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<p class=MsoNormal><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue'>Michele:<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue'>I am working
with the same LTC issue here in <st1:State w:st="on"><st1:place w:st="on">Kansas</st1:place></st1:State>.
Our Kansas Department of Health and Environment, has publish a guidance
document, <a href="http://www.kdheks.gov/waste/guidance/sw07-01.pdf">http://www.kdheks.gov/waste/guidance/sw07-01.pdf</a>,
that applies to the public and most LTC facilities. It documents a
hierarchy for pharmaceutical waste management that lists drain-disposal as the
very last option. <o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue'>Certainly
maximizing the use of return processing programs is the preferred option, but
in LTC it is not an option for controlled substances. I am working with
our Kansas Board of Pharmacy (and the DEA) to determine if these non-RCRA
controlled substances can be “wasted” or disposed of using an absorbent
like kitty liter and then go to the trash. If I understand it correctly, DEA’s
concern is that the controlled substances are destroyed so that they are “non-recoverable.”
Although land filling is not the best option, it is a legal,
practical, and economic option, that keeps these excess and expired pharms from
directly entering our waterways.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue'>If you are not
already aware of it, EPA is planning a teleconference on this topic next week. For
more information contact <a href="mailto:Hessenauer.Meghan@epamail.epa.gov">Hessenauer.Meghan@epamail.epa.gov</a>.
<st1:State w:st="on"><st1:place w:st="on">Kansas</st1:place></st1:State> plans
to host a LTC pharmacy waste management Web cast Dec 13. To learn more
about the <st1:State w:st="on"><st1:place w:st="on">Kansas</st1:place></st1:State>
program go to <a
href="http://www.sbeap.org/publications/Pharmaceutical/index.php">http://www.sbeap.org/publications/Pharmaceutical/index.php</a>.
<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue'><o:p> </o:p></span></font></p>
<div>
<p><font size=1 color=blue face="Comic Sans MS"><span style='font-size:7.5pt;
font-family:"Comic Sans MS";color:blue'>Nancy J. Larson, RS</span></font><font
color=blue><span style='color:blue'><o:p></o:p></span></font></p>
<p><font size=1 color=blue face="Comic Sans MS"><span style='font-size:7.5pt;
font-family:"Comic Sans MS";color:blue'>Director, KSU Pollution Prevention
Institute </span></font><font color=blue><span style='color:blue'><o:p></o:p></span></font></p>
<p><font size=1 color=blue face="Comic Sans MS"><span style='font-size:7.5pt;
font-family:"Comic Sans MS";color:blue'>Small Business Environmental Assistance
Program<br>
316/722-7721 ext. 104<br>
800/578-8898<br>
www.sbeap.org<br>
</span></font><font color=blue><span style='color:blue'><a
href="mailto:NLarson@ksu.edu"><font size=1 face="Comic Sans MS"><span
style='font-size:7.5pt;font-family:"Comic Sans MS"'>NLarson@ksu.edu</span></font></a></span></font><font
size=1 color=blue face="Comic Sans MS"><span style='font-size:7.5pt;font-family:
"Comic Sans MS";color:blue'> </span></font><font color=blue><span
style='color:blue'><o:p></o:p></span></font></p>
<p><em><b><i><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue;font-weight:
bold'>Attend the Diesel Technology Workshop and Equipment Expo, Nov. 2, 2007,
in <st1:place w:st="on"><st1:City w:st="on">Wichita</st1:City>, <st1:State
w:st="on">Kan.</st1:State></st1:place> Learn how your fleets can save
money while improving air quality. This FREE event includes a lunch, but you
must pre-register at </span></font></i></b></em><font color=blue><span
style='color:blue'><a
href="file:///C:\Documents%20and%20Settings\NLarson\Application%20Data\Microsoft\Signatures\www.sbeap.org"><em><b><i><font
size=2 face="Comic Sans MS"><span style='font-size:10.0pt;font-family:"Comic Sans MS";
font-weight:bold'>www.sbeap.org</span></font></i></b></em></a></span></font><em><b><i><font
size=2 color=blue face="Comic Sans MS"><span style='font-size:10.0pt;
font-family:"Comic Sans MS";color:blue;font-weight:bold'> by Oct. 25. The
first 50 registrants will receive a free No-Spill gas can.</span></font></i></b></em><font
color=blue><span style='color:blue'><o:p></o:p></span></font></p>
<p><em><b><i><font size=2 color=blue face="Comic Sans MS"><span
style='font-size:10.0pt;font-family:"Comic Sans MS";color:blue;font-weight:
bold'> </span></font></i></b></em><o:p></o:p></p>
</div>
<div>
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<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'> Price, John L.
[mailto:John.L.Price@dep.state.fl.us] <br>
<b><span style='font-weight:bold'>Sent:</span></b> Tuesday, October 09, 2007
9:23 AM<br>
<b><span style='font-weight:bold'>To:</span></b> Bunnell, Ross; Michele Berger;
<st1:PersonName w:st="on">pharmwaste@lists.dep.state.fl.us</st1:PersonName><br>
<b><span style='font-weight:bold'>Cc:</span></b> Walker-Coleman, Lauren J.;
Redig, Michael<br>
<b><span style='font-weight:bold'>Subject:</span></b> RE: [Pharmwaste] Long
term care drug disposal - still need Floridainformation?</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>
<div>
<p class=MsoNormal><font size=3 color=blue face=Arial><span style='font-size:
12.0pt;font-family:Arial;color:blue'>Michele: I have not seen any more
Pharmwaste chatter on your post. If you have not found the information on <st1:State
w:st="on"><st1:place w:st="on">Florida</st1:place></st1:State>’s
regulations and guidance, please contact me. We do have guidance that
discourages disposal by flushing and encourages other appropriate disposal (see
<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>).
This guidance is written for household users and may not apply to your
facility’s situation. We also allow management of unwanted
medications from commercial facilities under a reverse distribution system and
managed as universal waste (see <a
href="http://www.dep.state.fl.us/waste/quick_topics/rules/documents/62-730.pdf">http://www.dep.state.fl.us/waste/quick_topics/rules/documents/62-730.pdf</a>,
specifically 62-730.186). </span></font><o:p></o:p></p>
<p class=MsoNormal><font size=3 color=blue face=Arial><span style='font-size:
12.0pt;font-family:Arial;color:blue'> </span></font><o:p></o:p></p>
<p class=MsoNormal><font size=3 color=blue face=Arial><span style='font-size:
12.0pt;font-family:Arial;color:blue'>As Ross correctly observed, there may be
other regulations, guidance, etc. that is specific to the local wastewater
authority that receives wastewater from your facility. </span></font><o:p></o:p></p>
<p class=MsoNormal><font size=3 color=blue face=Arial><span style='font-size:
12.0pt;font-family:Arial;color:blue'> </span></font><o:p></o:p></p>
<p class=MsoNormal><font size=3 color=blue face=Arial><span style='font-size:
12.0pt;font-family:Arial;color:blue'>Please let me know what information you
need and we’ll hook you up with the appropriate information resources.</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=3 color=blue face=Arial><span style='font-size:
12.0pt;font-family:Arial;color:blue'> </span></font><o:p></o:p></p>
<p class=MsoNormal><font size=3 color=blue face=Arial><span style='font-size:
12.0pt;font-family:Arial;color:blue'>Jack.</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=3 color=blue face=Arial><span style='font-size:
12.0pt;font-family:Arial;color:blue'> </span></font><o:p></o:p></p>
<div>
<p class=MsoAutoSig><font size=3 color=blue face="Times New Roman"><span
style='font-size:12.0pt;color:blue'>John L. (Jack) Price</span></font><o:p></o:p></p>
<p class=MsoAutoSig><font size=3 color=blue face="Times New Roman"><span
style='font-size:12.0pt;color:blue'>Environmental Manager</span></font><o:p></o:p></p>
<p class=MsoAutoSig><font size=3 color=blue face="Times New Roman"><span
style='font-size:12.0pt;color:blue'>Hazardous Waste Management MS 4555</span></font><o:p></o:p></p>
<p class=MsoAutoSig><font size=3 color=blue face="Times New Roman"><span
style='font-size:12.0pt;color:blue'>Florida Department of Environmental
Protection</span></font><o:p></o:p></p>
<p class=MsoAutoSig><st1:Street w:st="on"><st1:address w:st="on"><font size=3
color=blue face="Times New Roman"><span style='font-size:12.0pt;color:blue'>2600
Blair Stone Road</span></font></st1:address></st1:Street><o:p></o:p></p>
<p class=MsoAutoSig><st1:place w:st="on"><st1:City w:st="on"><font size=3
color=blue face="Times New Roman"><span style='font-size:12.0pt;color:blue'>Tallahassee</span></font></st1:City><font
color=blue><span style='color:blue'>, <st1:State w:st="on">FL</st1:State>
<st1:PostalCode w:st="on">32399-2400</st1:PostalCode></span></font></st1:place><o:p></o:p></p>
<p class=MsoAutoSig><font size=3 color=blue face="Times New Roman"><span
style='font-size:12.0pt;color:blue'>Phone:850.245.8751</span></font><o:p></o:p></p>
<p class=MsoAutoSig><font size=3 color=blue face="Times New Roman"><span
style='font-size:12.0pt;color:blue'>Fax: 850.245.8811</span></font><o:p></o:p></p>
<p class=MsoAutoSig><font size=3 color=blue face="Times New Roman"><span
style='font-size:12.0pt;color:blue'>john.l.price@dep.state.fl.us</span></font><o:p></o:p></p>
<p class=MsoAutoSig><font size=3 color=blue face="Times New Roman"><span
style='font-size:12.0pt;color:blue'>www.dep.state.fl.us/waste</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=1 color=black face=Arial><span style='font-size:
7.5pt;font-family:Arial;color:black'>Please Note: <st1:State w:st="on"><st1:place
w:st="on">Florida</st1:place></st1:State> 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></font><o:p></o:p></p>
</div>
</div>
<div>
<p class=MsoNormal><em><i><font size=2 face=Arial><span style='font-size:10.0pt;
font-family:Arial'>The Department of Environmental Protection values your
feedback as a customer. DEP Secretary Michael W. Sole is committed to continuously
assessing and improving the level and quality of services provided to you.
Please take a few minutes to comment on the quality of service you received. <eXclaimer:HTML_ONLY>Simply
click on <a
href="http://survey.dep.state.fl.us/?refemail=John.L.Price@dep.state.fl.us"
target="_blank">this link to the DEP Customer Survey</a>.</eXclaimer:HTML_ONLY>
Thank you in advance for completing the survey.</span></font></i></em><font
size=1 face="Courier New"><span style='font-size:9.0pt;font-family:"Courier New"'><o:p></o:p></span></font></p>
</div>
<div>
<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'>
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>Bunnell, Ross<br>
<b><span style='font-weight:bold'>Sent:</span></b> Friday, September 14, 2007
4:05 PM<br>
<b><span style='font-weight:bold'>To:</span></b> Michele Berger; <st1:PersonName
w:st="on">pharmwaste@lists.dep.state.fl.us</st1:PersonName><br>
<b><span style='font-weight:bold'>Subject:</span></b> RE: [Pharmwaste] Long
term care drug disposal</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=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>Michele:</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>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>If you haven't done so already, check with
the Florida DEP and the local sewer authority to see what their rules are concerning
sewage discharges.</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>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>Here in CT, any discharge of a
substance other than septage to the sewer requires approval from the local
sewer authority AND a permit from the CT DEP. For many years,
our state permitting staff were unaware of this practice, until recently, when
a release from a long-term care facility caused the local wastewater treatment
plant to fail. What happened was that an adult diaper shredder at
the faculty became clogged, and a large amount of effluent from the facility
backed up in it; when the clog was cleared, the pharmaceutical-laden sewage hit
the treatment plant all at once and killed the beneficial bacteria that aid in
the digestion of the sewage.</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>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>Following this incident our water
permitting folks have become very interested in the issue of disposal of drugs
down the drain, and are working with other staff at the CT DEP to stop the
practice statewide.</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>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>Another point to consider: if any of
the long-term care facilities are NOT on local sewer, but are instead discharge
their sewage to an engineered septic system, there may be rules in <st1:State
w:st="on"><st1:place w:st="on">Florida</st1:place></st1:State> regarding the
types of wastes that can be discharged to such systems. Here in <st1:State
w:st="on"><st1:place w:st="on">Connecticut</st1:place></st1:State>, such
systems may only receive septic and associated wastewaters, and not chemical
wastes of any kind (e.g. pharmaceuticals).</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>
<p class=MsoNormal><font size=2 color=blue face=Arial><span style='font-size:
10.0pt;font-family:Arial;color:blue'>- - Ross Bunnell, CT DEP <br>
Bureau of Materials Management and Compliance Assurance <br>
Waste Engineering & Enforcement Division <br>
79 Elm Street <br>
Hartford, CT 06106-5127 <br>
Tel. (860) 424-3274 Fax (860) 424-4059 </span></font><o:p></o:p></p>
<p><font size=2 color=blue face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:blue'>Disclaimer: Any views expressed in this email represent
only the sender's personal opinion based on his knowledge and experience with
the DEP, and in no way should be considered a formal ruling by the
Department. It is always the obligation of a generator or other handler
of waste to be familiar with and to comply with all applicable state and
federal requirements.</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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face="Times New Roman"><span style='font-size:12.0pt'>
<hr size=2 width="100%" align=center tabIndex=-1>
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<p class=MsoNormal style='margin-bottom:12.0pt'><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'>
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>Michele Berger<br>
<b><span style='font-weight:bold'>Sent:</span></b> Friday, September 14, 2007
3:33 PM<br>
<b><span style='font-weight:bold'>To:</span></b> <st1:PersonName w:st="on">pharmwaste@lists.dep.state.fl.us</st1:PersonName><br>
<b><span style='font-weight:bold'>Subject:</span></b> [Pharmwaste] Long term
care drug disposal</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'>When I started at my long term care pharmacy, all
discontinued drugs were being flushed. I immediately got in touch
with a reverse distributor to have them disposed of properly. For many
months I have been encouraging the owner of our pharmacy to become more
pro-active in discontinued drug disposal in our homes, including
narcotics. Yesterday a surveyor was at one of our homes and insisted that
our policies be changed to state "All discontinued narcotics are to be
flushed down the toilet". After I have the owner so close to making
the disposal a consultant pharmacist responsibility, I have been foiled
again. I understand it isn't easy to change a set idea but when
options are there and you aren't allowed to use them it becomes
extremely frustrating! <o:p></o:p></span></font></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=3 face="Times New Roman"><span style='font-size:
12.0pt'>Can anyone tell me where to find, in <st1:State w:st="on"><st1:place
w:st="on">Florida</st1:place></st1:State> law, that flushing meds down a
toilet is more regulated than a DEA transfer? Not to mention better for
the environment! <o:p></o:p></span></font></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=3 face="Times New Roman"><span style='font-size:
12.0pt'>Michele Berger<o:p></o:p></span></font></p>
</div>
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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
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