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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D">Hi Allen,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D">Since enforcement of RCRA regs at LTCFs has just begun, most notably in MN and NY, the common practice has been to dispose of them in the sanitary sewer witnessed
by two licensed professionals (nurse, pharmacist, etc.). Controlled substances are more highly “controlled” in terms of security and the disposal process, but the drain is still the most common method. We are now working with LTCFs and it’s a bit more of a
challenge in that they do not usually have an in-house pharmacy so their stock of drugs changes daily.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D">There is still much work to be done both in education and changing practices in the alternate care market such as long term care facilities, physician practices,
veterinary practices, surgery centers, etc. <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Best regards,<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Charlotte A. Smith, R. Ph., M.S., HEM<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Director, PharmEcology Services<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">WM Healthcare Solutions, Inc.
<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">W124N8925 Boundary Road<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Menomonee Falls, WI 53051-2402<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">713-725-6363 (cell)<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">414-292-3959<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">414-479-9941(fax)<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">csmith@pharmecology.com<o:p></o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><b><i><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#00B050">Waste Management's renewable energy projects create enough energy to power over 1 million homes.<o:p></o:p></span></i></b></p>
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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><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>Gilliam, Allen<br>
<b>Sent:</b> Thursday, March 17, 2011 10:33 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<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D">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.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D">Charlotte Smith probably has a much better perspective of LTC facililties’ pharma disposal practices overall.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";
color:#1F497D">Allen Gilliam/ADEQ State Pretreatment Coordinator/501.682.0625<o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><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>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<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">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.<o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">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.<o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">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.<o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">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)?<o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">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.<o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin:0in;margin-bottom:.0001pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif""> <o:p></o:p></span></p>
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