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<div>Hey Allen,</div>
<div><font size="2" face="tahoma">I know they sewer a lot, so from that standpoint are a huge source. Are you also saying it is documented that they are a huge source for diversion? I did not know this. I figured it is much like any place that is well stocked
with pharms, there is always the potential for pilfering, but not that they are a large source of pharms that are being sold on the street. I assumed most of the source for abuse is people having access to almost unlimited prescriptions, including online
and from anyone's unguarded medicine cabinet. I guess I haven't thought about sources further than that. Does anyone know of a study?</font></div>
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<div><font size="2" face="tahoma">My thoughts on Mr. More's message, other than I agree with it all, is that if DEA is going to collect from LTC's as if they are households for this nationwide event, someone from high up in EPA should be involved in advising
them on participation and disposal. It appears to be causing some chaos at the state level.</font></div>
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<font color="#000000" size="2" face="Tahoma"><b>From:</b> pharmwaste-bounces@lists.dep.state.fl.us [pharmwaste-bounces@lists.dep.state.fl.us] On Behalf Of Gilliam, Allen [GILLIAM@adeq.state.ar.us]<br>
<b>Sent:</b> Thursday, March 17, 2011 10:32 AM<br>
<b>To:</b> 'William More'; pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> RE: [Pharmwaste] Re: LTC to DEA Pharm drop off<br>
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<p class="MsoNormal"><span style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt">LTCs are a HUGE source. This info from some co-workers who have worked in, have family or friends working in them. They both flush AND toss UEMs into their
outside dumpsters. I’m sure (kinda) they’re a little more cognitive regarding disposal of controlled substances what with the DEA’s mandatory paper trail, but am of the opinion most of the “nurses” on duty might not know a P or U haz waste from an aspirin.</span></p>
<p class="MsoNormal"><span style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt">Charlotte Smith probably has a much better perspective of LTC facililties’ pharma disposal practices overall.</span></p>
<p class="MsoNormal"><span style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt">Allen Gilliam/ADEQ State Pretreatment Coordinator/501.682.0625</span></p>
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<p style="MARGIN: 0in 0in 0pt" 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"> pharmwaste-bounces@lists.dep.state.fl.us [mailto:pharmwaste-bounces@lists.dep.state.fl.us]
<b>On Behalf Of </b>William More<br>
<b>Sent:</b> Thursday, March 17, 2011 9:01 AM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> [Pharmwaste] Re: LTC to DEA Pharm drop off</span></p>
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<p style="MARGIN: 0in 0in 0pt" class="MsoNormal"><span style="FONT-FAMILY: 'Tahoma','sans-serif'; FONT-SIZE: 10pt">How is it that commercial generators can get an allowance for use of a freebie, when there are regulations in place, that have been in place,
and should be considered a business expense and should be budgeted for.</span></p>
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<p style="MARGIN: 0in 0in 0pt" class="MsoNormal"><span style="FONT-FAMILY: 'Tahoma','sans-serif'; FONT-SIZE: 10pt">Is DEA sponsoring an, " anybody can bring it event" or are they sponsoring a home owner cleanup event to limit the available "pharms to the street
market". LTC's should not be a source to the "pharms in the street market". Are LTC such a source? If so, then we should be expending some effort there. An if they are, they should be held to meet the existing requirements for proper management through
commercial disposal under the regs. and not be given a pass.</span></p>
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<p style="MARGIN: 0in 0in 0pt" class="MsoNormal"><span style="FONT-FAMILY: 'Tahoma','sans-serif'; FONT-SIZE: 10pt">If we are piggybacking diversion from flushing to our Waste Water Treatment Plants and Landfills on the DEA event, then we need to look at our
regulations and see if they are adequate and if not allow a general amnesty on LTC storage until the regs are fixed.</span></p>
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<p style="MARGIN: 0in 0in 0pt" class="MsoNormal"><span style="FONT-FAMILY: 'Tahoma','sans-serif'; FONT-SIZE: 10pt">There are LTC generated pharms that are Hazardous Waste and even Acute Hazardous Waste. These regulations on the federal level were not enacted
yesterday, but are approx 30 yrs. old. What happens to these materials that are under a "cradle to grave" tracking when they are dumped wholesale at a DEA sponsored HHW pharm cleanup day? Is the LTC going to have a possibly required manifest for their Hazardous
Waste? Are the pharms going to be adequately identified and quantified for the required records? Are we just going to give them a pass on the federal regulations? Proper management has been mandated by the regulation for approx. 30 years and now we have a
problem? What have they been doing for the 30 years? And in regards to the Acute Hazardous Waste, are the LTC's meeting the paperwork regs. that go with being a Large Quantity Generator if the they have 1Kg(2.2lbs) in total Acute Hazardous Waste (and contaminated
packaging)?</span></p>
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<p style="MARGIN: 0in 0in 0pt" class="MsoNormal"><span style="FONT-FAMILY: 'Tahoma','sans-serif'; FONT-SIZE: 10pt">EPA has had outreach programs to Hospitals that included proper management of pharms, have they included LTC's? The Hospital outreach program
is ongoing and maybe LTC if they are not included could be added and there could be a organized/codified allowance for on site storage under consent until the LTC's could show that they can meet the regs.</span></p>
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