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<div class=Section1>
<p class=MsoNormal><span style='color:#1F497D'>We can all work together. I
certainly am not trying to mandate that all collections must be inventoried.
In fact, in the presentations I provide, I advocate that there need to be
several models. If you have a police dept that is willing to take everything
collected and incinerate it all, simply weighing the collections is great for
an outcome measure. This is a viable model for programs that have limited
sources and from a poison control and abuse prevention perspective, this is
just as effective as any inventoried program. <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'>Our events are conducted legally
with law enforcement participation. We do collect non-identifiable patient
information through a survey (i.e. why are you disposing of these meds? Change in
dose, change of drug, death of patient, etc.; What would you have done with
these if this event had not occurred?) However, to be able to do this, we did
go through our Institutional Review Board. The purpose of the IRB is to assure
the protection of the safety, rights, and welfare of people. This is not in
violation of privacy laws. Other specific details could be collected with the
use of consent forms that would also require approval through an Institutional
Review Board. <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 are trying to get unwanted
meds out of households and properly disposed of while also researching why the
meds are leftover, so we can begin to approach the root cause. Yes, this is
rudimentary at this point, but we must start somewhere.<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'>What have we learned? We’ve
only had one event thus far, but what appears to be evident is that many over-the-counter
products do not need to be marketed in quantities greater than 10. Nebulizer
solutions do not always need to be provided in boxes of 100. More than half of
the participants would have simply kept (at home) the meds that they turned in if
the event had not been available. Although the kitty litter/coffee grounds
method from household disposal is advocated, many people still believe this is an
environmentally poor practice.<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'>I certainly did not mean to
imply that what you are saying is wrong. This forum is simply for the sharing
of information and both of our perspectives are helpful. I have gained much
valuable information from the list and it has facilitated many networking
opportunities for which I am appreciative. <o:p></o:p></span></p>
<p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>Jeanie Jaramillo, PharmD<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>Managing Director, Texas Panhandle Poison Center<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>Assistant Professor, Texas Tech UHSC School of Pharmacy<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>1501 S. Coulter
St.
<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>Amarillo, TX 79106<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>P: (806) 354-1611<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>C: (806) 672-0833<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>F: (806) 354-1667<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva";
color:#1F497D'>Cisco IP: 30412<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'><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"'> Dennis Lucia
[mailto:djlucia@gw.dec.state.ny.us] <br>
<b>Sent:</b> Friday, January 22, 2010 7:52 AM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us; Stevan Gressitt; Jaramillo, Jeanie<br>
<b>Cc:</b> Allan Geisendorfer; Rod Larson; Jennifer_Crittenden@umit.maine.edu;
Len Kaye; John Schloss<br>
<b>Subject:</b> RE: [Pharmwaste] Sampling of med take back items<o:p></o:p></span></p>
</div>
</div>
<p class=MsoNormal><o:p> </o:p></p>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Before
you attempt to mandate that you need drug statistics for all collections.
What have you learned from the collections that have been held, where data on
the types of drugs and quantity has been recorded?<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Doing
an analysis of every 1/10 or 1/20 or 1/100 will not tell you much and requires
that at each collection you have a trained pharmacist. By the
way, you do know that having anyone other than law enforcement handle the
unwanted controlled substances at a collection event is illegal. <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Are
you planning to collect additional information in violation of privacy laws.<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Like:<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Diagnosis;
length of treatment; <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Did
the patient have health insurance, type of health insurance;<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>1st
prescription or multiple times that it has been prescribed<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Male/female,
age.<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Why
did patient stop taking drug? Reaction, type of reaction? Got better? Died?<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>You
will also need info on the location where the collection takes place and
demographic on the patient, regarding their life style, and medical history.<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>There
are many variables that make the analysis complicated...<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Are
you trying to get unwanted drugs out of households and properly disposed of or
are you trying to do a research study to analyze why patients don't take the
medications prescribed to them and why drugs are being over prescribed?<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Let's
simplify the drug collections and work on the other issues in other ways!!!<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'><br>
<o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <o:p></o:p></span></p>
</div>
<div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>Dennis
J. Lucia, P.E.<br>
Pollution Prevention Unit<br>
Division of Environmental Permits<br>
New York State Department of Environmental Conservation<br>
625 Broadway 4th Fl.- SW<br>
Albany, NY 12233-1750<br>
(518) 402-9469<br>
Fax (518) 402-9168<br>
<br>
<br>
>>> "Gressitt, Stevan" <Stevan.Gressitt@maine.gov>
1/22/2010 7:37 AM >>><o:p></o:p></span></p>
</div>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:navy'>Your internal consistency idea looks good. I am not the
mathematician or statistician, but I suspect there is enough horsepower on this
list to advise. It might also be interesting to see the difference in
consistency at 1/10 1/20 1/100 depending on sixze as we all who are trying to
sample will probably do best if we adopt a “best practice” <o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:navy'><o:p> </o:p></span></p>
<div>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>Stevan Gressitt, M.D.,
Medical Director</span><span style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>Office of Adult Mental
Health Services</span><span style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>Department of Health and
Human Services</span><span style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>Marquardt Building, 2nd
Floor</span><span style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>11 State House Station</span><span
style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>32 Blossom Lane</span><span
style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>Augusta, ME
04333-0011</span><span style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>Ph: (207)287-4273</span><span
style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>Fax: (207)287-1022</span><span
style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>Cell Phone: (207) 441-0291</span><span
style='color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='font-size:10.0pt;
font-family:"Goudy Old Style","serif";color:#993366'>E-Mail : <a
href="mailto:stevan.gressitt@maine.gov" title="mailto:stevan.gressitt@maine.gov">stevan.gressitt@maine.gov</a><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><u><span style='font-size:9.0pt;
font-family:"Goudy Old Style","serif";color:blue'><a
href="http://www.maine.gov/dhhs/mh/">http://www.maine.gov/dhhs/mh/</a></span></u><span
style='font-size:12.0pt;font-family:"Times New Roman","serif";color:navy'><o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in'><span style='color:navy'> <o:p></o:p></span></p>
<p class=MsoNormal style='margin-left:.5in;text-align:justify'><em><b><span
style='font-size:8.0pt;font-family:"Goudy Old Style","serif";color:black'>Confidentiality
Notice</span></b></em><span style='font-size:8.0pt;font-family:"Goudy Old Style","serif";
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<p class=MsoNormal style='margin-left:.5in;text-align:justify'><span
style='font-size:8.0pt;font-family:"Goudy Old Style","serif";color:black'>The
Department of Health and Human Services (DHHS) does not discriminate on the
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<p class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif";
color:navy'><o:p> </o:p></span></p>
<div>
<div class=MsoNormal align=center style='text-align:center'><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'>
<hr size=2 width="100%" align=center>
</span></div>
<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>Jaramillo,
Jeanie<br>
<b>Sent:</b> Wednesday, January 20, 2010 2:29 PM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> [Pharmwaste] Sampling of med take back items</span><span
style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p></o:p></span></p>
</div>
<p class=MsoNormal><o:p> </o:p></p>
<p class=MsoNormal>I had no luck with having our epidemiologist help with a
sampling protocol. He’s already being pulled in many different
directions. I did want to mention that our next event (3/27) will likely
be the last one in which we conduct a full inventory. We will be
collating the items collected by participant (i.e. these 20 items all came from
car #1), which will be a little more work this time around. I believe
this will allow us to validate sampling techniques that we could use for future
events. For instance, we could pull out the data from every X<sup>th</sup>
participant, summarize it, and extrapolate it to the total number of
participants and then compare that to the full inventory. I’m sure
there’s some statistical method to do that. <o:p></o:p></p>
<p class=MsoNormal><o:p> </o:p></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>Jeanie
Jaramillo, PharmD<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>Managing
Director, Texas Panhandle Poison Center<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>Assistant
Professor, Texas Tech UHSC School of Pharmacy<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>1501
S. Coulter
St.
<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>Amarillo,
TX 79106<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>P:
(806) 354-1611<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>C:
(806) 672-0833<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>F:
(806) 354-1667<o:p></o:p></span></p>
<p class=MsoNormal><span style='font-size:12.0pt;font-family:"Monotype Corsiva"'>Cisco
IP: 30412<o:p></o:p></span></p>
<p class=MsoNormal><o:p> </o:p></p>
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