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<P><FONT COLOR="#0000FF" SIZE=2 FACE="Arial">On 11/14, Wendi Shafir forwarded to this list serv a request from Donna Twickler, EPA Region 5, in the form of Donna's email to me. Here is what I sent to Donna with one small addition (Donna, that is EPA's website on pharmaceuticals and the environment). If anyone else responded to Donna, I invite you to post your response here also.</FONT></P>
<P><B><FONT COLOR="#800000" SIZE=2 FACE="Arial">Barb Bickford,</FONT></B> <FONT COLOR="#800000" SIZE=1 FACE="Arial">Medical Waste Coordinator</FONT>
<BR><FONT COLOR="#800000" SIZE=1 FACE="Arial">WI Dept. of Natural Resources, Bureau of Waste Management</FONT>
<BR><FONT COLOR="#800000" SIZE=1 FACE="Arial">101 S. Webster St., P.O. Box 7921, Madison, WI 53707-7921</FONT>
<BR><FONT COLOR="#800000" SIZE=1 FACE="Arial">Phone: 608-267-3548 FAX: 608-267-2768</FONT>
<BR><FONT COLOR="#800000" SIZE=1 FACE="Arial">barbara.bickford@dnr.state.wi.us OR medical.waste@dnr.state.wi.us</FONT>
<BR><FONT COLOR="#800000" SIZE=1 FACE="Arial">DNR medical waste information: </FONT><A HREF="file://www.dnr.wi.gov/org/aw/wm/medinf/"><U></U><U><FONT COLOR="#0000FF" SIZE=1 FACE="Arial">www.dnr.wi.gov/org/aw/wm/medinf/</FONT></U></A>
<BR><FONT COLOR="#800000" SIZE=1 FACE="Arial">Hospitals for a Healthy Environment: </FONT><A HREF="file://www.h2e-online.org"><U></U><U><FONT COLOR="#0000FF" SIZE=1 FACE="Arial">www.h2e-online.org</FONT></U></A>
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<P><FONT SIZE=1 FACE="Tahoma">______________________________________________ </FONT>
<BR><B><FONT SIZE=1 FACE="Tahoma">From: </FONT></B> <FONT SIZE=1 FACE="Tahoma">Bickford, Barbara J. </FONT>
<BR><B><FONT SIZE=1 FACE="Tahoma">Sent: </FONT></B> <FONT SIZE=1 FACE="Tahoma">Thursday, November 10, 2005 4:33 PM</FONT>
<BR><B><FONT SIZE=1 FACE="Tahoma">To: </FONT></B> <FONT SIZE=1 FACE="Tahoma">'Twickler.Donna@epamail.epa.gov'</FONT>
<BR><B><FONT SIZE=1 FACE="Tahoma">Subject: </FONT></B> <FONT SIZE=1 FACE="Tahoma">Drug collection information</FONT>
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<P><FONT SIZE=2 FACE="Courier New">Donna, my answers are indented below.</FONT>
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<P><FONT SIZE=2 FACE="Courier New">Hi Barb,</FONT>
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<P><FONT SIZE=2 FACE="Courier New">USEPA Region 5 was approached by CDC to participate in a pharmaceutical collection program with them (and FDA) in Michigan. The focus of their collection is antibiotics, however they will accept other solid pharmaceuticals that are not considered controlled substances.</FONT></P>
<P><FONT SIZE=2 FACE="Courier New">Apparently this is the first time CDC has done this, so they are looking for information and support. I mentioned Wisconsin has a pharmaceutical collection in Madison scheduled this Fall. CDC has contacts in Madison, so they are very interested in the specifics of the Madison collection event. I was wondering whether you could provide me with some specific information on the collection, which I can share with CDC?</FONT></P>
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<P><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">The collection will be April 29, 2006, not this fall. Contact: </FONT>
<BR><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">Grace Welham, Pharm.D.</FONT>
<BR><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">Drug Information Pharmacist</FONT>
<BR><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">Dean Health System</FONT>
<BR><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">(608) 250-1198</FONT>
<BR><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">grace.welham@deancare.com</FONT>
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<P><FONT SIZE=2 FACE="Courier New">The proposed Michigan collections would involve secure drop off containers/totes located at Meijer stores throughout Michigan, for a 3</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">month period. It's unclear whether these containers would be situated</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">in the customer area near the pharmacy or behind the counter. They will be somehow monitored by the pharmacy staff.</FONT></P>
<P><FONT SIZE=2 FACE="Courier New">The first question CDC asked is whether USEPA has any containers for depositing the pharmaceutical bottles in the container, but would prevent access to the drugs after they had been deposited. An example is a mailbox type container, either attached to a wall or free standing</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">that is secured. USEPA Region 5 does not have this type of container</FONT></P>
<P><FONT SIZE=2 FACE="Courier New">nor the ability to purchase them. Along these lines I was wondering what type of containers Wisconsin used/will use for their one day collection. Are you aware of containers that meet the above description in the healthcare setting that could possibly be borrowed for the duration of the project? I saw a medical waste contaier in the Federal</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">Occupational Health office today, when I received a flu shot. It was</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">designed like a mailbox, however it was smaller than would be needed for</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">pharmaceutical collections. The nurse thought there were larger</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">containers of the same design available for purchase.</FONT></P>
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<P><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">I don't know what containers Dean Health Systems intends to use. I suppose they will receive them, sort out the controlled substances, sharps, mercury thermometers, and aerosals and put the remainder directly into DOT compliant shipping containers.</FONT></P>
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<P><FONT SIZE=2 FACE="Courier New">The question I have is whether theMichigan project group had coordinated with U.S. Drug Enforcement Agency to date. I know you have received guidance from their DC HQ DEA office. I am not sure that the only thing that the project team has to do is say "no controlled substances will be collected". Do individuals always know whether their perscription is a controlled substance? Does it matter whether or not the individual deposits the drug directly into the container or the pharmacy staff</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">deposits it. How are containers typically secured? I know that the</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">DEA issues drive most programs to have 1 day pharm collection events, due to the fact that a law enforcement official has to be present during the collection.</FONT></P>
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<P><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">I don't know if prescriptions must be labelled as controlled substances. Even if they are, you cannot guarantee that CSs won't be brought in. Charlotte Smith told us last week that about 10% of prescriptions are CS's, which is a lot, and for painkillers (as are used after oral surgery) there are often unused Rx's out there in medicine cabinets.</FONT></P>
<P><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">I haven't heard anything to suggest that the person must deposit the drug vs the collector. I have heard of that for sharps, if the collector touches the container, they must have bloodborne pathogen training and have been offered the shots. This is really more of an OSHA issue, and maybe you should ask them. </FONT></P>
<P><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">Again, I don't know much about the containers or how they are secured.</FONT>
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<P><FONT SIZE=2 FACE="Courier New">Also, could you provide me with the name of the person at DEA you with</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">whom you have been coordinating? I would like to contact them</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"></FONT> <FONT SIZE=2 FACE="Courier New">directly, to ask them if they would like to or feel they need to participate on the work group. I would also like to ask whether they have secure containers that could be borrowed for the 3 month duration of the project. It is estimated that approximately 190 containers would be needed.</FONT></P>
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<P><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">I'll try to forward the letter Grace got from DEA.</FONT> <FONT COLOR="#0000FF" SIZE=2 FACE="Arial">[I did, and Grace had posted it to this listserve in mid-September]</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New"></FONT>
<BR><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">Charlotte Smith was at a meeting sometime recently where a DEA person said DEA may have to change its rules to accommodate drug collections. DEA is aware that their rules present a road block and force people to flush/landfill contrulled substances, and that that is not good for the environment. </FONT></P>
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<P><FONT SIZE=2 FACE="Courier New">CDC decided to use Phamlink (sp) for disposal. I don't know anything about this company, but according to CDC they meet all applicable</FONT></P>
<P><FONT SIZE=2 FACE="Courier New">disposal regulations (including EPAs). What company are you using for</FONT>
<BR><FONT SIZE=2 FACE="Courier New">disposal?</FONT>
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<P><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">I am not sure but I think they are using Onyx.</FONT>
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<P><FONT SIZE=2 FACE="Courier New">The last question I have is whether Wisconsin has information on the environmental hazards associated with the improper disposal of</FONT></P>
<P><FONT SIZE=2 FACE="Courier New">pharmaceuticals. We are checking with our headquarters office to</FONT>
<BR><FONT SIZE=2 FACE="Courier New">determine if there is any EPA information on this available for distibution.</FONT>
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<P><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">Nothing specific from us. USGS has done some studies linking the presence of some compounds with problems in aquatic life.</FONT><FONT COLOR="#0000FF" SIZE=2 FACE="Arial"> </FONT> <FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">EPA information on the environmental hazards associated with the improper disposal of pharmaceuticals is available at </FONT><A HREF="file://www.epa.gov/nerlesd1/chemistry/pharma/index.htm"><U></U><U><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">www.epa.gov/nerlesd1/chemistry/pharma/index.htm</FONT></U></A><FONT COLOR="#0000FF" SIZE=2 FACE="Courier New">.</FONT> </P>
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<P><FONT SIZE=2 FACE="Courier New">Any information you could provide would be greatly appreciated.</FONT>
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<P><FONT SIZE=2 FACE="Courier New">Thanks!</FONT>
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<P><FONT SIZE=2 FACE="Courier New">Donna</FONT>
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