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<h2 style='margin-bottom:0in;margin-bottom:.0001pt'><b><i><font size=6
face=Helvetica><span lang=EN style='font-size:22.0pt;font-family:Helvetica;
letter-spacing:-.6pt'>Where Should the Unused Meds Go? <o:p></o:p></span></font></i></b></h2>
<h3 style='margin-bottom:6.0pt;line-height:15.6pt' id=dek><b><font size=3
face=Helvetica><span lang=EN style='font-size:11.5pt;font-family:Helvetica'>Politicians
Want to Give Unused Drugs to Charity, But Much of it Gets Flushed<o:p></o:p></span></font></b></h3>
<h4 style='margin-bottom:0in;margin-bottom:.0001pt;line-height:15.6pt'
id=byline><b><font size=2 face=Helvetica><span lang=EN style='font-size:10.5pt;
font-family:Helvetica'>By LAUREN COX<br>
ABC News Medical Unit<o:p></o:p></span></font></b></h4>
<p><strong><b><font size=3 face="Times New Roman"><span lang=EN
style='font-size:12.0pt'>Feb. 24, 2010—</span></font></b></strong><span
lang=EN> <o:p></o:p></span></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Photos
go to relatives and the knickknacks might go to a garage sale, but who wants to
deal with the array of unused pills when grandma passes away? <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Some
politicians do. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>In
the last year, state legislators across the country have proposed bills aimed
at curbing the disposal of unused medication. <st1:State w:st="on">Colorado</st1:State>,
<st1:State w:st="on">Maine</st1:State>, <st1:State w:st="on">Minnesota</st1:State>,
<st1:State w:st="on">Maryland</st1:State> and <st1:State w:st="on"><st1:place
w:st="on">Washington</st1:place></st1:State> have all proposed legislation
that in one way or another tries to address the issue of<a
href="http://abcnews.go.com/Health/Decade/top-10-health-scares-past-10-years/story?id=9249373"
target=external>medicines that end up in landfills and watersheds</a> every
year. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Bills
in some states, such as <st1:State w:st="on"><st1:place w:st="on">Colorado</st1:place></st1:State>,
want nursing homes to be free <a
href="http://abcnews.go.com/WhatWouldYouDo/soaring-prescription-medicine-costs/story?id=8774859"
target=external>to donate the unused medication</a> to charities that help
developing countries. Bills in other states attempt to divert unused medication
back to manufacturer -- and are facing resistance from pharmaceutical
companies. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>But
whoever is fighting over the unused medicine, all involved hope that no one
flushes them down the toilet. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"Probably
about 50 percent of the medications that are sent to my nursing home from the
pharmacy end up having to be destroyed," said Maxine Roby, an
administrator at Rowan Community -- a 66-bed nursing home facility in <st1:place
w:st="on"><st1:City w:st="on">Denver</st1:City>, <st1:State w:st="on">Colo.</st1:State></st1:place>
<o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Roby
said the waste at her nursing home is not unusual. In fact, by regulation it's
often unavoidable. <a
href="http://abcnews.go.com/Entertainment/oversight-prescription-medication-needed/story?id=9408999"
target=external>When a doctor writes a prescription</a> at a nursing home, the
pills aren't dispensed as they would be from a local pharmacy. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>The
pills are shipped <a
href="http://abcnews.go.com/Health/Wellness/morning-pill-spurs-abortion-controversy/story?id=9700748"
target=external>from the pharmaceutical company </a>on 30-day supply cards --
each pill snugly in its own "bubble" so the nurse can pop it out.
But, Roby explained, if a patient has a bad reaction to the medicine after one
day and stops taking it, or even passes away, nurses are required to get rid of
the whole card. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"They
[<a
href="http://abcnews.go.com/Health/PainManagement/pfizers-23-billion-settlement-change-practices/story?id=8476391"
target=external>pharmaceutical manufacturers</a>] will not take the drugs back,
I don't even know why. Once they give it to us, where stuck with them,"
said Roby. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"A
lot of people would just flush them," said Roby. But "we were
notified by the Denver Water board, that they have no way to filter medications
out of the drinking water." <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Since
water treatment plants across the country have no way of filtering out
pharmaceutical waste -- which can come from bodily fluids as well as unused
medicine -- more and more environmental groups are encouraging people to
dispense of the medication in the trash and hospitals to incinerate leftover
medicine.<!-- page --> <o:p></o:p></span></font></p>
<h3><b><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>To
Donate or Flush?<o:p></o:p></span></font></b></h3>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>The
home alternative to flushing is to follow the U.S. Environmental Protection
Agency guidelines. Mixed unused medication with something unsavory -- like
kitty litter -- to keep it away from animals and seal it in a container for the
landfill so it does not dissolve and leach into groundwater. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"That's
a big issue. That's why they're telling people put your medicine in kitty
litter, or in coffee grounds and throw them away," said <st1:State w:st="on"><st1:place
w:st="on">Colorado</st1:place></st1:State> Democratic state Senator Lois
Tochtrop who co-sponsored the bill, HB 10-1061, Colorado Medical Donation Program.
<o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Tochtrop
had no clear estimation of exactly how much medication could be saved through
his bill. Few estimates of how much medical waste is generated have even been
done. A 2009 investigation by The Associated Press estimated that at least 250
million pounds of pharmaceuticals and contaminated packaging is generated in
medical facilities each year. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Tochtrop
noted whatever medicine is saved, will go not only to international charities
such as Project Cure, but also local ones. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"The
need is endless in the developing world. One of the largest things they ask for
is medications, and it's the hardest to ship," said George Roberge, vice
president of operations at Project Cure. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Of
course not all medicines can be donated, even from nursing homes where packaging
would make it easier to safely keep medicine. Roberge noted that Project Cure
can't accept open packaging, liquids, expired medicine, narcotics or even
medicine that's is not expired but that stayed at a nursing home longer than a
year. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>But
Tochtrop and Roby, who testified before the state legislature in support of the
<st1:State w:st="on"><st1:place w:st="on">Colorado</st1:place></st1:State>
bill, think every little bit will help. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>The
medicines that are thrown away, "are going to our landfills then those
medications will leach into our ground water eventually," said Tochtrop. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>But
across the country in <st1:State w:st="on"><st1:place w:st="on">Maine</st1:place></st1:State>,
a measure meant to reduce medical waste is shaping into a bit of a public
debate about the dangers in landfills. <o:p></o:p></span></font><!-- page --></p>
<h3><b><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>What
About the Take Back Approach?<o:p></o:p></span></font></b></h3>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Often
called "take back" programs, state legislators in <st1:State w:st="on">Maine</st1:State>,
<st1:State w:st="on">Minnesota</st1:State> and <st1:State w:st="on"><st1:place
w:st="on">Washington</st1:place></st1:State> are proposing, the medicines from
homes (not nursing homes) should be the responsibility of pharmaceutical
companies. Rather than encouraging citizens to flush unused medications or
throw them away, the waste could be picked up along with other hazardous waste
such as mercury, and disposed of at the pharmaceutical companies' expense. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>The
Pharmaceutical companies are resisting this kind of legislation. "We know
that it [unused medicine] does not leech from landfills," said Marjorie
Powell, senior assistant general counsel for Pharmaceutical Research and
Manufacturers of America, PhRMA. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>PhRMA
has come out in opposition to many of the bills that require pharmaceutical
companies be responsible for the disposal of unused medications. However,
Powell said that PhRMA began looking into the fate of unused medication years
ago. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"When
PhRMA learned that there were trace amounts of compounds in [water] we were
approached by the U.S. Fish and Wildlife Service," said Powell. "They
said 'why are these there?', and we said we think it's because people have a
habit of flushing unused medicine down the toilet." <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>But,
Powell argued rather than having medicine shipped to the pharmaceutical
companies for disposal, more public education on how to properly throw away
medication would solve environmental concerns. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"We
think they (take back programs) cause more environmental harm than they solve,
we think they're unnecessary," Powell said of the bills. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>However,
Scott Cassel, executive director at the Product Stewardship Institute,
disagreed with Powell's assertion that dissolved medicine would not leech out
of landfills. He also questioned whether having pharmaceutical companies
dispose of the medication would be a challenge, since the industry already
incinerates leftover medication from pharmacies in private take back programs. <o:p></o:p></span></font><!-- page --></p>
<h3><b><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>What
Really Happens To Unused Medicine?<o:p></o:p></span></font></b></h3>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"Putting
it in the trash, in the landfills doesn't mean that it won't get in the
water," said <st1:place w:st="on">Cassel</st1:place>. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>The
EPA is unsure and has funded a plethora of studies to track pharmaceuticals
contamination from hospitals, from farms, and from human waste. <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"Recent
studies have documented the presence of various pharmaceutical chemicals and
metabolic by-products in surface waters and groundwater in the <st1:country-region
w:st="on"><st1:place w:st="on">United States</st1:place></st1:country-region>,
and the issue of pharmaceutical use and management has become increasingly
important," the EPA wrote on its Web site in its proposal to add
pharmaceuticals to the <a
href="http://www.epa.gov/waste/hazard/wastetypes/universal/pharm.htm"
target=external>Universal Waste Rule</a>. "EPA is conducting research on
the presence of pharmaceutical compounds in water bodies and any ecological
effects the compounds may be causing, as well as research directed towards
improving water treatment capabilities." <o:p></o:p></span></font></p>
<p><st1:place w:st="on"><font size=3 face="Times New Roman"><span lang=EN
style='font-size:12.0pt'>Cassel</span></font></st1:place><span lang=EN> said
the Product Stewardship Institute has attempted to facilitate talks between
state government and pharmaceutical industry representatives to address the
problem. He said both sides can agree not to tell people to flush medicine down
the toilet. <o:p></o:p></span></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>But,
"it's too expensive for the local governments to take it back," <st1:place
w:st="on">Cassel</st1:place> noted. "They feel like they want to do
something, they want to protect their citizens but they don't have the funding
to do it." <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>"At
this point we got a lot of work ahead of us, I think this bill might have a
chance at really making it all the way through," said Maine state Senator
Anne C. Perry , a Democrat, who introduced the measure in Maine. "It's
still not a definite, and we got a lot of work to do." <o:p></o:p></span></font></p>
<p><font size=3 face="Times New Roman"><span lang=EN style='font-size:12.0pt'>Copyright
© 2010 ABC News Internet Ventures<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span lang=EN style='font-size:11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:11.0pt'><o:p> </o:p></span></font></p>
<p class=MsoNormal><strong><b><font size=2 face="Arial Narrow"><span
style='font-size:10.0pt;font-family:"Arial Narrow"'>Firouzan 'Fred' Massoomi,
Pharm.D., FASHP</span></font></b></strong><o:p></o:p></p>
<p class=MsoNormal><st1:place w:st="on"><st1:PlaceName w:st="on"><font size=2
face="Arial Narrow"><span style='font-size:10.0pt;font-family:"Arial Narrow"'>Nebraska</span></font></st1:PlaceName><font
face="Arial Narrow"><span style='font-family:"Arial Narrow"'> <st1:PlaceName
w:st="on">Methodist</st1:PlaceName> <st1:PlaceType w:st="on">Hospital</st1:PlaceType></span></font></st1:place><o:p></o:p></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span style='font-size:
10.0pt;font-family:"Arial Narrow"'>Pharmacy Operations Coordinator</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span style='font-size:
10.0pt;font-family:"Arial Narrow"'>Department of Pharmacy Services</span></font><o:p></o:p></p>
<p class=MsoNormal><st1:Street w:st="on"><st1:address tabIndex="0"
style="BACKGROUND-POSITION: left bottom; BACKGROUND-IMAGE: url(res://ietag.dll/#34/#1001); BACKGROUND-REPEAT: repeat-x"
w:st="on"><font size=2 face="Arial Narrow"><span style='font-size:10.0pt;
font-family:"Arial Narrow"'>8303 Dodge St</span></font></st1:address></st1:Street><font
face="Arial Narrow"><span style='font-family:"Arial Narrow"'>.</span></font><o:p></o:p></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span lang=FR
style='font-size:10.0pt;font-family:"Arial Narrow"'>Omaha, NE 68114</span></font><span
lang=FR><o:p></o:p></span></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span style='font-size:
10.0pt;font-family:"Arial Narrow"'><a href="mailto:fred.massoomi@nmhs.org"><span
lang=FR>fred.massoomi@nmhs.org</span></a></span></font><span lang=FR><o:p></o:p></span></p>
<p class=MsoNormal><font size=2 face="Arial Narrow"><span style='font-size:
10.0pt;font-family:"Arial Narrow"'>(402) 354-4340
office (402)
354-3139 fax</span></font><o:p></o:p></p>
<p class=MsoNormal><strong><b><font size=2 color="#ff8000" face="Arial Narrow"><span
style='font-size:10.0pt;font-family:"Arial Narrow";color:#FF8000'>A proud
supporter of the Multiple Sclerosis Society<o:p></o:p></span></font></b></strong></p>
<p class=MsoNormal><font size=5 color=green face=Webdings><span lang=EN-GB
style='font-size:18.0pt;font-family:Webdings;color:green'>P</span></font><font
color=green><span lang=EN-GB style='color:green'> </span></font><font
color=green face="Arial Narrow"><span lang=EN-GB style='font-family:"Arial Narrow";
color:green'>Think Green & </span></font><font color=green
face="Arial Narrow"><span lang=EN-GB style='font-family:"Arial Narrow";
color:green'>Think before <strong><b><font face="Arial Narrow"><span
style='font-family:"Arial Narrow"'>YOU</span></font></b></strong> print.</span></font><font
color=green face="Arial Narrow"><span lang=EN-GB style='font-family:"Arial Narrow";
color:green'> </span></font><font size=3 color=green face="Times New Roman"><span
style='font-size:12.0pt;font-family:"Times New Roman";color:green'><o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Arial><span style='font-size:10.0pt'><o:p> </o:p></span></font></p>
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