June 21st!


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Hi, from the explanations I have received during the many years that this proposal was in the works, FDA has been working with both DEA and EPA on this issue. The FDA convened a workshop last year, via Duke, that had both FDA and EPA staff listening in to expert speakers.

My understanding is that several different disposal facilities have the correct permits and authorizations to dispose of controlled substances in mailers or mixtures of drugs that may contain controlled substances. There are many more options than in past years. I'm mostly aware of west coast programs. MED-Project and Inmar are operating pharmaceutical stewardship programs on behalf of drug manufacturers in WA, OR, and some CA counties in compliance with state or local drug take-back laws. These programs offer collection kiosks, collection events, and mail-back, collecting all prescription and over-the-counter medicines including controlled substances by each method. They have figured out how to properly dispose of returned mailers per the DEA regulations. So the drug manufacturers participating in those stewardship organizations have ready access to that information.

Hoping this is an idea whose time has finally come!
Margaret

From: Smith, Charlotte <csmith32 at wm.com<mailto:csmith32 at wm.com>>
Sent: Friday, June 3, 2022 2:52 PM
To: Volkman, Jennifer (MPCA) <jennifer.volkman at state.mn.us<mailto:jennifer.volkman at state.mn.us>>; margaret.shield at cehstrategies.com<mailto:margaret.shield at cehstrategies.com>; pharmwaste at lists.dep.state.fl.us<mailto:pharmwaste at lists.dep.state.fl.us>
Subject: RE: Re: [Pharmwaste] FDA's proposed mail-back requirement for opioid prescriptions - comments due June 21st!

Great idea but they will need to involve DEA as only a reverse distributor with an on-site incinerator can currently receive a controlled substance by mail from a consumer. Hopefully FDA is engaged with DEA on this issue.

Best regards,

Charlotte A. Smith, RPh, MS
Senior Regulatory Advisor
PharmEcology Services
csmith32 at wm.com<mailto:csmith32 at wm.com>

C: 713-725-6363
800 Capitol Street, Suite 3000
Houston, TX 77002

[cid:image002.jpg at 01D8798A.6EF5A630]

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From: Pharmwaste <pharmwaste-bounces at lists.dep.state.fl.us<mailto:pharmwaste-bounces at lists.dep.state.fl.us>> On Behalf Of Volkman, Jennifer (MPCA)
Sent: Friday, June 3, 2022 4:20 PM
To: margaret.shield at cehstrategies.com<mailto:margaret.shield at cehstrategies.com>; pharmwaste at lists.dep.state.fl.us<mailto:pharmwaste at lists.dep.state.fl.us>
Subject: [EXTERNAL] Re: [Pharmwaste] FDA's proposed mail-back requirement for opioid prescriptions - comments due June 21st!

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This is excellent news! Manufacturer sponsored disposal as it should be! Many people receive medications through the mail, so there's no reason they can't be returned or sent for destruction via that same pathway. I plan to comment. Mail back is much less work for the consumer, and a lower cost option than the mix and toss products. Incineration = destruction!

Thank you for tracking this Margaret, I was unaware of the comment period.

Happy Friday!
JV

From: Pharmwaste <pharmwaste-bounces at lists.dep.state.fl.us<mailto:pharmwaste-bounces at lists.dep.state.fl.us>> On Behalf Of Margaret Shield
Sent: Friday, June 3, 2022 3:50 PM
To: pharmwaste at lists.dep.state.fl.us<mailto:pharmwaste at lists.dep.state.fl.us>
Subject: [Pharmwaste] FDA's proposed mail-back requirement for opioid prescriptions - comments due June 21st!

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Hello, I'm emailing about an important FDA comment period on safe and environmental sound disposal of opioid medications that I hope you can engage in. Comments are due June 21st!

FDA is proposing to use its Opioid Analgesic REMS<https://secure-web.cisco.com/120xXw9lKyjtS9WNRP8EvnLynoEIka03HXxuo2y4Hsnn4wpF1hfEYzRtljP1-FqmQMVEGAopfFfcBu606Zz3clPH9YwvwpVyqW4dLt9KUzd5PZSSWl_CcZl86ykv1dpmE2aFK8nlMGx12TtdEO7en_IpcdAHDP65kJScFgSUhsVl-HLaeH8Ce_VHz43FJtika-FQhpyJeH11aSDYSoEIKQdzqtwC4Y_gFGPcqyvk-X67k7aH76xAI4SAilfjYLnmsw5IJpQFuNLtWOhJM-wYbYWhcWemQ93KEut8gJVc9N-k/https%3A%2F%2Fnam11.safelinks.protection.outlook.com%2F%3Furl%3Dhttps%253A%252F%252Fsecure-web.cisco.com%252F1pTLCljyro7rnsOFu58daQs_Mx7iiKV5vF3FSSHwfgWjYezbzgwToJhaolLOnCMdU81xHH3xjSczdeC1D07DdAbSXfnDc9R-qYbR5ENUGeNxeqtfkFirMxheedur_b_r0svbTnrJqGFdA7sxiLF7qshmFAjzcMudxr49nupRVIgBl0g62-_2S6ibWxM3fu6HpJ8c77CEWaOaSRSCG_YAcIjIsSsesE95XVYdrHE5gGsUkltSc3N8J_hhriCQJWAWqOVSpulZe5H0YgaGXC7dM7A%252Fhttps%25253A%25252F%25252Furldefense.com%25252Fv3%25252F__https%25253A%25252Fsecure-web.cisco.com%25252F1uBd3Uu_RHcXLLy57Mhk-DiTukEoBtiQ1ngLmSaMgCNqSfeq9scMm_TAn6J7cItvg2fndX8f5Vq1c8MWJPYtUOXGHCOuwfls2YH7ZbK0t85H5LVsaNcR963iLIcwnoQBwVzJhWReMelJDtdTD_AKv3ISyKaLXsr8j5G6U3bw28gtzYM_LelDrx83x3hCTCZyWnRar8qIpzKs_aBRsVGNOntlLDPAK4ecPEVQGvyhjAX5nI2bVPXTY0St-rNQC2yACGAWBcVLoixTSWeUNLYDjzIptQ0yO8nn07RqgZJTxA5dAH4u5Qv_yFZs2hwMDegfd12QCQmJNyTNmJQjsIo0fZmXEBQtbb3HO8uu9C2WvlrU%25252Fhttps%25252A3A%25252A2F%25252A2Fgcc02.safelinks.protection.outlook.com%25252A2F%25252A3Furl%25252A3Dhttps%25252A253A%25252A252F%25252A252Fsecure-web.cisco.com%25252A252F1toB8LufNyEipRNEwMNg-KaPgNLG464VCU0AS8SRBq-1v67wl3UEtUR1dohw0lSsHf8u3tfLDIfEYLrso7V0DiLbIvuPiTehaensp_NxJNQrBQ42IQYZvJozCEdGrclyzcgQhJWkZtw68btb9Z_leSkW7Uu2zz3K9N63ipM0t5PFxEXytSHRZcJbCxP-nwKfym0x3IuJEHhhJS6oq7bedJwIe-6v-2A7Ib69sfW1h_-5hEI6CnkhKyVakJQdy6HZRX0q6Dp3I98kTIP3vT74PlSgjRk3HuSPXzO8ADcsxiV4U4To6_Qu5fPDdH7AeyaKEI1x4l7qN_y5SPAkHDbhacw%25252A252Fhttps%25252A25253A%25252A25252F%25252A25252Fwww.fda.gov%25252A25252Fdrugs%25252A25252Finformation-drug-class%25252A25252Fopioid-analgesic-risk-evaluation-and-mitigation-strategy-rems%25252A26data%25252A3D05%25252A257C01%25252A257Cjennifer.volkman%25252A2540state.mn.us%25252A257Cab4d711fe7984c8daa5b08da45a2b4a3%25252A257Ceb14b04624c445198f26b89c2159828c%25252A257C0%25252A257C0%25252A257C637898863100038747%25252A257CUnknown%25252A257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%25252A253D%25252A257C3000%25252A257C%25252A257C%25252A257C%25252A26sdata%25252A3D9V4lJnjiIh9Ka0sWVtTTO%25252A252FU7pZyvyF2o1p8Gd0vqKmI%25252A253D%25252A26reserved%25252A3D0__%25253BJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJQ%252521%252521DHXL-mcXkJmB%252521-2LNc3Brp93egTxOJxwQ6M9m72XKSQUFDU8a0m3mg> authority to require that all opioid drugs are dispensed with a prepaid mail-back envelope and educational material. Drug manufacturers will be responsible for providing this secure and safe medicine disposal method and FDA encourages them to innovate in their design of the mailer, packaging, and service.
>From FDA's media release:
"Mail-back envelopes have several favorable characteristics. They do not require patients to mix medications with water, chemicals or other substances nor use other common at-home disposal techniques. Opioid analgesics sent back to Drug Enforcement Administration-registered facilities in mail-back envelopes do not enter the water supply and landfills (instead, they are incinerated). The nondescript mail-back envelopes provided would be postage paid, offering patients a free disposal option. Additionally, there are long-standing regulations and policies in place to ensure that mail-back envelopes are fit for that purpose and can safely and securely transport unused medicines from the patient's home to the location where they will be destroyed."

Comments supporting FDA's proposed mail-back requirement are needed!
This is a very positive step by FDA, and an action that many of us have advocated for. Making it easy for patients and family members to dispose of unwanted medication - especially potent opioid drugs - is a key prevention strategy to reduce medicine misuse and help prevent poisonings. Mail-back programs are regulated for security by the DEA and ensure non-retrievable destruction that prevents release of APIs into the environment. FDA's mailer requirement would be consistent with existing drug take-back programs - using drop boxes, events, and mailers. This requirement would complement widespread messaging promoting take-back and discouraging disposal of leftover drugs in the household trash or down the sewer from local, state, and federal agencies, and many allied organizations and community groups.

There is a dynamic back story to FDA's good, evidence-based decision. This new requirement is not a certainty yet. For years, FDA has been receiving pressure in many forms from manufacturers of medicine disposal products to choose their disposal mixtures or pouches or this mandatory nationwide requirement. Those companies are pressuring FDA's leaders and lobbying Congress. Yet their products remain inadequately tested for consumer safety, for effectiveness, or for environmental protection. It is not clear that any of the medicine disposal products make drugs non-retrievable. Ultimately all of those products are designed for trash disposal of a liquid or semi-solid mixture of pharmaceuticals and other incompletely identified materials. In the docket already, there is a comment from a medicine disposal product manufacturer supporting their products over DEA-regulated mail-back. There are other comments from entities with ties to those companies.

Your supportive comments, even brief ones, can make a significant difference. Here is more information to assist you in commenting by June 21st.

"Providing Mail-Back Envelopes and Education on Safe Disposal With Opioid Analgesics Dispensed in an Outpatient Setting"
Comments are due by or on Tuesday June 21, 2022.
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Some background resources that support of FDA's mail-back envelope requirement:

  *   2019 comment letter from San Francisco Department of the Environment supporting using REMS authority to require mail-back envelopes with opioid prescriptions. https://secure-web.cisco.com/1i0x1GQetfklW1CdAFsdfShgU3cqqo_82FczBDX1Ccg8A9ByHomZ6Rjp_AlCUmZsXNPpMAqhJ6wRn40gxoBFzYHFefTEsfWOSK38xBBFGbcRIJjbTNyuF5cOtqNJ6SeeSW9bUPptkd1J8V4RN7EA_K8m9pPcraADxji-UEci55AWX_EKHxYPDtdETwdKmS4kwP5YlfmPBJZH-RyT1sfb76GY6K5xRYJ2NvwDYUEuCgOkmfJs8fAFhjJOotyqarYK11bFU33sZhH1TOQe1RdwMRFTagYb-FXqSnOyzwHExsEJ_BezpqIE63nMU8ztcwXVMNYOJK4_NdZ9Fk3Ugh3KCpuM2yUthtzEEBl2Igpr2hBY/https%3A%2F%2Fwww.regulations.gov%2Fcomment%2FFDA-2019-N-1845-0126<https://secure-web.cisco.com/11HUHSGJTLbKRsoibePdlEUBN082pUcBaqmXSLm65TNzp8TaFEGo2Gtx50cS_Pwybs4dvTVr61qvKcgFzAXECljd9BD2ArPgTpTVdwnVKF0nJgVrdRJgDzhQEP4UHPJrOzYByMl_fPhqV3e7o2-3zovRRohbwX-tVK2j0SvCkAhiWy2nLdu_LOzzjKXcvuBcDWJoJFiuHSg2QH0cyAJmTzTBUm5n88JZvYpo5SgJVE555mWeqj8a17h36Ze4Fj7b0kSRPw4JZaenrwyh1WKVa80RtcjYIJcEv0dNh8si-GUA/https%3A%2F%2Fnam11.safelinks.protection.outlook.com%2F%3Furl%3Dhttps%253A%252F%252Fsecure-web.cisco.com%252F1FiYQ30JbxtJ2S_xYzUKFRPQcEnYlaVy5pXz_hvnHvKXWS0eSI7OojxvxFHL6a0PQ4GaJrWh5aCEqEdr_mrAK0eyUT-61qsILeo-qnywdkK_mA8IadWGs79r8mY3Bo-PBdOpeNDMwnCgXkqaeOO1O-1L1qW2Ohn38GudZlVb5VmSig0bECuDKP1G662jL6BK94sMN6sbRXUhCLN_brp4KqHAURNUzYv7HtMm8_mMfGkeNvQszSMeHhsUsPaZ-EnMmrnVq66coM0w3hOfdginkv0nU9wRqCClPguIdTnZX3SZMMBFjPZzYf_Y7mm6W1SqNYEmUcpwYduqZs9ghjwXp8g%252Fhttps%25253A%25252F%25252Furldefense.com%25252Fv3%25252F__https%25253A%25252Fsecure-web.cisco.com%25252F1Di1MLqj6CSSugqVA2R1DKotNPJMLfK1JKjx5jaVYTY94KbNr_L0Jil3e0DluTLY2-TAqQ6MUgMHfM_-oNTKFaJfnp4G4IP9kIkmPJBonACwfzgpeG3xIRJzlXmz-hrPCeS7jug_KIuquNr-2r31zt9a7zjVj_057ot1r0JQFxhRjvZthAhM9tmDNzRpOdJrIfnsYOxX_-BP5fBU1dNIVdgYph7lIR_G9Cwv-WCThdDeQe7GBPSNMTq4AocPDvXqQNhXD5AzocR7AtirMyurkgqOI0MLcLpLynguP0VPTZzYbGf_OJ-lQ3EyHqOA-Fd4lAoCQ4lxNINHTxYNMgMdNi7RT4-8iw-lX4_2gAnSLHWA%25252Fhttps%25252A3A%25252A2F%25252A2Fgcc02.safelinks.protection.outlook.com%25252A2F%25252A3Furl%25252A3Dhttps%25252A253A%25252A252F%25252A252Fsecure-web.cisco.com%25252A252F160YJ78bZWfh-hbAwMzX0d-jTMlUCwgQzw1OraY14JD94cNgt5BMjpxLpJFgqgtm_ovwXMzec_7H1hAh-9tlJgVKKG8pQB1izBzdKodoD6erBNNQna2Ar3Vpa0H0dE9Fm35EkUR6Zptd_REeusQdoRtk94zvgSMxdFRwZSqTRTjNF9xPtZskheK7KwQdvoh7hC5WaCbtE26_frycXq81A0nXFxYqJwT7ZiXjC-mqGLFsDA20-tVPLskujk7Y8ncVsp0OQE7DGQaANUOkhlKGyET2yDRfPiqnNt5lmG42bHAkzqbHWZeX-QiFlY1MpfqTFWcm140uZxrM2_584S7zYqg%25252A252Fhttps%25252A25253A%25252A25252F%25252A25252Fwww.regulations.gov%25252A25252Fcomment%25252A25252FFDA-2019-N-1845-0126%25252A26data%25252A3D05%25252A257C01%25252A257Cjennifer.volkman%25252A2540state.mn.us%25252A257Cab4d711fe7984c8daa5b08da45a2b4a3%25252A257Ceb14b04624c445198f26b89c2159828c%25252A257C0%25252A257C0%25252A257C637898863100038747%25252A257CUnknown%25252A257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%25252A253D%25252A257C3000%25252A257C%25252A257C%25252A257C%25252A26sdata%25252A3Dc1cMp8Eff83zdkrJqk%25252A252FH7jKPrmoQGx58CdhyrDPG6cg%25252A253D%25252A26reserved%25252A3D0__%25253BJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUl%252521%252521DHXL-mcXkJmB%252521-2LNc3Brp93egTxOJxwQ6M9m72XKSQUFDU8a0m3mgxv>   Portions of this letter could be adapted for your comments.
  *   Link to my 2019 report for SF DOE "Medicine Disposal Products: an overview of products & performance questions" describing the many unknowns and concerns with these products: https://secure-web.cisco.com/1zOEZIN9DNwF--76A4U5aDCi5Hf1CdU96OaWamj4kM3vTmYmgmmvvcDz9Ne0lHYLIRDXSGpSlOpflRrkAKr0puyfyE-Hl5QugUx626JsR_XKWi10qIcFnVRlgtTzIwkCXJVNuiernJd8iHS6PjbiyWUvEapzCYvSJF5qrttnSoC813t1ZdYzwd5FWW7ctZnBMoxgqEMDHZVP0g3Ok-wd6humBOmQgCty-YFo1A3_DAHj-_tkRZVx0eDtRHe214qfl-cv6PG0A4bke_lPhAgXcqTnqywitschMhDze1FrPmpf129cIo5VbOL23a6s3Ze80irSd8_N-ELQV1JP4WW3eCA/https%3A%2F%2Fsfenvironment.org%2Fsites%2Fdefault%2Ffiles%2Ffliers%2Ffiles%2Fmedicinedisposalproducts_march2019.pdf<https://secure-web.cisco.com/1z9RTpKinpT4yvtAE_cCjIN7GUvJxm2n2g-JD6KLij-D_G99AqMb2vhm7I16xrfViW1IsiREppXoFJYzieForf0zpH0Slse0miWd-V6lw8nSAy8n-wm-QqLPN4fxvIzG8TTUnxTNfpeFz09wrKthUw_xOmVW-6AUia8qtuT9-FfjntmN3y5kVpJG8pLsdD6PWjG0yX6fGJCw7hHStKYzzPbtz2jOsY8343_jQJ1Xd5lMy58VU-VTCbhVowVehrRVSMF_QMp8u31NXwDNqfASc6hpjOcXDnKFNQIZuikha83k/https%3A%2F%2Fnam11.safelinks.protection.outlook.com%2F%3Furl%3Dhttps%253A%252F%252Fsecure-web.cisco.com%252F10WRHUtKD6a7wOx1VYRSPNMOQmotuV_I2n9MPL2JvtqSeuKT0OLXVkASj4H0K137yxTpb5geB3aQFCRkLuIeofr76Q1qltzNqPvslzC0jLdMWZ0zlRsFlx9edzdP8uzeXjZegje1t7ifHZGdzR6N1NrwXiwE8fbrCk8XQMHPcnnxVp7aZYT7wHogW0WRYGeS__o4XL0iUdhXJIzfD60FOSglt7mfas95MIPtn1Puhw5gCbo-J_U_zMXlnOp3d1ioOuyYlAd0E25zvDQUQTjWSuA%252Fhttps%25253A%25252F%25252Furldefense.com%25252Fv3%25252F__https%25253A%25252Fsecure-web.cisco.com%25252F1KU4BxvSNB8Nno53DLj_rv91q-G-vrI06v7_oxtOajneHqk_AJUqF-wDkTSIDgRluamy5DtUx7YRdCVk2DC79Z49Z9BuZENbb2enbEMzPL1nXnBCGAIZBOlPHLLHvsHWJ13Sx0ryz7aDCWSQbjk6CGJgyP7LahsMkz5bByGQxbr8UQlpDAlnvcUhppVpB0ZX8yVQYammgULoHtl5GTxQ6H2uJ4c2uTFE5T24hQk4W00aupNjZmUs_TmjHt1FTbMmPNxairahK-5YJ41m0lnEdVxCfWn-rMih8avisUyz3ky6AmWjrplYvPfwEJv_O1yyOjGAniffLMcoz-QCuXapDMJNuA3eFcJlLRClM2DfrLOM%25252Fhttps%25252A3A%25252A2F%25252A2Fgcc02.safelinks.protection.outlook.com%25252A2F%25252A3Furl%25252A3Dhttps%25252A253A%25252A252F%25252A252Fsecure-web.cisco.com%25252A252F1FXaxGp-m9p8_kOJRUbRLHUi9TFm5_lftO1i9RAJX7sHqhM22n80u_33hvt8acseL8LTn6V2XpeJHmlQ6V-_GZUTj4R2Wj_cxOLPbM30_knJDfSiHIsZRdRSeX70ogktx_b-pcYBuEZ4Zc3kTpkKFPVvQOYq-RktZIE1kFz0jK9AD38pPciZBMC0MKmjzPREnrGqQWkq5vw-rteWsIOGmd1RTscvZlO0fvTjd0_yiure5aLkSBm-KeEE9j9rRkuhpI50qbd5QIJ9aNCTFumHTtoSK73sQXrKD38Ly8yNvuaL--cS3MM7czfAdkyoDcZPC%25252A252Fhttps%25252A25253A%25252A25252F%25252A25252Fsfenvironment.org%25252A25252Fsites%25252A25252Fdefault%25252A25252Ffiles%25252A25252Ffliers%25252A25252Ffiles%25252A25252Fmedicinedisposalproducts_march2019.pdf%25252A26data%25252A3D05%25252A257C01%25252A257Cjennifer.volkman%25252A2540state.mn.us%25252A257Cab4d711fe7984c8daa5b08da45a2b4a3%25252A257Ceb14b04624c445198f26b89c2159828c%25252A257C0%25252A257C0%25252A257C637898863100038747%25252A257CUnknown%25252A257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%25252A253D%25252A257C3000%25252A257C%25252A257C%25252A257C%25252A26sdata%25252A3DpX4kNByd0auhEXCCC6tDXdulJsD0ebXVs%25252A252Bx0ugQ7Y%25252A252FA%25252A253D%25252A26reserved%25252A3D0__%25253BJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSUlJSU%252521%252521DHXL-mcXkJmB%252521-2LNc3Brp93egTxOJxwQ6M9m72XKSQUFD>
  *   Link to my PowerPoint presentation with talking points for a June 2021 Duke University workshop sponsored by the FDA on Exploring Options for Safe and Effective In-Home Opioid Disposal https://secure-web.cisco.com/1dW2HTccrIsGTDd5kwSkTstwz8fxrMzZF4nmQlrenjZpGXvup0zyuDaWenWxVEGYKtsu6JhaRyEBV90wXm71ujomSBcwLUdY9ZfF3py30sgksUdgaSkAI7SMdT9XZWf5b5sVVzA-AyAMaYfYvEh7sg8m2KwAUeyGN0MzD4lJiciewxZQu3TNraDPTlbjoJh_EM_qEqPSX6XLe5sIVRf-xV7XbB00VIqmcDY9hVaysn9ty9T5Po0-mJ_OxWR5RzK0XcSphNZW3zxT4oZajGAkf2moJpYZLN7Gxp8vTkXKLhPCwYTW-Xx1Bpdws69iciFRAbyCDjieo16O0s-c7evHztIP_825cYA3PowH4_mQdc9Q/https%3A%2F%2Fdocs.google.com%2Fpresentation%2Fd%2F1ewyN33DGVwHJP4Te1MXPvTMmjifu_xUV%2Fedit%3Fusp%3Dsharing%26ouid%3D115293893377595943300%26rtpof%3Dtrue%26sd%3Dtrue<https://secure-web.cisco.com/1rKvH4Ptahgy5yG-1mu05iGYkV25O6hc4uJDEUdyIU4_LD07ydNiwihk4k-yNysEF0tHHo5xaIskwwgtIXNmEPbT5wQYMuNaq_prhWP8uiy5tnbhuB9v6rZLrz1M5Rsuu54rnqMiqvZomX8paDcr28OOylW6NF4KhxaGfaEoj5g6VSidOIS6jefdcemoq7moD3iy6ao8_0sv6sqrSGAfblXgMINwgMWoEbMgZvbEzsfNzkeXleb-k8eS_hTorCAQ9iVYEwjKM_bkV2MtrwN9Dh2ST_1M0y3SV2Ah3qErlFyk/https%3A%2F%2Fnam11.safelinks.protection.outlook.com%2F%3Furl%3Dhttps%253A%252F%252Fsecure-web.cisco.com%252F1TuF4X6AhAO5pvLAzy1IK7Z1ZYczlsKj7t1LlLmUoQkv52olwAjwG0_To4otezlzQVHLVVknD3ihtKOI5KbaE3pWEFDDPO6UDH2sooCtspBnG-gk87DCnitCieD-HLlZAWTL5c9uuGWReWKNMqxdX5z-wsFhMVq4WI_tCxldDUk2TgogyPygWax0cmKVQW7NWTGD0R4rKgnUrp3A_Sz0-vOkJV0iNmKpz1GGgea4_Tlv30W7cTD1-W-cWLbxxMMrFCvRmutL1jEwc1QyI_NZAqQ%252Fhttps%25253A%25252F%25252Furldefense.com%25252Fv3%25252F__https%25253A%25252Fsecure-web.cisco.com%25252F1OSZY85UnOKGh2uha6o1D-w9nteQzH2K9QQ9I8hxGbx9Udm0cxcmXkvJoZWB_xGekCbntM1OQXxh3Q0kBudAvCs2dLfnVKSw7Gw_1_fnyR1RSp6zk8KAPx4gBis4dKBDgdzPqvgPOr9dS_u3VC_LavhJRkM9ZkPTHnfvEqFpi-srttMxtpB2glyVaDk5GrEyxKAbk52Fk3cG94hjvtA9tkPIy7dnynJS6nMs-kbEowR0Cje6sEMLJozinnEyd_-kW0X5LjEX61qXSjyUM5STyemxDDrRmYDrcd2ovUzkllqbP3tkJu082C2KJJWOYg4oH67rSJt_rQh0GR7gNczpO9PVvdTP1L7s3WY8fLcalCsU%25252Fhttps%25252A3A%25252A2F%25252A2Fgcc02.safelinks.protection.outlook.com%25252A2F%25252A3Furl%25252A3Dhttps%25252A253A%25252A252F%25252A252Fsecure-web.cisco.com%25252A252F13WJFNw2pJYnOLABiHdWgFaur43A3nXyFua0sRQUzKqIZuyM_0CHp2n7KQFB6D2_fY8GuWqTmtPqMM197RomvyUav82COM93GUIyHNhYS2TTkIhqepFuk_ro2qoRTDP86iMVNE8lwI8crIxAM6sA9qVrUAatkyXMv3C7r-93czer5JUGwu2D5cnO3smOJBSLbVhRhFD84Gx_Suxt_wNDooh5X4PznehQZdBGq69NPqqPRgP4kiQIw1L13hdCW0nEX2wnBqSLRgLXy4Aza14KTXS18mPCL4t_FBgUlIcKMDbvYcvHwsYdeA0yVqv0wBCbHLhqDSm3LFlqZrlF8N-0bYg%25252A252Fhttps%25252A25253A%25252A25252F%25252A25252Fdocs.google.com%25252A25252Fpresentation%25252A25252Fd%25252A25252F1ewyN33DGVwHJP4Te1MXPvTMmjifu_xUV%25252A25252Fedit%25252A25253Fusp%25252A25253Dsharing%25252A252526ouid%25252A25253D115293893377595943300%25252A252526rtpof%25252A25253Dtrue%25252A252526sd%25252A25253Dtrue%25252A26data%25252A3D05%25252A257C01%25252A257Cjennifer.volkman%25252A2540state.mn.us%25252A257Cab4d711fe7984c8daa5b08da45a2b4a3%25252A257Ceb14b04624c445198f26b89c2159828c%25252A257C0%25252A257C0%25252A257C637898863100038747%25252A257CUnknown%25252A257CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%25252A253D%25252A257C3000%25252A257C%25252A257C%25252A257C%25252A26sdata%25252A3D2f5yVMDvOzWr%25252A252F4IRyqwUaPYLOKKfSKi0rrKLaYGZl0k%25252A253D%25252A26reserved%25252A3D0__%25253BJSUlJSU>   (this is a Google docs link, if you cannot access, please email me)

Thank you!
Margaret

Margaret Shield, PhD
(pronouns: she/her/hers)
Community Environmental Health Strategies, LLC
margaret.shield at CEHstrategies.com<mailto:margaret.shield at CEHstrategies.com>
mobile:  206-499-5452
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