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<div class=Section1>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Here’s what the Guidance does. It brings the topic up to a
higher level of public discussion if not awareness. It helps legitimize concern
about the subject. It provides a solution that begs for the 2 year time frame to
get used constructively. It serves as a challenge for us to “provide
better.” It also leaves open the fact that there may very well be no one single
solution. I for one do not believe there is one singular cookie cutter
solution. They have offered encouragement for local communities to engage in
collaboration with police in addressing the drug problem with collaborative
takebacks. That is a very good thing to get the police and community not just
talking but doing something together. Too many programs of the police initiated
type get little take up in the community. This is one where the community will
bring them along. I believe that is healthy. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>When I go into Irving to pay for gas there is a coffeepot with
some genuine never-seen-a-cow “flavoring cream” I can put in
my coffee. So it seems to me a little Oxycontin in with the ground is just
another, might just be a new recipe for variety. Who knows maybe Starbucks
might experiment in their labs. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>What I am more concerned is the raccoon that rips up my garbage,
the mice or the failure of the landfill and the fact that the leachate is going
to plow right through our current level water treatment plants.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>It will take some time to get fully organized, but a debate on
the guidelines is needed, an open debate, with more than just governmental
agencies. Though we had some initial plans for next year’s conference, we
have talked and will suggest that given that there is some time for preparation,
that a significant amount of the 4<sup>th</sup> Annual Unused Drug Disposal
Conference be set up to offer that discussion with the ONDCP. We need a review
of thoughts, folks will have had time to consult within their own local
organizations and come up with a considered reply/proposal by then ( End of
October in Portland Maine.) Other Federal agencies will need to be involved,
but these guidelines need the input of a broad swath of those who have been
working on this. I will be formalizing this, but ONDCP will need feedback as
well. This is an opportunity for all of us to move forward I believe. If we
approach this as more of a “congress” than a “conference”
we will be more constructive. If we recognize that last year feedback for our
conference included that there was too little time for networking and
conversation, and we do, we plan to curtail the “classroom sessions”
in order to have more dialogue, but now perhaps it should be more consensus
building as well. I welcome response to this idea either on list or privately. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>I truly believe ONDCP has given us, ourselves, 2 years
ahead to do better. To be constructive. I will continue with a few more
conversational items, not solutions.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Looking at the guidelines themselves, they don’t even look
like an official document with the weight of a finished product. I trust the
Drug Strategy Document. I do not believe that the level of support for that
guideline meets what is needed for Federal cross departmental needs. Fish and
Wildlife for instance, OSHA, DOT, and I’ll include the US Postal Service.
SAMHSA has it’s own iron as does NIDA in this conflagration. And as the
numbers on prescription drug abuse soar from some Federal policies themselves,
in my personal opinion, there may be inter-federal agency issues that need to
be resolved. As an example I point to eh unintended ( and I do believe
unintended) consequences of Medicare Part D, with no more take backs to
pharmacies that some states had put in place and no interest to date by the
Prescription Management Programs to initiate any similar process. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>I also wonder if there isn’t a dearth of landfill types as
opposed to water types and hazardous waste folks ( Now I use my MD to claim
ignorant outsider status) who have spoken up on the proposals to solve the
problem? I actually don’t know, but I seem to think there are more “water
people” or “Household Hazardous Waste” people writing on this
list, but I’m not sure. I wonder if Laurie knows what the balance is? I
just wonder if the landfill “types” have had their fair time to
talk? <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>I have lost track of some people who have become disillusioned
by the unresponsiveness of one agency or another, and when I’ve contacted
them there is a sense of failure. A sense that the bureaucracy has tamped down
their efforts. ( I am a psychiatrist after all.) And I would like to suggest we
take this for what it is, a step in the awkward ungainly process of maturing a
project, developing a plan, and making progress. <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>And I take full responsibility for all I just wrote, if I
offended anyone, but I didn’t mean to.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Stevan Gressitt, M.D.<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>207-441-0291<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><a href="http://www.mainebenzo.org">www.mainebenzo.org</a> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'><o:p> </o:p></span></p>
<div>
<div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'>
<p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";
color:windowtext'>From:</span></b><span style='font-size:10.0pt;font-family:
"Tahoma","sans-serif";color:windowtext'>
pharmwaste-bounces@lists.dep.state.fl.us
[mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>Pete
Pasterz<br>
<b>Sent:</b> Friday, February 23, 2007 4:39 PM<br>
<b>To:</b> Price, John L.; rachel golden<br>
<b>Cc:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> RE: [text][html][heur] RE: [Pharmwaste] Federal Government
issues drug disposal guidance -if not that, then what?<o:p></o:p></span></p>
</div>
</div>
<p class=MsoNormal><o:p> </o:p></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>John--</span><span style='color:windowtext'><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>I agree that we have to make a concrete recommendation when
asked; however IMHO, there are problems with both the federal guidelines
AND your recommendations. </span><span style='color:windowtext'><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>First, with the Federal guidelines, not everyone has a cat or
drinks coffee [I don't]. There is really no destruction of the pills, so
they are still readily identified. There's a risk of inadvertent
depositing the grounds/pills mix in the backyard compost. And I'm not sure
that coffee grounds are a sufficient deterrent to a prescription drug addict;
it would have to be WAY MORE disgusting [cat litter MAY be, if its USED,
but the Federal Guidelines do not specify].</span><span style='color:windowtext'><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>With your FL guidelines, I also have concerns about patient
confidentiality if the information is just crossed out and the label NOT
removed. And, although I'm sure prescription drug abusers know what
the pills they are targeting look like, I'm uncomfortable in having a billboard
on the containers saying "Oxycontin in Here".</span><span
style='color:windowtext'><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>I DO like your idea of dissolving the pills, but expanded more
fully, so that they are TOTALLY dissolved into newspaper, paper towel,
shredded paper, old rags, etc. </span><span style='color:
windowtext'><o:p></o:p></span></p>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>I don't like the packaging from either the Federal or FL
guidelines. The problem with the FL recommendation is that the vial
is not water tight, and the duct or packaging tape will not make it so.
The amber PP vials are also brittle, cracking easily under pressure when
the coffee can gets crushed around it, or the snap-on flimsy lid pops off
and it falls out [I DO like detergent bottle, but with more
prep; see below]. This means it can LEAK into the rest of the trash, and
thus become part of the ooze coming out of the garbage truck onto streets and
into rivers, or become leachate in a landfill [obviously not an issue if your
community uses an incinerator, but most of US trash is still
landfilled]. Leachate is treated at POTWs, and we know they are
largely ineffective in treating drugs.</span><span style='color:windowtext'><o:p></o:p></span></p>
<div>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>The problem with Fed guidelines is similar...the plastic
bags break easily under pressure of a compacting trash truck or the
compaction equipment at landfills, resulting in the same problems listed
above. And if the bag [or vial] should survive the compaction upon
deposit, they can still degrade and break over time under increasing pressure
of trash piled on top...the dirty little secret of "dry tomb
landfills"...EPA says they will all leak in time...maybe 30 - 60 years,
after the financial responsibility of the owner has ended, and long after most
remember that the land WAS and landfill. This means a encapsulate
drug which has not leached upon deposit becomes a "timed-release"
drug dose to groundwater.</span><span style='color:windowtext'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>So, you're probably wondering what I suggest....here goes [while
holding my nose]:</span><span style='color:windowtext'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>1] Crush and mix all pills/liquids together onto absorbent such as
napkins, kleenex, papertowels, newspaper, shredded paper, cat litter, rags,
etc... with just enough water to dissolve them into paste. 2]Place
absorbent/paste mix into a locking plastic bag, squeeze out excess air, and
seal. 3]Place bag into second plastic locking bag , squeeze excess
air, seal 4]Place into old detergent bottle, squeeze excess
air, and replace cap 5]Discard inconspicuously in trash DO NOT
FLUSH OR POUR DOWN DRAIN</span><span style='color:windowtext'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>Yes, this is also subject to breaking under pressure, but it's less
likely because of the toughness of the detergent bottle, the double bagging and
removing the "popping balloon" effect by squeezing out the excess
air. It also addresses the issue of palatability of the drugs by
addicts or by children. It still CAN leak, but this reduces the
risk/buys more time...</span><span style='color:windowtext'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>I'm not sure this passes the "Convenience Test"
that Rachel has raised so that people would be deterred enough just to
flush...but I see it as an interim recommendation while we work toward Producer
Responsibility/changes in Drug Law to allow for better return and recycling
solutions.</span><span style='color:windowtext'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='color:windowtext'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>Pete Pasterz</span><span style='color:windowtext'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>Cabarrus County HHW</span><span style='color:windowtext'><o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Comic Sans MS";
color:blue'>Concord, NC</span><span style='color:windowtext'><o:p></o:p></span></p>
</div>
<p class=MsoNormal><span style='color:windowtext'><o:p> </o:p></span></p>
<div class=MsoNormal align=center style='text-align:center'><span
style='color:windowtext'>
<hr size=2 width="100%" align=center>
</span></div>
<p class=MsoNormal style='margin-bottom:12.0pt'><b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:windowtext'>From:</span></b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif";color:windowtext'>
pharmwaste-bounces@lists.dep.state.fl.us
[mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>Price,
John L.<br>
<b>Sent:</b> Friday, February 23, 2007 2:19 PM<br>
<b>To:</b> rachel golden<br>
<b>Cc:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> [text][html][heur] RE: [Pharmwaste] Federal Government issues drug
disposal guidance -if not that, then what?</span><span style='color:windowtext'><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-family:"Arial","sans-serif";color:blue'>Rachel:
I appreciate your critique and thoughts about this. Not sure I’m
with you on the “First of all” but I would concur with you on the
“Second.” And I agree that this guidance does not completely
acknowledge or address this “enormous issue.” I do find it to be a
step in the right direction, though.</span><o:p></o:p></p>
<p class=MsoNormal> <o:p></o:p></p>
<p class=MsoNormal><span style='font-family:"Arial","sans-serif";color:blue'>May
I ask, however, what DO you recommend as practical guidance to the general
public’s inquiries if not this? From where I sit, we cannot answer
inquiries about “What should I do with my unwanted pharmaceuticals”
with “Well, we aren’t sure what you should do, but don’t do
this.” That’s an incomplete answer. People who want to do the
right thing, and ask us what that is, need to be given our best guidance based
on what we know that, while not perfect, easy, etc., allows them to do
SOMETHING positive or at least SOMETHING less negative. In my opinion,
that’s what fostering public buy-in to environmental protection is all
about – empowering people to help in some small or big way.</span><o:p></o:p></p>
<p class=MsoNormal> <o:p></o:p></p>
<p class=MsoNormal><span style='font-family:"Arial","sans-serif";color:blue'>I
have attached our agency’s answer to inquiries about “What should I
do with my unwanted pharmaceuticals?” Also, find at <a
href="http://www.dep.state.fl.us/waste/quick_topics/publications/shw/meds/DEPMedicationDisposalFlyer111706Final.pdf">http://www.dep.state.fl.us/waste/quick_topics/publications/shw/meds/DEPMedicationDisposalFlyer111706Final.pdf</a>.
</span><o:p></o:p></p>
<p class=MsoNormal> <o:p></o:p></p>
<p class=MsoNormal><span style='font-family:"Arial","sans-serif";color:blue'>Thanks
for the post and for any feedback to mine.</span><o:p></o:p></p>
<p class=MsoNormal> <o:p></o:p></p>
<p class=MsoNormal><span style='font-family:"Arial","sans-serif";color:blue'>Jack.</span><o:p></o:p></p>
<p class=MsoNormal> <o:p></o:p></p>
<div>
<p class=MsoAutoSig><span style='color:blue'>John L. (Jack) Price</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>Environmental Manager</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>Hazardous Waste Management MS 4555</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>Florida Department of
Environmental Protection</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>2600 Blair Stone Road</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>Tallahassee, FL 32399-2400</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>Phone:850.245.8751</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>Fax: 850.245.8811</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>john.l.price@dep.state.fl.us</span><o:p></o:p></p>
<p class=MsoAutoSig><span style='color:blue'>www.dep.state.fl.us/waste</span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:7.5pt;font-family:"Arial","sans-serif"'>Please
Note: Florida has a very broad public records law. Most written
communications to or from state officials regarding state business are public
records available to the public and media upon request. Your e-mail is
communications and may therefore be subject to public disclosure.</span><o:p></o:p></p>
</div>
<div>
<div class=MsoNormal align=center style='text-align:center'><span
style='color:windowtext'>
<hr size=2 width="100%" align=center>
</span></div>
<p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif";
color:windowtext'>From:</span></b><span style='font-size:10.0pt;font-family:
"Tahoma","sans-serif";color:windowtext'>
pharmwaste-bounces@lists.dep.state.fl.us [mailto:pharmwaste-bounces@lists.dep.state.fl.us]
<b>On Behalf Of </b>rachel golden<br>
<b>Sent:</b> Friday, February 23, 2007 12:06 PM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> Re: [Pharmwaste] Federal Government issues drug disposal
guidance</span><o:p></o:p></p>
</div>
<p class=MsoNormal> <o:p></o:p></p>
<p class=MsoNormal>Concerning the Federal Government Drug Disposal Guidance...<br>
<br>
I'm not quite sure where to begin...<br>
<br>
First of all, the fact of the matter is that people just won't do this.
The folks who are calling our organizations and asking about how they can
safely dispose of their drugs are not representative of the overall population,
and I don't even think all of them would go through the trouble of mixing their
drugs in coffee grounds or cat litter. This is not a realistic solution,
or even a realistic temporary solution. It might be a way to remove any
responsibility from themselves, but it in no way gets us closer to a solution.<br>
<br>
Second, is this the actual guidance document that the public is supposed to get
their information from? Please tell me it's not, and that the writers of
this guidance document are currently working with educators to craft the actual
public document. The reading level is not appropriate for the general
public. Most material for the public is written at a 6th to 8th grade
reading level. The bulleted points in the drug disposal guidance document
are at a 12th grade reading level. I also would not recommend one of the
bullet points reading, "Flush prescription drugs down the toilet only
if..." This guidance document is needed specifically to let people
know NOT to flush their drugs, an action that was once recommended, so giving
guidance that phrases flushing in positive terminology will only confuse
people.<br>
<br>
This is an enormous issue that I think will require law changes as well as the
public being educated to think about waste and disposal in an entirely new
framework. I don't think the guidance document even begins to acknowledge
this.<br>
<br>
Sincerely,<br>
Rachel Golden<o:p></o:p></p>
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<p class=MsoNormal>-- <br>
Rachel Golden<br>
Adult Environmental Education Program Manager<br>
Office of Environmental Education<br>
NC Department of Environment and Natural Resources<br>
1609 Mail Service Center, Raleigh, NC 27699-1609<br>
919-733-0711 (phone) 919-733-1616 (fax)<br>
<a href="mailto:rachel.golden@ncmail.net">rachel.golden@ncmail.net</a><br>
<a href="http://www.eenorthcarolina.org">www.eenorthcarolina.org</a><br>
<br>
Check out the EcoSmart Consumer <a
href="http://www.myspace.com/ecosmartconsumer">MySpace page</a> and <a
href="http://ecosmartconsumer.blogspot.com/">blog</a>!<o:p></o:p></p>
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<p class=MsoNormal><span style='color:windowtext'>DISCLAIMER:<br>
E-mail correspondence to and from this address may be subject to the North
Carolina Public Records Law and may be disclosed to third parties.<o:p></o:p></span></p>
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