<HEAD>
<STYLE>body{font-family: Geneva,Arial,Helvetica,sans-serif;font-size:9pt;background-color: #ffffff;color: black;}p{margin:0px}</STYLE>
<META name=GENERATOR content="MSHTML 8.00.6001.18813"></HEAD>
<BODY id=compText>
<P>Jeanie,</P>
<P>In 2004, we as a patient safety research group based in Houston have never even heard of unused and expired meds. We became involved because we had to verify that this is a patient safety and public health problem. We have been collecting data since Fall 2004. You are perfectly correct about noncontrolled to include OTC and prescription drugs. We are now picking up returned items that are categorized as complementary and alternative medicines. A School of Pharmacy is introducing the issue of unused and expired meds to its pharm students. new concepts of "green chemistry" and "green pharmacy" have emerged and are attracting some attention. </P>
<P> </P>
<P>We have been working on a preventive, educational program for teens and parents/teachers called "Teens Against Pharming" (TAP) and have been following cases of pharming in the Houston area. Our work is now recognized by the National Center for Patient Information and Education (NCPIE). We have checklists to help prevent "pharming" and "improve adherence to medical treatment", and others. I'll share them with you as soon as I get back to Houston.</P>
<P> </P>
<P>Your group in Amarillo seem to know the right way to do things. I hope you'll consider working with us and helping increase our understand of the long-term impact of unwanted by collecting and sharing your data. I'll forward a paper that describes our National Unused and Expired Medicines Registry. </P>
<P> </P>
<P>Matthew Mireles<BR><BR><BR></P>
<BLOCKQUOTE style="BORDER-LEFT: #0000ff 2px solid; PADDING-LEFT: 5px; MARGIN-LEFT: 0px">-----Original Message----- <BR>From: "Jaramillo, Jeanie" <JEANIE.JARAMILLO@TTUHSC.EDU><BR>Sent: Aug 6, 2009 12:47 PM <BR>To: "Matthew C. Mireles" <MIRELESMC@EARTHLINK.NET>, Tony Madruga <TONY.MADRUGA@DVAULT.COM>, "McKinley, Gena" <GENA.MCKINLEY@H-GAC.COM>, pharmwaste@lists.dep.state.fl.us <BR>Cc: john.r.prince@dvault.com, easmith@communityofcompetence.com, Gressitt Stevan <STEVAN.GRESSITT@MAINE.GOV>, karen.bartkowiak@dvault.com <BR>Subject: [Pharmwaste] Rx Abuse Stats and Controlled Substances at Take-Backs <BR><BR><?XML:NAMESPACE PREFIX = [default] http://www.w3.org/TR/REC-html40 NS = "http://www.w3.org/TR/REC-html40" /><ZZZhtml xmlns="http://www.w3.org/TR/REC-html40" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns:ZZZhtml="http://www.w3.org/TR/REC-html40" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:v="urn:schemas-microsoft-com:vml" xmlns:st="" xmlns:Z="urn:schemas-microsoft-com:" xmlns:spsl="http://microsoft.com/webservices/SharePointPortalServer/PublishedLinksService" xmlns:pptsl="http://schemas.microsoft.com/sharepoint/soap/SlideLibrary/" xmlns:ex12m="http://schemas.microsoft.com/exchange/services/2006/messages" xmlns:ex12t="http://schemas.microsoft.com/exchange/services/2006/types" xmlns:spwp="http://microsoft.com/sharepoint/webpartpages" xmlns:mrels="http://schemas.openxmlformats.org/package/2006/relationships" xmlns:mver="http://schemas.openxmlformats.org/markup-compatibility/2006" xmlns:mdssi="http://schemas.openxmlformats.org/package/2006/digital-signature" xmlns:dssi="http://schemas.microsoft.com/office/2006/digsig" xmlns:dsss="http://schemas.microsoft.com/office/2006/digsig-setup" xmlns:wf="http://schemas.microsoft.com/sharepoint/soap/workflow/" xmlns:udcp2p="http://schemas.microsoft.com/data/udc/parttopart" xmlns:udcxf="http://schemas.microsoft.com/data/udc/xmlfile" xmlns:udcs="http://schemas.microsoft.com/data/udc/soap" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:sps="http://schemas.microsoft.com/sharepoint/soap/" xmlns:sp="http://schemas.microsoft.com/sharepoint/" xmlns:ec="http://www.w3.org/2001/04/xmlenc#" xmlns:sub="http://schemas.microsoft.com/sharepoint/soap/2002/1/alerts/" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:udc="http://schemas.microsoft.com/data/udc" xmlns:dsp="http://schemas.microsoft.com/sharepoint/dsp" xmlns:ds="http://www.w3.org/2000/09/xmldsig#" xmlns:dir="http://schemas.microsoft.com/sharepoint/soap/directory/" xmlns:ois="http://schemas.microsoft.com/sharepoint/soap/ois/" xmlns:ppda="http://www.passport.com/NameSpace.xsd" xmlns:x2="http://schemas.microsoft.com/office/excel/2003/xml" xmlns:mt="http://schemas.microsoft.com/sharepoint/soap/meetings/" xmlns:Repl="http://schemas.microsoft.com/repl/" xmlns:D="DAV:" xmlns:rtc="http://microsoft.com/officenet/conferencing" xmlns:q="http://schemas.xmlsoap.org/soap/envelope/" xmlns:oa="urn:schemas-microsoft-com:office:activation" xmlns:odc="urn:schemas-microsoft-com:office:odc" xmlns:c="urn:schemas-microsoft-com:office:component:spreadsheet" xmlns:ss="urn:schemas-microsoft-com:office:spreadsheet" xmlns:b="urn:schemas-microsoft-com:office:publisher" xmlns:z="#RowsetSchema" xmlns:rs="urn:schemas-microsoft-com:rowset" xmlns:s="uuid:BDC6E3F0-6DA3-11d1-A2A3-00AA00C14882" xmlns:dt="uuid:C2F41010-65B3-11d1-A29F-00AA00C14882" xmlns:a="urn:schemas-microsoft-com:office:access" xmlns:p="urn:schemas-microsoft-com:office:powerpoint" xmlns:x="urn:schemas-microsoft-com:office:excel"><ZZZhead><ZZZmeta content="text/html; charset=utf-8" http-equiv="Content-Type"><ZZZmeta content="Microsoft Word 12 (filtered medium)" name="Generator"><ZZZ!--[if !mso]>
<STYLE>
v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</STYLE>
<ZZZ![endif]-->
<STYLE>
<ZZZ!--
/* Font Definitions */
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;}
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
@font-face
{font-family:"Monotype Corsiva";
panose-1:3 1 1 1 1 2 1 1 1 1;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri","sans-serif";}
a:ZZZlink, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:purple;
text-decoration:underline;}
p
{mso-style-priority:99;
margin:0in;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman","serif";}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri","sans-serif";}
span.emailstyle17
{mso-style-name:emailstyle17;
font-family:"Calibri","sans-serif";
color:windowtext;}
span.EmailStyle19
{mso-style-type:personal;
font-family:"Calibri","sans-serif";
color:#1F497D;}
span.EmailStyle21
{mso-style-type:personal-reply;
font-family:"Calibri","sans-serif";
color:#1F497D;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;}
@page Section1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.Section1
{page:Section1;}
/* List Definitions */
@list l0
{mso-list-id:1274485171;
mso-list-type:hybrid;
mso-list-template-ids:637017184 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
text-indent:-.25in;
font-family:Symbol;}
ol
{margin-bottom:0in;}
ul
{margin-bottom:0in;}
-->
</STYLE>
<ZZZ!--[if 9] mso gte><xml><?xml:namespace prefix = o /><o:shapedefaults spidmax="1026" v:ext="edit"></o:shapedefaults></xml><ZZZ![endif]--><ZZZ!--[if 9] mso gte><xml><o:shapelayout v:ext="edit"><o:idmap v:ext="edit" data="1"></o:idmap></o:shapelayout></xml><ZZZ![endif]--></ZZZhead><ZZZbody id=compText lang=EN-US vlink="purple" link="blue" bgcolor="white">
<DIV class=Section1>
<P class=MsoNormal><SPAN style="COLOR: #1f497d">I’m going to continue the dialogue with the hopes that we’re not cluttering your inboxes. I would have loved to have all of this information a few years back, so I’m hopeful it is helping somebody out there. <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d">You’re right – it is virtually impossible to have a take-back event without collecting controlled substances. If you tell the public “don’t bring controlled substances”, the average person has no idea what that means. Also, one of the earlier emails seemed to imply that anything not over-the-counter is a controlled substance. I may have misread it, but that certainly is not true. There are OTC meds, non-controlled prescriptions, and controlled substance prescriptions. <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d">From our perspective, it is necessary to include controlled substances in take-back events. These are your OxyContin, Vicodin, Lortab – some might recognize the C-I, C-II, C-III nomenclature. As I am from a poison center, these are some of the most dangerous substances out there in terms of poisonings. These can result in respiratory depression and death. (Others can as well.) As one of our goals is to prevent poisonings, we feel it important to include controls. Controlled substances are also highly abused – particularly by teens who participate in “pharming” (raiding of medicine cabinets for prescription drugs.) Prevention of abuse is another goal of our take-back events. The stats on abuse are astounding: <o:p></o:p></SPAN></P>
<P style="TEXT-INDENT: -0.25in; mso-list: l0 level1 lfo1" class=MsoListParagraph><SPAN style="FONT-FAMILY: Symbol; COLOR: #1f497d"><SPAN style="mso-list: Ignore">·<SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN></SPAN><ZZZ![endif]><SPAN style="COLOR: #1f497d">62% of teens report prescription pain relievers are easy to get from parents’ medicine cabinets (2005 Partnership Attitude Tracking Study)<o:p></o:p></SPAN></P>
<P style="TEXT-INDENT: -0.25in; mso-list: l0 level1 lfo1" class=MsoListParagraph><SPAN style="FONT-FAMILY: Symbol; COLOR: #1f497d"><SPAN style="mso-list: Ignore">·<SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN></SPAN><ZZZ![endif]><SPAN style="COLOR: #1f497d">Prescription drug abuse is second only to marijuana use (2007 National Survey on Drug Use and Health)<o:p></o:p></SPAN></P>
<P style="TEXT-INDENT: -0.25in; mso-list: l0 level1 lfo1" class=MsoListParagraph><SPAN style="FONT-FAMILY: Symbol; COLOR: #1f497d"><SPAN style="mso-list: Ignore">·<SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN></SPAN><ZZZ![endif]><SPAN style="COLOR: #1f497d">Each day 2,500 teens use a prescription medication for the first time for a non-medical reason (Prescription for Danger: A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Use Among the Nation’s Teens, 2008; Office of National Drug Control Policy, Executive Office of the President)<o:p></o:p></SPAN></P>
<P style="TEXT-INDENT: -0.25in; mso-list: l0 level1 lfo1" class=MsoListParagraph><SPAN style="FONT-FAMILY: Symbol; COLOR: #1f497d"><SPAN style="mso-list: Ignore">·<SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN></SPAN><ZZZ![endif]><SPAN style="COLOR: #1f497d">There are now more people aged 12 and up who use psychotherapeutic drugs for non-medical reasons than those who abuse cocaine, heroin, and methamphetamine combined (2007 National Survey on Drug Use and Health)<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d">When we began collaborating with our local law enforcement to participate in our events, we had drafted a letter for them to send to the DEA to obtain “authorization” for the collection of controlled substances. DEA National Headquarters had stated that a letter would be needed, that it should come from the participating law enforcement agency, that it should detail the steps taken to prevent diversion, should state that LE will witness the burn of the controls, etc. We were told by our regional DEA office (Dallas) yesterday that the requirement for a letter of authorization from DEA is at the discretion of the regional Special Agent in Charge (SAC). Our does not require a request for authorization as long as law enforcement is involved and they handle the drugs in accordance with their local policy. <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d">The difficult thing about the DEA is that they are not consistent (case in point – regional SAC has discretion to determine need for letter of authorization) and they generally will not provide anything in writing unless it is through the Federal Register. (On a personal level, I do not like the idea of participating in something that could result in criminal prosecution, not to mention the loss of my license, based on someone’s word-- i.e “You don’t need a letter of authorization from us.”) Work is currently being done to amend the Controlled Substances Act to make drug take-back programs easier to conduct, but it will be at least 1-2 years before that is done. I don’t mean to degrade the DEA. When we started working on this ~ 5 years ago, we met road block after road block. The DEA is much better now as this problem has grown and they’ve become more aware. <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d">We’d be happy to complete the survey.<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"><o:p> </o:p></SPAN></P>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Jeanie Jaramillo, PharmD<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Managing Director, Texas Panhandle Poison Center<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Assistant Professor, Texas Tech UHSC School of Pharmacy<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">1501 S. Coulter St. <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Amarillo, TX 79106<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">P: (806) 354-1611<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">C: (806) 672-0833<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">F: (806) 354-1667<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Cisco IP: 30412<o:p></o:p></SPAN></P></DIV>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"><o:p> </o:p></SPAN></P>
<DIV>
<DIV style="BORDER-BOTTOM: medium none; BORDER-LEFT: medium none; PADDING-BOTTOM: 0in; PADDING-LEFT: 0in; PADDING-RIGHT: 0in; BORDER-TOP: #b5c4df 1pt solid; BORDER-RIGHT: medium none; PADDING-TOP: 3pt">
<P class=MsoNormal><B><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; FONT-SIZE: 10pt">From:</SPAN></B><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; FONT-SIZE: 10pt"> Matthew C. Mireles [mailto:mirelesmc@earthlink.net] <BR><B>Sent:</B> Wednesday, August 05, 2009 4:01 PM<BR><B>To:</B> Jaramillo, Jeanie; Tony Madruga; McKinley, Gena; pharmwaste@lists.dep.state.fl.us<BR><B>Cc:</B> john.r.prince@dvault.com; easmith@communityofcompetence.com; Gressitt Stevan; karen.bartkowiak@dvault.com<BR><B>Subject:</B> RE: [Pharmwaste] RE: Texas Pharmaceutical Disposal Programs<o:p></o:p></SPAN></P></DIV></DIV>
<P class=MsoNormal><o:p> </o:p></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Jeanie, many thanks for your input. I just returned from a meeting with DEA folks in DC. Yes, there many programs that do not involve law enforcement and might get by with it. the main challenge for these program is to ensure that no controlled substances are collected and handled. Our research has indicated that this is almost impossible.<o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Invariably controlled substances are commingled in the return. <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">The question is "would the DEA come down on you if you stated that you're not collecting FCS and they show up in your sample?" Here's an unofficial statement from the DEA. "They might if they want to."<o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Drug take-back program is a relatively new movement in the US whereas other countries have successfully implemented return systems without much problems, mostly direct return to the pharmacies. Historically, there has been a great deal of diversion in the US that spans all sector but particularly in our healthcare system (hosp, clinic) and pharmacy system (retail pharmacy, etc.). This is the rationale behind the DEA's "closed loop system" with first registrant and the Controlled Substance Act of 1970. <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Believe me, everyone wants to do the right thing but don't put yourself in any risk with the law. While our group work closely with federal agencies in the research of unused and expired medicines in the US, we DO NOT work for any federal or state agency. We are completely independent. We provide research support (data collection, analysis, reporting, etc.) to anyone or any group that wants to have the info for any number of reasons (program eval, monitoring, policy, QC, reliability, community education, etc.). We help groups do sampling to basically ensure that they are not collecting FCS when they are not supposed to. And we don't report any group to the law enforcement or DEA, because we are researchers only!<o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Interestingly, our data are showing unusual post-market side effects. This is the only area where our researchers believe it is ethically an obligation for us to notify the FDA or drug manufacturers. <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">I'd like to send your our Annual Survey so your group can be included in our National Directory. Again, congrats on your tremendous leadership and work in TX. Let me know how we can help.<o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> <o:p></o:p></SPAN></P>
<P style="MARGIN-BOTTOM: 12pt"><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Matt<BR><BR><o:p></o:p></SPAN></P>
<BLOCKQUOTE style="BORDER-BOTTOM: medium none; BORDER-LEFT: blue 1.5pt solid; PADDING-BOTTOM: 0in; MARGIN-TOP: 5pt; PADDING-LEFT: 4pt; PADDING-RIGHT: 0in; MARGIN-BOTTOM: 5pt; MARGIN-LEFT: 0in; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0in">
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">-----Original Message----- <BR>From: "Jaramillo, Jeanie" <BR>Sent: Aug 5, 2009 2:25 PM <BR>To: "Matthew C. Mireles" , Tony Madruga , "McKinley,Gena" , pharmwaste@lists.dep.state.fl.us <BR>Cc: john.r.prince@dvault.com, easmith@communityofcompetence.com, karen.bartkowiak@dvault.com <BR>Subject: RE: [Pharmwaste] RE: Texas Pharmaceutical Disposal Programs <BR><BR><BR><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d">I am from the Texas Panhandle Poison Center which is in Amarillo (not Lubbock). We are having our first take back program on September 12<SUP>th</SUP>. Law enforcement is involved. DEA has been our most significant obstacle, but we are finally getting there. We’ve also had discussions with the TX State Board of Pharmacy. It is my belief that there are programs in the State that are conducted without law enforcement involvement. From my correspondence with the DEA, they are beginning to “crack down” on these. There are many groups who do not understand all of the regulations and unfortunately, they are not summarized in any one place. </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Jeanie Jaramillo, PharmD</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Managing Director, Texas Panhandle Poison Center</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Assistant Professor, Texas Tech UHSC School of Pharmacy</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">1501 S. Coulter St. </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Amarillo, TX 79106</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">P: (806) 354-1611</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">C: (806) 672-0833</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">F: (806) 354-1667</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Monotype Corsiva'; COLOR: #1f497d; FONT-SIZE: 12pt">Cisco IP: 30412</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<P class=MsoNormal><SPAN style="COLOR: #1f497d"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<DIV>
<DIV style="BORDER-BOTTOM: medium none; BORDER-LEFT: medium none; PADDING-BOTTOM: 0in; PADDING-LEFT: 0in; PADDING-RIGHT: 0in; BORDER-TOP: #b5c4df 1pt solid; BORDER-RIGHT: medium none; PADDING-TOP: 3pt">
<P class=MsoNormal><B><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: black; FONT-SIZE: 10pt">From:</SPAN></B><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: black; FONT-SIZE: 10pt"> Matthew C. Mireles [mailto:mirelesmc@earthlink.net] <BR><B>Sent:</B> Wednesday, August 05, 2009 9:44 AM<BR><B>To:</B> Tony Madruga; McKinley,Gena; 'pharmwaste@lists.dep.state.fl.us'<BR><B>Cc:</B> john.r.prince@dvault.com; easmith@communityofcompetence.com; Karen Bartkowiak (karen.bartkowiak@dvault.com)<BR><B>Subject:</B> Re: [Pharmwaste] RE: Texas Pharmaceutical Disposal Programs</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV></DIV>
<P class=MsoNormal><SPAN style="COLOR: black"> <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Gena,</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">We run the </SPAN><EM><B><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: blue; FONT-SIZE: 9pt">National Unused and Expired Medicines Registry</SPAN></B></EM><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> and conduct an annual survey of all the drug take-back programs in the US. We publish the survey data in our </SPAN><EM><B><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: blue; FONT-SIZE: 9pt">National Directory of Drug Take-Back and Disposal Programs</SPAN></B></EM><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">. The Directory lists all the programs in the nation. Please contact me if you wish to have a copy.</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Our group is based in Houston, but most of our work in drug return system are in Maine and CA. We also are consulting with federal agencies in designing a national drug take back system.</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">There are a few take-back programs in TX (Plano, Dallas area). One is beginning in Corpus I believe. All of these are small community-based programs. In Houston, we ran one pilot study with senior citizens. One for-profit company in Houston has a mail-back system set up with shipping kits and an incineration unit in Carthage TX. Another large company in anticipation for a business venture has purchased a large industrial incineration facility in Chamber Co. </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Since we provide technical assistance in designing these programs around the country, we highly encourage the involvement of law enforcement whenever there's a possibility of collecting controlled substances. Most of the programs in TX mentioned above all have law enforcement involvement. </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">We also publish a comprehensive </SPAN><EM><B><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: blue; FONT-SIZE: 9pt">manual of procedures</SPAN></B></EM><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> for drug take back. This manual has been selected as the official reference of instructions for an upcoming international conference on drug disposal in Maine (mainebenzo.org).</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">As far as partnership between city govt and retail pharmacies in TX, we have not seen this in our survey. CA, OR, and WA use this model for their take back system. In TX, the most promising initiative and partnership are coming from the Poison Center (Lubbock, Galveston, etc.) You may want to join the listserv and get involved right away. My advice for now is to proceed carefully. The DEA is keeping a close eye on TX. Our programs are in compliance with DEA regs.</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">I hope my info is useful. Please contact me if you have questions. By the way, I worked at UTMB before I move to Houston for grad school.</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Matthew C. Mireles, PhD, MPH</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">President and CEO</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Community Medical Foundation for Patient Safety</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">6300 West Loop South, Suite 288</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">Bellaire, TX 77401</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">832-778-7777</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"><A href="http://www.communityofcompetence.com">www.communityofcompetence.com</A></SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt"><BR><BR> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<BLOCKQUOTE style="BORDER-BOTTOM: medium none; BORDER-LEFT: blue 1.5pt solid; PADDING-BOTTOM: 0in; MARGIN-TOP: 5pt; PADDING-LEFT: 4pt; PADDING-RIGHT: 0in; MARGIN-BOTTOM: 5pt; MARGIN-LEFT: 0in; BORDER-TOP: medium none; BORDER-RIGHT: medium none; PADDING-TOP: 0in">
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">-----Original Message----- <BR>From: Tony Madruga <BR>Sent: Aug 4, 2009 4:18 PM <BR>To: "McKinley, Gena" , "'pharmwaste@lists.dep.state.fl.us'" <BR>Cc: "john.r.prince@dvault.com" , "Karen Bartkowiak (karen.bartkowiak@dvault.com)" <BR>Subject: [Pharmwaste] RE: Texas Pharmaceutical Disposal Programs <BR><BR><BR><BR></SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">Hi Gena,</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">I am not aware of any current programs in your area, however we can provide all of your unattended collection unit needs through our sister company Take Back Express.com.</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">More information can be found at: <A href="http://www.takebackexpress.com/" target=_blank>http://www.takebackexpress.com</A></SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">Regards,</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV></DIV>
<DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Times New Roman','serif'; COLOR: black; FONT-SIZE: 12pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">Tony O. Madruga</SPAN><SPAN style="COLOR: black"><BR></SPAN><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">President</SPAN><SPAN style="COLOR: black"><BR></SPAN><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: navy; FONT-SIZE: 10pt">dVault® Companies, Inc.</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Times New Roman','serif'; COLOR: black; FONT-SIZE: 12pt"><A title=http://www.dvault.com href="http://www.dvault.com/" target=_blank><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 8pt">www.dvault.com</SPAN></A></SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Times New Roman','serif'; COLOR: black; FONT-SIZE: 12pt"> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 7.5pt">voice: 720.895.1908<BR>fax: 720.895.1909</SPAN><SPAN style="COLOR: black"><BR><BR></SPAN><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: blue; FONT-SIZE: 7.5pt"><A title=mailto:tony.madruga@dvault.com href="mailto:tony.madruga@dvault.com" target=_blank><SPAN style="COLOR: black">tony.madruga@dvault.com</SPAN></A></SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: black"> <o:p></o:p></SPAN></P>
<P><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 7.5pt">**** dVault®</SPAN><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt"> </SPAN><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 7.5pt"> Confidential ****************************************<BR>This email and any files transmitted with it are confidential<BR>and intended solely for the individual or entity to<BR>whom they are addressed. If you have received this email<BR>in error destroy it immediately.<BR>**********************************************************************</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<DIV id=divRpF115272>
<DIV style="TEXT-ALIGN: center" class=MsoNormal align=center><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 9pt">
<HR align=center SIZE=2 width="100%">
</SPAN></DIV>
<P style="MARGIN-BOTTOM: 12pt" class=MsoNormal><B><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: black; FONT-SIZE: 10pt">From:</SPAN></B><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: black; FONT-SIZE: 10pt"> pharmwaste-bounces@lists.dep.state.fl.us [pharmwaste-bounces@lists.dep.state.fl.us] On Behalf Of McKinley, Gena [Gena.McKinley@h-gac.com]<BR><B>Sent:</B> Tuesday, August 04, 2009 2:01 PM<BR><B>To:</B> 'pharmwaste@lists.dep.state.fl.us'<BR><B>Subject:</B> [Pharmwaste] Texas Pharmaceutical Disposal Programs</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P></DIV>
<DIV>
<DIV>
<P class=MsoNormal><SPAN style="COLOR: black">Hello!<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: black"> <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: black">I am in the process of working on a BMP guide for the management of pharmaceutical waste, and am looking for example programs in the State of Texas. I am also interested to know if any pharmacies in the State of Texas have partnered with municipalities in the collection of pharmaceuticals. Please contact me if you have any information. <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: black"> <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: black">Thanks!<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: black">Gena<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: black"> <o:p></o:p></SPAN></P>
<P class=MsoNormal><B><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">Gena McKinley, MPH</SPAN></B><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">Environmental Planner</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">Houston-Galveston Area Council</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">Tel: 713-993-4529</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt">Fax: 713-993-4503</SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; COLOR: black; FONT-SIZE: 10pt"><A href="http://www.h-gac.com/recycleguide" target=_blank>www.RecycleInfo.org</A> </SPAN><SPAN style="COLOR: black"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="COLOR: black"> <o:p></o:p></SPAN></P></DIV></DIV></BLOCKQUOTE></BLOCKQUOTE></DIV></ZZZbody></ZZZhtml></BLOCKQUOTE></ZZZ![endif]></ZZZ![endif]></ZZZ![endif]></ZZZ![endif]></ZZZ![endif]--></ZZZ!--[if></ZZZ![endif]--></ZZZ!--[if></ZZZ![endif]--></ZZZ!--[if></ZZZmeta></ZZZmeta></BODY>