<HEAD>
<STYLE>body{font-size:10pt;font-family:arial,sans-serif;background-color:#ffffff;color:black;}p{margin:0px;}</STYLE>
<META name=GENERATOR content="MSHTML 8.00.6001.19088"></HEAD>
<BODY>
<P><FONT color=#000000><FONT size=2><FONT face=arial,sans-serif>Jeff,</FONT></FONT></FONT></P>
<P>You raised some terrific questions! We have been doing research on unused & expired medicines (UEMs) since 2004, initially to support the work of the Maine Benzodiazepine Study Group. So far, we've funded our own studies and projects to better understand the magnitude and impact of UEMs. In 2005 we set up the National UEM Registry to collect data on returned drugs by patients and consumers. We have about 30,000 items, nearly 2.7 million pills, capsules, tablets (estimated count), AWP, therapeutic categories, environmental risk/hazard classification, and some demographic info in our database. We are seeking funds to continue our analysis and reporting. In 2010, we completed and submitted a special report to CMS on the cost and impact of wasted medicines (non-adherence) among seniors. Data were provided from the Safe Medicine Disposal for Maine Pilot Program, First Phase. Some of your questions are answered in this report. You may download a copy at the following site, but you better fill your coffee cup first. It's 92-pages!</P>
<P> </P>
<P><A href="http://www.scribd.com/doc/47905144/CMFPS-Publication-CMS-Report-Final-Document-100510">http://www.scribd.com/doc/47905144/CMFPS-Publication-CMS-Report-Final-Document-100510</A></P>
<P><FONT color=#000000><FONT size=2><FONT face=arial,sans-serif></FONT></FONT></FONT> </P>
<P><FONT color=#000000><FONT size=2><FONT face=arial,sans-serif></FONT></FONT></FONT> </P>
<P><FONT color=#000000><FONT size=2><FONT face=arial,sans-serif>Additionally, we have been sampling various drug take-back programs in the U.S. to get a snapshot of the activities and outcomes of these programs. The sampling is conducted annually through our survey. The results of the survey are compiled, analyzed, and published in our National Directory of Drug Take-Back and Disposal Programs. We are now publishing the second edition of this Directory. For those who have ordered the new edition, please be patient. We are printing them as fast as we can. The National Directory lists more than 480 drug take-back programs with breakdown on type of collection (mail back, drop off, etc.), purpose of program (patient safety, environmental protection, ect.), involvement of law enforcement, among many other variables. </FONT></FONT></FONT></P>
<P> </P>
<P>Our immediate conclusion is that there is no perfect or failproof drug take-back system. Every model that we studied has inherent risks and benefits to the participants. You are absolutely right that more oversight is needed and returned meds should at least be sampled to determine the pattern and amount of wasted meds. Each state seems to interpret RCRA slightly differently based on the definition of "waste generator". From our survey, we know that there is still no consensus on how to label household (consumer) unwanted meds. Is it "hazardous" or "nonhazardous"; "medical" or "household" or "pharmaceutical" waste...?</P>
<P> </P>
<P>We believe that you and others who raise relevant questions about the effectiveness of these drug take-back programs deserve to be heard. Moreover, there is a continued need to objectively evaluate the programs and outcomes with measurements. I personally urge anyone who is interested in this discussion to attend the upcoming International Symposium on Safe Medicine, Oct 2-4, Portland, ME. More info at <A href="http://www.safemedicine.une.edu">www.safemedicine.une.edu</A></P>
<P> </P>
<P>This is one important annual gathering of leaders are discussing and addressing your questions and ideas. If anyone is doing similar research on comparison and evaluation of drug take-back programs, please let us know. And if you want to be listed in the National Directory, let us know too.</P>
<P> </P>
<P> </P>
<P>Matthew Mireles</P>
<P>Community Medical Foundation for Patient Safety</P>
<P>832-778-7777</P>
<P><A href="mailto:mcmireles@comofcom.com">mcmireles@comofcom.com</A></P>
<P> </P>
<P><FONT color=#000000><FONT size=2><FONT face=arial,sans-serif> </P>
<P> </P>
<P> </P>
<P> </P>
<P><BR> </P></FONT></FONT></FONT>
<BLOCKQUOTE style="BORDER-LEFT: #0000ff 2px solid; PADDING-LEFT: 5px; MARGIN-LEFT: 0px">-----Original Message----- <BR>From: Jeff Hollar <JHOLLAR@PWASTE.COM><BR>Sent: Jul 7, 2011 8:54 AM <BR>To: 'Stevan Gressitt' <GRESSITT@GMAIL.COM>, 'pharmwaste' <PHARMWASTE@LISTS.DEP.STATE.FL.US>, 'rxnews' <RXNEWS@LISTSERVE.COM><BR>Subject: RE: [Pharmwaste] Fwd: Google Alert - unused medicine disposal <BR><BR><?XML:NAMESPACE PREFIX = [default] http://www.w3.org/TR/REC-html40 NS = "http://www.w3.org/TR/REC-html40" /><ZZZhtml xmlns="http://www.w3.org/TR/REC-html40" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:v="urn:schemas-microsoft-com:vml"><ZZZhead><ZZZmeta content="text/html; charset=us-ascii" http-equiv="Content-Type"><ZZZmeta content="Microsoft Word 12 (filtered medium)" name="Generator"><ZZZ!--[if !mso]>
<STYLE>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</STYLE>
<ZZZ![endif]-->
<STYLE><ZZZ!--
/* Font Definitions */
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:12.0pt;
font-family:"Times New Roman","serif";}
a:ZZZlink, span.MsoHyperlink
{mso-style-priority:99;
color:blue;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:purple;
text-decoration:underline;}
p.MsoAcetate, li.MsoAcetate, div.MsoAcetate
{mso-style-priority:99;
mso-style-link:"Balloon Text Char";
margin:0in;
margin-bottom:.0001pt;
font-size:8.0pt;
font-family:"Tahoma","sans-serif";}
span.EmailStyle17
{mso-style-type:personal-reply;
font-family:"Calibri","sans-serif";
color:#1F497D;}
span.BalloonTextChar
{mso-style-name:"Balloon Text Char";
mso-style-priority:99;
mso-style-link:"Balloon Text";
font-family:"Tahoma","sans-serif";}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
--></STYLE>
<ZZZ!--[if 9] mso gte><xml><?xml:namespace prefix = o /><o:shapedefaults spidmax="1026" v:ext="edit"></o:shapedefaults></xml><ZZZ![endif]--><ZZZ!--[if 9] mso gte><xml><o:shapelayout v:ext="edit"><o:idmap v:ext="edit" data="1"></o:idmap></o:shapelayout></xml><ZZZ![endif]--></ZZZhead><ZZZbody lang=EN-US vlink="purple" link="blue">
<DIV class=WordSection1>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt">Regarding mailback programs: What about the potential of theft in transit? Mailmen, sorters, etc. What controls in place to 100% eliminate this? If someone diverts one mail back pouch, will this be caught? What if someone opens one up and takes 5 pills from a bottle? What if someone puts the mail back pouch in their mailbox and it gets swiped before the mailman picks it up? How do the various mailback programs address these diversion issues? <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt">On a related note, I am aware of at least one mailback program that is not permitted to take back DEA controlled substances. Obviously DEA controls will make it through. What happens when this mailback program facility receives DEA controls? How can this even be monitored if the container contents being shipped are not 100% examined?<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt">Regarding disposal: If these pharmaceuticals came from a non-household entity, the RCRA waste would likely have to be segregated and destroyed in a RCRA incinerator. What is the typical disposal method used in mailback programs? WTE Incinerator, RCRA Incinerator, autoclave, landfilled?<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt">I would like to learn more about the issues I raised above. Can those of you involved with the various mailback programs shed some light on these questions? <o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt">Warmest Regards,<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: #1f497d; FONT-SIZE: 10pt"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: #1f497d; FONT-SIZE: 10pt">Jeff Hollar</SPAN><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p></o:p></SPAN></P>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: #1f497d; FONT-SIZE: 10pt">President</SPAN><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><B><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: navy; FONT-SIZE: 10pt">PharmWaste Technologies, Inc.</SPAN></B><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: #1f497d; FONT-SIZE: 10pt">4164 NW Urbandale Dr., Ste A</SPAN><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: #1f497d; FONT-SIZE: 10pt">Urbandale, IA 50322</SPAN><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: #1f497d; FONT-SIZE: 10pt">515-276-5302 (general)</SPAN><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p></o:p></SPAN></P></DIV>
<DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: #1f497d; FONT-SIZE: 10pt">515-331-7310 (direct)<o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; COLOR: #1f497d; FONT-SIZE: 10pt">515-360-9785 (cell)</SPAN><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p></o:p></SPAN></P></DIV>
<P class=MsoNormal><A title=http://www.pwaste.com/ href="http://www.pwaste.com/" target=_blank><SPAN style="FONT-FAMILY: 'Tahoma','sans-serif'; FONT-SIZE: 10pt">www.pwaste.com</SPAN></A><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p></o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p> </o:p></SPAN></P>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Calibri','sans-serif'; COLOR: #1f497d; FONT-SIZE: 11pt"><o:p> </o:p></SPAN></P>
<DIV style="BORDER-BOTTOM: medium none; BORDER-LEFT: medium none; PADDING-BOTTOM: 0in; PADDING-LEFT: 0in; PADDING-RIGHT: 0in; BORDER-TOP: #b5c4df 1pt solid; BORDER-RIGHT: medium none; PADDING-TOP: 3pt">
<P 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"> Stevan Gressitt <A href="mailto:[mailto:gressitt@gmail.com]" target=_blank>[mailto:gressitt@gmail.com]</A> <BR><B>Sent:</B> Tuesday, July 05, 2011 5:55 PM<BR><B>To:</B> pharmwaste; rxnews<BR><B>Subject:</B> [Pharmwaste] Fwd: Google Alert - unused medicine disposal<o:p></o:p></SPAN></P></DIV>
<P class=MsoNormal><o:p> </o:p></P>
<P style="MARGIN-BOTTOM: 12pt" class=MsoNormal>Mailback would have precluded this problem<o:p></o:p></P>
<DIV>
<P style="MARGIN-BOTTOM: 12pt" class=MsoNormal>---------- Forwarded message ----------<BR>From: <B>Google Alerts</B> <<A href="mailto:googlealerts-noreply@google.com" target=_blank>googlealerts-noreply@google.com</A>><BR>Date: Tue, Jul 5, 2011 at 5:43 PM<BR>Subject: Google Alert - unused medicine disposal<BR>To: <A href="mailto:gressitt@gmail.com" target=_blank>gressitt@gmail.com</A><BR><BR><o:p></o:p></P>
<DIV>
<DIV>
<TABLE class=MsoNormalTable border=0 cellSpacing=0 cellPadding=0>
<TBODY>
<TR>
<TD style="PADDING-BOTTOM: 3pt; PADDING-LEFT: 6pt; PADDING-RIGHT: 6pt; BACKGROUND: #ebeff9; PADDING-TOP: 3pt">
<TABLE style="WIDTH: 100%" class=MsoNormalTable border=0 cellSpacing=0 cellPadding=0 width="100%">
<TBODY>
<TR>
<TD style="PADDING-BOTTOM: 0in; PADDING-LEFT: 0in; PADDING-RIGHT: 0in; PADDING-TOP: 0in">
<P class=MsoNormal><B><SPAN style="FONT-SIZE: 10pt">News</SPAN></B><o:p></o:p></P></TD>
<TD style="PADDING-BOTTOM: 0in; PADDING-LEFT: 0in; WIDTH: 70%; PADDING-RIGHT: 0in; PADDING-TOP: 0in" width="70%">
<P style="TEXT-ALIGN: right" class=MsoNormal align=right><B><SPAN style="FONT-SIZE: 10pt">1</SPAN></B><SPAN style="FONT-SIZE: 10pt"> new result for <B>unused medicine disposal</B></SPAN><o:p></o:p></P></TD></TR></TBODY></TABLE></TD></TR>
<TR>
<TD style="PADDING-BOTTOM: 0in; PADDING-LEFT: 0in; PADDING-RIGHT: 0in; PADDING-TOP: 0in">
<P class=MsoNormal> <o:p></o:p></P></TD></TR>
<TR>
<TD style="PADDING-BOTTOM: 12pt; PADDING-LEFT: 6pt; PADDING-RIGHT: 6pt; PADDING-TOP: 0in">
<P class=MsoNormal><A href="http://www.google.com/url?sa=X&q=http://beaconnews.suntimes.com/news/6358045-418/accused-yorkville-officer-takes-unpaid-leave.html&ct=ga&cad=CAcQARgAIAAoATAAOABA5YrO8ARIAVAAWABiBWVuLVVT&cd=506Kb9rPxRU&usg=AFQjCNHLWhpF3cML2daOKmUAOJ3ZsIiQng" target=_blank><SPAN style="COLOR: #1111cc">Accused Yorkville officer takes unpaid leave</SPAN></A><BR><SPAN style="FONT-SIZE: 10pt">Chicago Sun-Times<BR>Prosecutors claim that Delaney took prescription medicine for his personal use from the supplies turned in by residents as part of an <B>unused medication disposal</B> program. He is scheduled to make his first appearance in court today. <B>...</B><BR><A title=http://news.google.com/news/story?ncl=http://beaconnews.suntimes.com/news/6358045-418/accused-yorkville-officer-takes-unpaid-leave.html&hl=en&geo=us href="http://www.google.com/url?sa=X&q=http://news.google.com/news/story%3Fncl%3Dhttp://beaconnews.suntimes.com/news/6358045-418/accused-yorkville-officer-takes-unpaid-leave.html%26hl%3Den%26geo%3Dus&ct=ga&cad=CAcQARgAIAAoBjAAOABA5YrO8ARIAVAAWABiBWVuLVVT&cd=506Kb9rPxRU&usg=AFQjCNFzJphdvxpixG92roh6mgxa275I4A" target=_blank><SPAN style="COLOR: #228822">See all stories on this topic ยป</SPAN></A></SPAN><o:p></o:p></P></TD></TR></TBODY></TABLE>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'"><o:p> </o:p></SPAN></P>
<DIV style="TEXT-ALIGN: center" class=MsoNormal align=center><SPAN style="FONT-FAMILY: 'Arial','sans-serif'">
<HR style="COLOR: #cccccc" align=center SIZE=1 width="100%" noShade>
</SPAN></DIV>
<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt">Tip: Use quotes ("like this") around a set of words in your query to match them exactly. <A href="http://www.google.com/support/websearch/bin/answer.py?answer=136861&hl=en&source=alertsmail&cd=506Kb9rPxRU&cad=CAcQARgAQOWKzvAESAE" target=_blank>Learn more</A>.</SPAN><SPAN style="FONT-FAMILY: 'Arial','sans-serif'"><BR><BR></SPAN><SPAN style="FONT-FAMILY: 'Arial','sans-serif'; FONT-SIZE: 10pt"><A href="http://www.google.com/alerts/remove?hl=en&gl=us&source=alertsmail&s=AB2Xq4gFWqYoaePpTBqWBdAM9CT2lCybXFzgJYc&cd=506Kb9rPxRU&cad=CAcQARgAQOWKzvAESAE" target=_blank>Remove</A> this alert.<BR><A href="http://www.google.com/alerts?hl=en&gl=us&source=alertsmail&cd=506Kb9rPxRU&cad=CAcQARgAQOWKzvAESAE" target=_blank>Create</A> another alert.<BR><A href="http://www.google.com/alerts/manage?hl=en&gl=us&source=alertsmail&cd=506Kb9rPxRU&cad=CAcQARgAQOWKzvAESAE" target=_blank>Manage</A> your alerts.</SPAN><SPAN style="FONT-FAMILY: 'Arial','sans-serif'"><o:p></o:p></SPAN></P></DIV></DIV></DIV>
<P class=MsoNormal><BR><BR clear=all><BR>-- <o:p></o:p></P>
<DIV>
<P class=MsoNormal>Stevan Gressitt, M.D.<BR>Faculty Associate, University of Maine Center on Aging<BR>Academic Member, Athens Institute for Education and Research<o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal>Athens, Greece<o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal>Founding Director, International Institute for Pharmaceutical Safety<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" target=_blank>gressitt@gmail.com</A> <BR>Cell: 207-441-0291 <o:p></o:p></P></DIV>
<DIV>
<P class=MsoNormal><A href="http://www.benzos.une.edu/" target=_blank>www.benzos.une.edu</A> <o:p></o:p></P></DIV>
<DIV>
<P style="MARGIN-BOTTOM: 12pt" class=MsoNormal><A href="http://www.safemeddisposal.com/" target=_blank>www.safemeddisposal.com</A> <o:p></o:p></P></DIV>
<P class=MsoNormal><o:p> </o:p></P></DIV></ZZZbody></ZZZhtml></BLOCKQUOTE></ZZZ![endif]--></ZZZ!--[if></ZZZ![endif]--></ZZZ!--[if></ZZZ![endif]--></ZZZ!--[if></ZZZmeta></ZZZmeta></BODY>