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<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Hi Everyone,<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'>Mathew is correct that expired pharmaceuticals in original
packaging can be sent through reverse distribution for the purpose of obtaining
credit 9with some state restrictions based on hazardous waste regulations).
This function does not assess, however, how actual drug waste is being managed
in hospitals and other healthcare facilities. The upcoming EPA Office of Water
survey will likely provide the first comprehensive look at disposal practices
ofr actual drug waste in these facilities. <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>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Best regards, <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'>Charlotte A. Smith, R. Ph., M.S., HEM<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Director, PharmEcology Services<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>WM Healthcare Solutions<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>12229 W. North Ave., Suite 2<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>Wauwatosa, WI 53226<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>414-292-3959<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>414-915-4026(cell)<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>414-479-9941 (fax)</span><span style='font-size:11.0pt;
font-family:"Calibri","sans-serif";color:red'><o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D'>csmith@pharmecology.com<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 style='text-autospace:none'><b><i><span style='font-size:
11.0pt;font-family:Univers-Oblique;color:green'>Waste Management’s renewable
energy projects create enough energy to power over 1 million homes.<o:p></o:p></span></i></b></p>
<p class=MsoNormal><b><i><span style='font-family:"Calibri","sans-serif";
color:#76923C'><o:p> </o:p></span></i></b></p>
</div>
<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"'>From:</span></b><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>
pharmwaste-bounces@lists.dep.state.fl.us
[mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>Tenace,
Laurie<br>
<b>Sent:</b> Tuesday, June 23, 2009 6:48 AM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> FW: [Pharmwaste] Re: Pharmwaste Digest, Vol 44, Issue 12<o:p></o:p></span></p>
</div>
</div>
<p class=MsoNormal><o:p> </o:p></p>
<div>
<div>
<p class=MsoNormal><span style='font-size:11.0pt;color:#1F497D'> </span><o:p></o:p></p>
<p class=MsoNormal><span style='font-size:11.0pt;color:#1F497D'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-bottom:12.0pt'><o:p> </o:p></p>
</div>
<div>
<p class=MsoNormal><em><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>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. Simply click on <a
href="http://survey.dep.state.fl.us/?refemail=Laurie.Tenace@dep.state.fl.us"
target="_blank">this link to the DEP Customer Survey</a>. Thank you in advance
for completing the survey.</span></em><span style='font-size:9.0pt;font-family:
"Courier New"'><o:p></o:p></span></p>
</div>
<div>
<div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'> mcmireles@communityofcompetence.com
[mailto:mcmireles@communityofcompetence.com] <br>
<b>Sent:</b> Monday, June 22, 2009 4:22 PM<br>
<b>To:</b> VeoraLittle@aol.com; MMccarro@dtsc.ca.gov; wamore@gw.dec.state.ny.us;
pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> Re: [Pharmwaste] Re: Pharmwaste Digest, Vol 44, Issue 12</span><o:p></o:p></p>
</div>
<p class=MsoNormal style='margin-left:.5in'> <o:p></o:p></p>
<p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:0in;margin-bottom:
12.0pt;margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>We
conduct the Annual Survey of non-institutional drug take-back programs and
publish the National Directory of Drug Take-Back and Disposal Programs.
We have been in contact with 80 such programs organized by community
coalitions. Our Survey has provided some valuable "baseline
info" that we wish to measure over time. <br>
<br>
We don't survey healthcare instititions because most are involved with
commerical reverse distributors for disposal of unused and expired meds
(UEMs). You may be able to get some info from the companies.
However, I don't believe you can obtain a total picture of all the institutions
because of the number of vendors involved. No federal agency is
collecting this info.<br>
<br>
However, we set up the National UEM Registry in 2004 and have been receiving,
coding, and analyzing a large volume of UEM data shared by several drug
take-back programs. They mainly submit the data to us for
evaluation. We enter all the info into the Registry for national
comparison. We are seeing several best practices and are offering a handy
Manual of Procedures to assist any group in organizing a drug take-back
program. <br>
<br>
If anyone wants a copy of these publications, please contact me directly.<br>
<br>
<br>
Matthew C. Mireles, PhD, MPH<br>
President and CEO<br>
Community Medical Foundation for Patient Safety<br>
6300 West Loop South, Suite 288<br>
Bellaire, TX 78401<br>
832-778-7777<br>
<a href="http://www.communityofcompetence.com">www.communityofcompetence.com</a></span><o:p></o:p></p>
<div style='margin-left:.5in'>
<div class=MsoNormal align=center style='text-align:center'><span
style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>
<hr size=2 width="100%" align=center>
</span></div>
</div>
<p class=MsoNormal style='margin-left:.5in'><b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>From</span></b><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif"'>: VeoraLittle@aol.com<br>
<b>Sent</b>: Monday, June 22, 2009 11:53 AM<br>
<b>To</b>: MMccarro@dtsc.ca.gov, wamore@gw.dec.state.ny.us,
pharmwaste@lists.dep.state.fl.us<br>
<b>Subject</b>: Re: [Pharmwaste] Re: Pharmwaste Digest, Vol 44, Issue 12</span><span
style='font-size:10.0pt;font-family:"Arial","sans-serif"'><br>
<br>
<br>
<br>
</span><o:p></o:p></p>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:black'>Consider this program, Operation
Medicine Cabinet, A pharmaceutical take-back program. This program
utilizes many community partners including Waste Management, Law enforcement
and coalitions for drug free spaces.</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:black'>is a community event that Collier
County Sheriff's Office and Drugfreecollier have been doing for many
years. We have worked with Collier County Solid Waste Management (Danette
Huff and Beth Ryan) for several years. They have </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:black'>We know that it is illegal to
collect controlled substances without Law enforcement present. We know
that not only our environment but our youth and seniors (overdose, errors,
abuse, selling) are in danger. Attached is a wonderful program we
can start in all communities to bring education and the beginnings
of a solution. </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:black'>Veora Little,CRNA
239-649-4202 <a href="mailto:veoralittle@gmail.com">veoralittle@gmail.com</a>
a volunteer with <a href="http://www.drugfreecollier.org">www.drugfreecollier.org</a>
</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Arial","sans-serif";color:black'>In a message dated 6/22/2009
11:32:16 A.M. Central Daylight Time, MMccarro@dtsc.ca.gov writes:</span><o:p></o:p></p>
</div>
<blockquote style='border:none;border-left:solid blue 1.5pt;padding:0in 0in 0in 4.0pt;
margin-left:3.75pt;margin-top:5.0pt;margin-bottom:5.0pt'>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>This would seem to call for a
"baseline assessment" of the industry's handling practices, so that
we can look at "take back" efforts with more informed vision.</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>I would add that we would
need the same assessment for:</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>-long term care facilities</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>-Skilled nursing/rehabilitation
facilities</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>-mental heath facilities</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>-Medical Clinics </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>-retirement complexes with
medial clinics</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>-veterinary hospital/kennels</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>-veterinary services for
agricultural purposes -livestock/ feed lot/dairy</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>There may be others.</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>Matt McCarron</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>Pollution Prevention/Green
Business</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>CA Dept. of Toxic Substances
Control</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>700 Heinz Ave. Suite 300
MS R2 - 2-3</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>Berkeley, CA 94710</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>510-540-3828</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>Sustaining our resources
sustains our future generations</span><o:p></o:p></p>
</div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'><br>
<br>
>>> "William More" <wamore@gw.dec.state.ny.us>
6/22/2009 7:57 AM >>></span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>So what <u>is</u> the present
compliance rate with our Hospitals Pharmacies with the RCRA - Hazardous waste
regulations? </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>How are they achieving Hazardous
Waste Determinations? How do they segregate wastes, and when?</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>How many have a program that
know where the stuff that the reverse distributors don't want to take go?
What happens to the waste - contaminated packaging - that comes from dispensing
drugs that can be a "P" waste? Do the reverse
distributors(RDs) tell the hospitals about these materials? Do they, the RDs,
take these back?</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>Does that make them a
TSDF? Are they manifested? What mechanisms are the Hospital
Pharmacies using to recover these materials from the patient floors?</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>What are the RDs doing with
those materials that are never credited? The partials that can't be reused
because that are not factory sealed? Those materials that are <u>so</u>
far out of date? The RDs know what they are. Do they pick them up anyway.
Does that make them a TSDF? Are they manifested?</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>Have all of the Hospital
Pharmacies had their Formulary,(likely stocked Drugs), reviewed as to which
ones can be a Hazardous Waste when unusable ,unreturnable, un credited, when a
waste. Have they looked for characteristic Hazardous Waste? Mercury compounds
that may be used as a preservative? Metals in vitamins or dietary supplements?
Alcohol or CFCs in inhalers?</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'>What are we seeing when we look
at these questions???????</span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'> </span><o:p></o:p></p>
</div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";color:black'><br>
<br>
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