<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN"><html><head><meta content="text/html;charset=UTF-8" http-equiv="Content-Type"></head><body ><FONT face=Verdana,Arial,Helvetica,sans-serif>HAving presented at a couple Patient Adherence and Compliance conferences over the past several years, I'd like to say that the manufacturers have a deep abiding interest in people taking their meds and not stopping. Much money has been spent commercially and in support of academicresearch to eke out small percentage gains in adherence. Almost any one of those programs would be more than all of us have spent in drug disposal. I really think that nobody in this whole process wants the waste. </FONT><BR><BR>
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<P style="MARGIN: 0in 0in 10pt" class=MsoNormal>Stevan Gressitt, M.D.<BR>Faculty Associate, University of Maine Center on Aging<BR>Founding Director<BR>Maine Institute for Safe Medicine<BR>University of New England, College of Pharmacy<BR>Department of Pharmaceutical Sciences <BR>Associate Professor of Clinical Psychiatry<BR>University of New England, College of Osteopathic Medicine<BR>716 Stevens Avenue <BR>Portland, Maine 04103<BR><A href="mailto:gressitt@gmail.com">gressitt@gmail.com</A> <BR>Cell: 207-441-0291 </P>
<P style="MARGIN: 0in 0in 10pt" class=MsoNormal> </P></DIV></DIV></DIV><BR><BR>---- On Wed, 07 Jul 2010 20:39:48 -0400 <B>Jennifer (MPCA) Volkman <<a href='mailto:Jennifer.Volkman@state.mn.us' target='_blank'>Jennifer.Volkman@state.mn.us</a>></B> wrote ---- <BR><BR>
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<DIV>Regardless of PhRMA's assumptions, anyone who has sorted pharms from collection programs knows well that an incredible amount of drugs are completely wasted. We have pharmatizing in every media and taking up more space each day, desperate patients looking for the magic pill, internet scam sales, the disconnect between insurance dollars and prescribing practices. There are so many issues coming into better light as we generate more data. It is just one more area where excess generates so many problems: pollution, abuse, poisoning, millions of dollars down the drain and up in smoke. There is hope in this article? I'm sure we can turn the ship while the interest is still building.</DIV>
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<DIV><STRONG><FONT color=#666666 size=2>HEALTH </FONT></STRONG> <FONT color=#000000 size=-1 face="Times New Roman,Times,Serif">| July 06, 2010</FONT> <BR clear=none><FONT color=#000066 size=+1 face="Times New Roman,Times,Serif"><STRONG><A href="http://www.nytimes.com/2010/07/06/health/06waste.html?emc=eta1" shape=rect target=_blank>In a World of Throwaways, Making a Dent in Medical Waste</A></STRONG></FONT><BR clear=none><FONT color=#000000 size=-1 face="Times New Roman,Times,Serif">By INGFEI CHEN</FONT> <BR clear=none><FONT color=#000000 face="Times New Roman,Times,Serif">Untold numbers of unused, and reusable, health care supplies and equipment end up in millions of tons of health care industry trash. <BR clear=none></FONT> </DIV>
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<FONT color=#000000 size=2 face=Tahoma><B>From:</B> <A href="mailto:pharmwaste-bounces@lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste-bounces@lists.dep.state.fl.us</A> [<A href="mailto:pharmwaste-bounces@lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste-bounces@lists.dep.state.fl.us</A>] On Behalf Of Pamela Ortner [<A href="mailto:portner@angelahospice.net" shape=rect target=_blank>portner@angelahospice.net</A>]<BR clear=none><B>Sent:</B> Wednesday, July 07, 2010 5:36 PM<BR clear=none><B>To:</B> gressitt; Tenace, Laurie<BR clear=none><B>Cc:</B> <A href="mailto:pharmwaste@lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste@lists.dep.state.fl.us</A><BR clear=none><B>Subject:</B> Re: [Pharmwaste] FW: 99.9% of drugs in water are from excretion<BR clear=none></FONT><BR clear=none></DIV>
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<DIV>I think one needs to be careful about quoting PhRMA. The <STRONG>EPA</STRONG> did not say 99.99% of APIs come from excretion; <STRONG>PhRMA (Pharmaceutical Research and Manufacturers of America)</STRONG> did. PhRMA accounts for 80% of drug sales in the US so it might be in their best interest to say the majority of the drug comes from excretion as it might lessen liability.</DIV>
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<DIV><FONT size=2>Pamela Ortner, MS, RN, CHPN, COHN-S<BR clear=none>Quality Improvement/Education Coordinator<BR clear=none>Angela Hospice<BR clear=none>14100 Newburgh Rd.<BR clear=none>Livonia, Michigan 48154<BR clear=none>(734) 953-6040</FONT></DIV>
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<DIV><FONT size=2>"Willing is not enough, we must act. Knowing is not enough, we must do."<BR clear=none> Goethe </FONT> </DIV>
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<DIV><B>From:</B> <A <a href='mailto:gressitt@zoho.com' target='_blank'>gressitt@zoho.com</a> href="mailto:gressitt@zoho.com" shape=rect target=_blank>gressitt</A> </DIV>
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<DIV style="FONT: 10pt arial"><B>To:</B> <A <a href='mailto:Laurie.Tenace@dep.state.fl.us' target='_blank'>Laurie.Tenace@dep.state.fl.us</a> href="mailto:Laurie.Tenace@dep.state.fl.us" shape=rect target=_blank>Tenace, Laurie</A> </DIV>
<DIV style="FONT: 10pt arial"><B>Cc:</B> <A <a href='mailto:pharmwaste@lists.dep.state.fl.us' target='_blank'>pharmwaste@lists.dep.state.fl.us</a> href="mailto:pharmwaste@lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste@lists.dep.state.fl.us</A> </DIV>
<DIV style="FONT: 10pt arial"><B>Sent:</B> Wednesday, July 07, 2010 2:31 PM</DIV>
<DIV style="FONT: 10pt arial"><B>Subject:</B> Re: [Pharmwaste] FW: 99.9% of drugs in water are from excretion</DIV>
<DIV><BR clear=none></DIV><FONT face=Verdana,Arial,Helvetica,sans-serif>One problem is much household waste in Maine is incinerated, not landfilled. I suspect likewise with WTE plants....</FONT><BR clear=none><BR clear=none>
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<P style="MARGIN: 0in 0in 10pt">Stevan Gressitt, M.D.<BR clear=none>Faculty Associate, University of Maine Center on Aging<BR clear=none>Founding Director<BR clear=none>Maine Institute for Safe Medicine<BR clear=none>University of New England, College of Pharmacy<BR clear=none>Department of Pharmaceutical Sciences <BR clear=none>Associate Professor of Clinical Psychiatry<BR clear=none>University of New England, College of Osteopathic Medicine<BR clear=none>716 Stevens Avenue <BR clear=none>Portland, Maine 04103<BR clear=none><A href="mailto:gressitt@gmail.com" shape=rect target=_blank>gressitt@gmail.com</A> <BR clear=none>Cell: 207-441-0291 </P>
<P style="MARGIN: 0in 0in 10pt"> </P></DIV></DIV></DIV><BR clear=none><BR clear=none>---- On Wed, 07 Jul 2010 13:33:09 -0400 <B>Laurie Tenace <<A href="mailto:Laurie.Tenace@dep.state.fl.us" shape=rect target=_blank>Laurie.Tenace@dep.state.fl.us</A>></B> wrote ---- <BR clear=none><BR clear=none>
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<P><SPAN style="COLOR: #1f497d; FONT-SIZE: 11pt">Several months ago a list serve member mentioned that 99.9% of active pharmaceutical ingredient surface water releases were from patient excretion. I stumbled across this reference to that number the other day:</SPAN></P>
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<P style="MARGIN-LEFT: 0.5in">page 69 of <A href="http://nepis.epa.gov/EPA/html/DLwait.htm?url=/Adobe/PDF/P1001AWF.PDF" shape=rect target=_blank>http://nepis.epa.gov/EPA/html/DLwait.htm?url=/Adobe/PDF/P1001AWF.PDF</A> (or section 6.3)</P>
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<P style="MARGIN-LEFT: 0.5in">EPA performed a literature search for studies or reports on pharmaceuticals disposed of in landfills. EPA found that in 2007, the Pharmaceutical Research and Manufacturers of America (PhRMA) evaluated the potential for 24 active pharmaceutical ingredients to leach from MSW landfills and their potential releases to surface water (Tischler, 2007). PhRMA compared the modeled landfill leachate releases to estimates of surface water releases from disposal of unused pharmaceuticals down the drain. PhRMA selected the 24 example pharmaceutical ingredients to represent a range of sales per year in the U.S. (i.e., high quantities and low quantities) and a range of physical-chemical properties. These pharmaceutical ingredients were also evaluated in the 2002 USGS study of pharmaceuticals in surface waters (Kolpin et al., 2002).</P>
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<P style="MARGIN-LEFT: 0.5in">The PhRMA study calculated that the landfill disposal pathway to surface water accounted for an average of 0.03% to 0.10% of the estimated aggregate annual surface water releases for the 24 active pharmaceutical ingredients. Therefore, the study estimated that over <SPAN style="BACKGROUND: yellow">99.9% of active pharmaceutical ingredient surface water releases would be due to patient excretion</SPAN>, not landfill disposal of unused medicines, assuming that landfill disposal were used for all unused medicine disposal. The evaluation was based on the assumption that the efficiency of the pharmaceuticals partitioning to solids in the landfill is 50% of the efficiency of partitioning in a biological wastewater treatment unit (Tischler, 2007).</P>
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<P style="MARGIN-LEFT: 0.5in">Laurie Tenace</P>
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<P style="MARGIN-LEFT: 0.5in">Environmental Specialist</P>
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<P style="MARGIN-LEFT: 0.5in">Waste Reduction Section</P>
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<P style="MARGIN-LEFT: 0.5in">Florida Department of Environmental Protection</P>
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<P style="MARGIN-LEFT: 0.5in">2600 Blair Stone Rd., MS 4555</P>
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<P style="MARGIN-LEFT: 0.5in">Tallahassee FL 32399-2400</P>
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<P style="MARGIN-LEFT: 0.5in">P: 850.245.8759</P>
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<P style="MARGIN-LEFT: 0.5in">F: 850.245.8811</P>
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<P style="MARGIN-LEFT: 0.5in"><A href="mailto:Laurie.Tenace@dep.state.fl.us" shape=rect target=_blank>Laurie.Tenace@dep.state.fl.us</A> </P>
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<P style="MARGIN-LEFT: 0.5in">Mercury: <A href="http://www.dep.state.fl.us/waste/categories/mercury/default.htm" shape=rect target=_blank>http://www.dep.state.fl.us/waste/categories/mercury/default.htm</A></P>
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<P style="MARGIN-LEFT: 0.5in">Batteries: <A href="http://www.dep.state.fl.us/waste/categories/batteries/default.htm" shape=rect target=_blank>http://www.dep.state.fl.us/waste/categories/batteries/default.htm</A></P>
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<P style="MARGIN-LEFT: 0.5in">Pharmaceuticals: </P>
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<P style="MARGIN-LEFT: 0.5in"><A href="http://www.dep.state.fl.us/waste/categories/medications/default.htm" shape=rect target=_blank>http://www.dep.state.fl.us/waste/categories/medications/default.htm</A></P>
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<P style="MARGIN-LEFT: 0.5in">To join the Pharmwaste listserve: <A href="http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste" shape=rect target=_blank>http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste</A></P>
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<P style="MARGIN-LEFT: 0.5in">Household Hazardous Waste:</P>
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<P style="MARGIN-LEFT: 0.5in"><A href="http://www.dep.state.fl.us/waste/categories/hazardous/pages/household.htm" shape=rect target=_blank>http://www.dep.state.fl.us/waste/categories/hazardous/pages/household.htm</A></P>
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<DIV style="FONT-FAMILY: courier new; FONT-SIZE: 9pt"><EM><FONT size=2 face=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. Simply click on <A href="http://survey.dep.state.fl.us/?refemail=Laurie.Tenace@dep.state.fl.us" shape=rect target=_blank>this link to the DEP Customer Survey</A>. Thank you in advance for completing the survey.</FONT></EM></DIV>
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<DIV style="FONT-FAMILY: courier new; FONT-SIZE: 9pt"></DIV></DIV></DIV>--- <BR clear=none>Note: As a courtesy to other listserv subscribers, please post messages to the listserv in plain text format to avoid the garbling of messages received by digest recipients. <BR clear=none>--- <BR clear=none>TO SUBSCRIBE, go to: <A href="http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste" shape=rect target=_blank>http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste</A> <BR clear=none>TO UNSUBSCRIBE, DO NOT REPLY TO THE LISTSERV. Please send an e-mail to <A href="mailto:pharmwaste-unsubscribe@lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste-unsubscribe@lists.dep.state.fl.us</A> -- the subject line and body of the e-mail should be blank. <BR clear=none>If you believe you may be subscribed with a different email address, please visit the subscriber listing at <A href="http://lists.dep.state.fl.us/cgi-bin/mailman/roster/pharmwaste" shape=rect target=_blank>http://lists.dep.state.fl.us/cgi-bin/mailman/roster/pharmwaste</A> <BR clear=none>FOR PROBLEMS: Contact List Administrator <A href="mailto:Laurie.Tenace@dep.state.fl.us" shape=rect target=_blank>Laurie.Tenace@dep.state.fl.us</A> <BR clear=none>SEND MAIL to the list server at: <A href="mailto:pharmwaste@lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste@lists.dep.state.fl.us</A> <BR clear=none></DIV></BLOCKQUOTE><BR clear=none></BLOCKQUOTE></DIV></DIV>--- <BR clear=none>Note: As a courtesy to other listserv subscribers, please post messages to the listserv in plain text format to avoid the garbling of messages received by digest recipients. <BR clear=none>--- <BR clear=none>TO SUBSCRIBE, go to: <A href="http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste" shape=rect target=_blank>http://lists.dep.state.fl.us/cgi-bin/mailman/listinfo/pharmwaste</A> <BR clear=none>TO UNSUBSCRIBE, DO NOT REPLY TO THE LISTSERV. Please send an e-mail to <A href="mailto:pharmwaste-unsubscribe@lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste-unsubscribe@lists.dep.state.fl.us</A> -- the subject line and body of the e-mail should be blank. <BR clear=none>If you believe you may be subscribed with a different email address, please visit the subscriber listing at <A href="http://lists.dep.state.fl.us/cgi-bin/mailman/roster/pharmwaste" shape=rect target=_blank>http://lists.dep.state.fl.us/cgi-bin/mailman/roster/pharmwaste</A> <BR clear=none>FOR PROBLEMS: Contact List Administrator <A href="mailto:Laurie.Tenace@dep.state.fl.us" shape=rect target=_blank>Laurie.Tenace@dep.state.fl.us</A> <BR clear=none>SEND MAIL to the list server at: <A href="mailto:pharmwaste@lists.dep.state.fl.us" shape=rect target=_blank>pharmwaste@lists.dep.state.fl.us</A> <BR clear=none></DIV></BLOCKQUOTE><BR></body></html>