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<p class=MsoNormal><st1:City w:st="on"><st1:place w:st="on"><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:navy'>Charlotte</span></font></st1:place></st1:City><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:navy'> et al. -- This is one of the key unanswered questions of the
moment. I am aware of only two published studies that try to assess what
people do with old/unused medications, both via surveys. Neither directly
answers the question, but both at least give a glimmer of what avenue people
use for disposal, and the more recent study also attempts to proportion out use
vs. disposal avenues.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>A ten-year-old study from <st1:City w:st="on"><st1:place
w:st="on">Pittsburg</st1:place></st1:City> (I have only seen references to it,
have not tracked down the original article), appears to be the only American data
published: Kuspis, D.A., and E.P. Krenzelok. 1996. "What
happens to expired medications? A survey of community medication
disposal." <i><span style='font-style:italic'>Vet. Human Toxicol</span></i>.
38: 48-49. The survey found that 54 percent of people dispose of unused
medications in the solid waste, 35 percent via the sink or toilet, and only 1
percent by returning them to pharmacies (as summarized in the following source).<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>In the December, 2005, issue of <i><span
style='font-style:italic'>Environmental Health Perspectives</span></i> (available
on-line earlier), a new British study gives us the most useful look at this
issue: Bound, J.P., and N. Voulvoulis. 2005. "Household
disposal of pharmaceuticals as a pathway for aquatic contamination in the <st1:country-region
w:st="on"><st1:place w:st="on">United Kingdom</st1:place></st1:country-region>."
<i><span style='font-style:italic'>Environmental Health Perspectives</span></i>
113 (12): 1705-1711 (accessible at: <a
href="http://ehp.niehs.nih.gov/members/2005/8315/8315.pdf">http://ehp.niehs.nih.gov/members/2005/8315/8315.pdf</a>
). This survey of residents in southeast <st1:country-region w:st="on"><st1:place
w:st="on">England</st1:place></st1:country-region> found that, on average,
half do not finish prescription medications and thus end up with waste
medications to dispose. While 80 percent of pain meds are typically used
up, only 18 percent of antibiotics are used as prescribed, leaving 82 percent
as waste. Roughly half of beta-blockers and anti-depressants go
unused. Overall, British residents dispose of 63 percent of used meds in
the solid waste, 11 percent in the toilet, and bring 22 percent back to
pharmacies. The authors present a very useful conceptual model for quantifying
the pathways of pharmaceuticals from domestic use into the environment.
They conclude, "...disposal of unused pharmaceuticals either by
household waste or via the sink or toilet may be a prominent route that
requires greater attention."<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>If we could get some up-to-date surveys of
this kind here in the states, they would be very useful to enlighten us all and
help fill in the blanks in the Bound and Voulvoulis model. Maybe together
with the non-compliance rate information that Dr. Gressitt has referred to, we
could begin to get our arms around a rough quantification of waste
pharmaceuticals in this country.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>I hope this helps.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>-- Dave Galvin<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> Local Hazardous Waste
Management Program in <st1:place w:st="on"><st1:PlaceName w:st="on">King</st1:PlaceName>
<st1:PlaceType w:st="on">County</st1:PlaceType></st1:place><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> <st1:place w:st="on"><st1:City
w:st="on">Seattle</st1:City>, <st1:State w:st="on">Washington</st1:State></st1:place><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> 206-263-3085<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'> <a
href="mailto:Dave.Galvin@metrokc.gov">Dave.Galvin@metrokc.gov</a> <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<div>
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face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> Charlotte A.
Smith [mailto:csmith@pharmecology.com] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Friday, November 11, 2005
6:01 AM<br>
<b><span style='font-weight:bold'>To:</span></b> Gilliam, Allen;
pharmwaste@lists.dep.state.fl.us<br>
<b><span style='font-weight:bold'>Cc:</span></b> Stevan Gressitt<br>
<b><span style='font-weight:bold'>Subject:</span></b> RE: [Pharmwaste]
Percentage of waste drugs from unwanted consumer meds</span></font><o:p></o:p></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Thanks, Allen, and much success at your
seminar. Will you be discussing drug waste with folks? The more often the
better! <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Steve, if you have any hard data, that
would be very helpful. I have given your name to the <st1:place w:st="on"><st1:State
w:st="on">Washington</st1:State></st1:place> staffers, so they may be
contacting you. Hope you don't mind! <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><o:p> </o:p></span></font></p>
<div>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Charlotte A. Smith, R. Ph., M.S., HEM</span></font><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>President</span></font><font color=navy><span
style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>PharmEcology Associates, LLC</span></font><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><st1:Street w:st="on"><st1:address w:st="on"><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:navy'>200 S. Executive Drive, Suite 101</span></font></st1:address></st1:Street><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><st1:place w:st="on"><st1:City w:st="on"><font size=2
color=navy face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:navy'>Brookfield</span></font></st1:City><font size=2 color=navy
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:navy'>, <st1:State
w:st="on">WI</st1:State> <st1:PostalCode w:st="on">53005</st1:PostalCode></span></font></st1:place><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>262-814-2635</span></font><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>Fax: 414-479-9941</span></font><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><a href="mailto:csmith@pharmecology.com">csmith@pharmecology.com</a></span></font><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'><a href="http://www.pharmecology.com">www.pharmecology.com</a></span></font><font
color=navy><span style='color:navy'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=navy face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:navy'>H2E Champion for Change Award 2004</span></font><o:p></o:p></p>
</div>
<div>
<div class=MsoNormal align=center style='text-align:center'><font size=3
face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabindex=-1>
</span></font></div>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:Tahoma;font-weight:bold'>From:</span></font></b><font size=2
face=Tahoma><span style='font-size:10.0pt;font-family:Tahoma'> Gilliam, Allen
[mailto:GILLIAM@adeq.state.ar.us] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Friday, November 11, 2005
7:38 AM<br>
<b><span style='font-weight:bold'>To:</span></b> Charlotte A. Smith;
pharmwaste@lists.dep.state.fl.us<br>
<b><span style='font-weight:bold'>Cc:</span></b> Stevan Gressitt<br>
<b><span style='font-weight:bold'>Subject:</span></b> RE: [Pharmwaste]
Percentage of waste drugs from unwanted consumer meds</span></font><o:p></o:p></p>
</div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
<div>
<p class=MsoNormal><st1:City w:st="on"><font size=2 color=blue face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:blue'>Charlotte</span></font></st1:City><font
size=2 color=blue face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:blue'> (we're gonna miss ya at our next H2E seminar in n.w. <st1:place
w:st="on"><st1:State w:st="on">arkansas</st1:State></st1:place> in january!),</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>i hope Stevan (cc'd above) will respond
with more detailed info he had provided (back in july?)
regarding "non-compliance rates" (% of meds not used by residential
recipients). i believe he referred to another person and
report (by a pharmaceutical company?) that indicated 40 to 60 % of
drugs prescribed are "tossed". the med's final resting
place (landfill or toilet?) i don't believe was mentioned because of lack of
data. i believe he even estimated the monetary losses to states'
healthcare programs to be about $1 million for a state the size of <st1:place
w:st="on"><st1:State w:st="on">arkansas</st1:State></st1:place> (~2.5 million
population) because of this waste. considering today's economic woes and
the rising costs of healthcare, one would think state legislators' eyes would
pop out of their sockets if they had this type of info and try to mitigate.</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>Stevan? think you can dig up that
source again?</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>Thanx in advance,</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>allen gilliam</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>adeq state pretreatment coordinator</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>501.682.0725</span></font><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'> <o:p></o:p></span></font></p>
</div>
<blockquote style='margin-top:5.0pt;margin-right:0in;margin-bottom:5.0pt'>
<p class=MsoNormal style='margin-bottom:12.0pt'><font size=2 face=Tahoma><span
style='font-size:10.0pt;font-family:Tahoma'>-----Original Message-----<br>
<b><span style='font-weight:bold'>From:</span></b>
pharmwaste-bounces@lists.dep.state.fl.us
[mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b><span style='font-weight:
bold'>On Behalf Of </span></b>Charlotte A. Smith<br>
<b><span style='font-weight:bold'>Sent:</span></b> Thursday, November 10, 2005
4:16 PM<br>
<b><span style='font-weight:bold'>To:</span></b>
pharmwaste@lists.dep.state.fl.us<br>
<b><span style='font-weight:bold'>Subject:</span></b> [Pharmwaste] Percentage
of waste drugs from unwanted consumer meds</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>Hello,<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>I just received a call from a staffer at the US House of
Representatives Science Committee inquiring as to what percentage of drugs entering
the environment, primarily through drain/sewer disposal, can be attributed to
consumers flushing unwanted medications. I do not know of any studies on this
or available data. Do any of you have information you can share that I can
refer back to this gentleman? It appears the House of Representatives is
starting to become interested in this issue so I think we should do all we can
to make the case for enabling legislation, especially with respect to DEA and
funding of programs. Thanks much! <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><o:p> </o:p></span></font></p>
<p class=MsoNormal><st1:PersonName
style="BACKGROUND-POSITION: left bottom; BACKGROUND-IMAGE: url(res://ietag.dll/#34/#1001); BACKGROUND-REPEAT: repeat-x"
w:st="on"><font size=2 face=Arial><span style='font-size:10.0pt;font-family:
Arial'>Charlotte A. Smith</span></font></st1:PersonName><font size=2
face=Arial><span style='font-size:10.0pt;font-family:Arial'>, R. Ph., M.S., HEM</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>President</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>PharmEcology Associates, LLC</span></font><o:p></o:p></p>
<p class=MsoNormal><st1:Street w:st="on"><st1:address
style="BACKGROUND-POSITION: left bottom; BACKGROUND-IMAGE: url(res://ietag.dll/#34/#1001); BACKGROUND-REPEAT: repeat-x"
w:st="on"><font size=2 face=Arial><span style='font-size:10.0pt;font-family:
Arial'>200 S. Executive Drive, Suite 101</span></font></st1:address></st1:Street><o:p></o:p></p>
<p class=MsoNormal><st1:place w:st="on"><st1:City w:st="on"><font size=2
face=Arial><span style='font-size:10.0pt;font-family:Arial'>Brookfield</span></font></st1:City><font
size=2 face=Arial><span style='font-size:10.0pt;font-family:Arial'>, <st1:State
w:st="on">WI</st1:State> <st1:PostalCode w:st="on">53005</st1:PostalCode></span></font></st1:place><o:p></o:p></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>262-814-2635</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>Fax: 414-479-9941</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><a href="mailto:csmith@pharmecology.com">csmith@pharmecology.com</a></span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'><a href="http://www.pharmecology.com">www.pharmecology.com</a></span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>H2E Champion for Change Award 2004</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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