<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META content=text/html;charset=UTF-8 http-equiv=Content-Type>
<META name=GENERATOR content="MSHTML 8.00.6001.18928">
<STYLE></STYLE>
</HEAD>
<BODY bgColor=#ffffff>
<DIV><FONT size=2>Of course no one wants the waste and everyone would like to
increase compliance, but when it comes to responsible parties, efforts will be
made to mitigate loss; that's all I am saying. The incinerator industry would
like for APIs to be incinerated, so they are working to that end. As health care
providers we need to look to how to reduce risks both to human health and the
environment. </FONT></DIV>
<BLOCKQUOTE
style="BORDER-LEFT: #000000 2px solid; PADDING-LEFT: 5px; PADDING-RIGHT: 0px; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px">
<DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
<DIV
style="FONT: 10pt arial; BACKGROUND: #e4e4e4; font-color: black"><B>From:</B>
<A title=gressitt@zoho.com href="mailto:gressitt@zoho.com">gressitt</A> </DIV>
<DIV style="FONT: 10pt arial"><B>To:</B> <A title=Jennifer.Volkman@state.mn.us
href="mailto:Jennifer.Volkman@state.mn.us">Volkman, Jennifer (MPCA)</A> </DIV>
<DIV style="FONT: 10pt arial"><B>Cc:</B> <A title=portner@angelahospice.net
href="mailto:portner@angelahospice.net">Pamela Ortner</A> ; <A
title=Laurie.Tenace@dep.state.fl.us
href="mailto:Laurie.Tenace@dep.state.fl.us">Tenace, Laurie</A> ; <A
title=pharmwaste@lists.dep.state.fl.us
href="mailto:pharmwaste@lists.dep.state.fl.us">,"pharmwaste@lists.dep.state.fl.us</A>
</DIV>
<DIV style="FONT: 10pt arial"><B>Sent:</B> Wednesday, July 07, 2010 9:05
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></DIV><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>
<DIV>
<DIV>
<DIV>
<P>
<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>
<BLOCKQUOTE style="BORDER-LEFT: #0000ff 1px solid; PADDING-LEFT: 6px">
<DIV bgcolor="#ffffff" ocsi="x">
<DIV
style="FONT-FAMILY: tahoma; DIRECTION: ltr; COLOR: #000000; FONT-SIZE: 13px">
<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>
<DIV> </DIV>
<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>
<DIV dir=ltr><FONT color=#000000 size=2 face=Tahoma></FONT> </DIV>
<DIV style="DIRECTION: ltr">
<HR tabIndex=-1>
<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>
<DIV></DIV>
<DIV>
<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>
<DIV> </DIV>
<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>
<DIV> </DIV>
<DIV><FONT size=2>"Willing is not enough, we must act. Knowing is not
enough, we must do."<BR
clear=none>
Goethe
</FONT> </DIV>
<DIV><FONT size=2></FONT> </DIV>
<DIV><FONT size=2></FONT> </DIV>
<DIV><B>From:</B> <A href="mailto:gressitt@zoho.com" target=_blank
<a>gressitt@zoho.com</A> href="mailto:gressitt@zoho.com" shape=rect
target=_blank>gressitt</A> </DIV>
<BLOCKQUOTE
style="BORDER-LEFT: #000000 2px solid; PADDING-LEFT: 5px; PADDING-RIGHT: 0px; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px">
<DIV style="FONT: 10pt arial"><B>To:</B> <A
href="mailto:Laurie.Tenace@dep.state.fl.us" target=_blank
<a>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
href="mailto:pharmwaste@lists.dep.state.fl.us" target=_blank
<a>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>
<DIV>
<DIV>
<DIV>
<P></P>
<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>
<BLOCKQUOTE style="BORDER-LEFT: #0000ff 1px solid; PADDING-LEFT: 6px">
<DIV>
<DIV>
<DIV>
<DIV>
<DIV>
<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>
<P><SPAN style="COLOR: #1f497d; FONT-SIZE: 11pt"></SPAN> </P>
<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>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P>
<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>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P>
<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>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">Laurie Tenace</P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">Environmental Specialist</P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">Waste Reduction Section</P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">Florida Department of Environmental
Protection</P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">2600 Blair Stone Rd., MS 4555</P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">Tallahassee FL 32399-2400</P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">P: 850.245.8759</P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">F: 850.245.8811</P>
<P></P>
<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>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P>
<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>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P>
<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>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">Pharmaceuticals: </P>
<P></P>
<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>
<P></P>
<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>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P>
<P style="MARGIN-LEFT: 0.5in">Household Hazardous Waste:</P>
<P></P>
<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>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P>
<P style="MARGIN-LEFT: 0.5in"></P>
<P></P></DIV></DIV>
<DIV><BR clear=none><BR clear=none></DIV>
<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>
<DIV style="FONT-FAMILY: courier new; FONT-SIZE: 9pt"><EM><FONT size=2
face=Arial></FONT></EM></DIV>
<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></BLOCKQUOTE></BODY></HTML>