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<DIV><div class=WordSection1><p class=MsoNormal><span style='font-size:11.0pt;color:#1F497D'>Please note that Fred Miller’s email did not originate with me – Laurie<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;color:#1F497D'><o:p> </o:p></span></p><div></DIV>
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<DIV STYLE="FONT-FAMILY: Courier New; FONT-SIZE: 9pt"><EM><FONT FACE="Arial" SIZE="2">Please take a few minutes to share your comments on the service you received from the department by clicking on this link <A HREF="http://survey.dep.state.fl.us/?refemail=Laurie.Tenace@dep.state.fl.us" TARGET="_blank">DEP Customer Survey</A>.</FONT></EM></DIV>
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<DIV STYLE="FONT-FAMILY: Courier New; FONT-SIZE: 9pt"><p class=MsoNormal style='margin-left:.5in'><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"'> Fredrick L. Miller [mailto:millerfl@tricity.wsu.edu] <br><b>Sent:</b> Friday, May 18, 2012 12:29 PM<br><b>To:</b> pharmwaste-bounces@lists.dep.state.fl.us<br><b>Subject:</b> RE: OH MY - For Medication Disposal, New Advice Is Trash Beats Take-Back<o:p></o:p></span></p></div></div><p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p><p class=MsoNormal style='margin-left:.5in'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>As an environmental management practitioner I have no problem with landfilling pharmaceuticals in cells constructed to modern standards. By the time they make their way through the biological and chemical processes going on in the landfill itself and the leachate collection/treatment system it’s at least as well degraded as in many of the thermal treatment options (waste to energy and other non-RCRA permitted burners). The UM study is a good start at examining the costs, both fiscal and environmental, of take-back programs but its limited scope precludes full examination of the problem. I must say their work is a great start to launching a rational discussion of the problem rather than simply continuing down the knee-jerk path to take-back. Let’s not let the bureaucrats promulgate regulations the normal way but rather use our brains and voices to influence the outcome this time ‘round.<o:p></o:p></span></p><p class=MsoNormal style='margin-left:.5in'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal style='margin-left:.5in'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><a href="http://www.epa.gov/epawaste/nonhaz/municipal/landfill.htm">http://www.epa.gov/epawaste/nonhaz/municipal/landfill.htm</a><o:p></o:p></span></p><p class=MsoNormal style='margin-left:.5in'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal style='margin-left:.5in'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Fred Miller<o:p></o:p></span></p><p class=MsoNormal style='margin-left:.5in'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>USTUR<o:p></o:p></span></p><p class=MsoNormal style='margin-left:.5in'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal style='margin-left:.5in'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal style='margin-left:.5in'><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"'> <a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">pharmwaste-bounces@lists.dep.state.fl.us</a> [<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">mailto:pharmwaste-bounces@lists.dep.state.fl.us</a>] <b>On Behalf Of </b>Lotzer Donna M<br><b>Sent:</b> Friday, May 18, 2012 8:45 AM<br><b>To:</b> Lotzer Donna M<br><b>Subject:</b> [Pharmwaste] OH MY - For Medication Disposal, New Advice Is Trash Beats Take-Back<o:p></o:p></span></p></div></div><p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p><p class=MsoNormal style='margin-left:.5in'><o:p> </o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>18 May 2012 </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>Returning extra medicine to the pharmacy for disposal might not be worth the extra time, money or greenhouse gas emissions, according to a University of Michigan study that is the first to look at the net effects of so-called take-back programs. The new evidence suggests that discarding unused drugs in the trash is a better option to limit the risk of poisoning and at the same time curb pollution of both water and air. </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>To arrive at this conclusion, the researchers compared the total emissions created by take-back, trash and toilet disposal methods. This included emissions of pharmaceutical active ingredients as well as releases of other water and air pollutants. "National policy seems to be changing to support take-back programs, and we don't know if that's justified," said Sherri Cook, a doctoral student in the U-M Department of Civil and Environmental Engineering. Cook is first author of a paper on the findings published in Environmental Science & Technology. </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>U.S. households accumulate an estimated 200 million pounds of unused pharmaceuticals every year, the researchers say. In most cases today, the FDA recommends throwing them away, but only if you don't have access to a take-back program. Cities, states and even some stores have initiated them. From collection sites, the returned drugs are transferred to another facility where they're incinerated as hazardous waste. </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>Health officials caution that unused pills should be out of the house as soon as possible to prevent poisoning and drug abuse by other family members. But that need must be balanced with pollution control, both for human health and environmental reasons. Flushing unused pills down the toilet is no longer advised, as the active ingredients in drugs have been found in drinking water and aquatic environments. </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>The new study found: </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>* If half of people threw away unused medications and half took them back to the drug store, the amount of active pharmaceutical ingredients in the environment would be reduced by 93 percent compared with today. </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>* If everyone trashed their extra drugs, those amounts would be reduced by 88 percent. </span><br><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>* That 5 percent improvement in pharmaceutical emission reduction due to take-back programs would come at a significant cost, possibly more than a billion dollars annually, along with a 300 percent increase in other emissions such as greenhouse gases and smog-forming substances. </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>"Nobody has ever added up all the emissions associated with disposing of medication," said Steve Skerlos, a professor in the departments of Mechanical Engineering and Civil and Environmental Engineering and a co-author of the study. "When you look at the available evidence to support take-back, it just doesn't add up." The researchers focused on a 50 percent take-back compliance rate based on actual practice in Sweden, which has had a national take-back program for 40 years. The compliance rate there is just 43 percent. Drugs that aren't returned tend to stay in the medicine cabinet, defeating the goal of getting unused medications out of the home quickly, the researchers say. </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>The U-M researchers considered a wide range of factors, including how often people would return medication, how far they live from take-back sites, how rainfall might affect landfill leachate leaking into groundwater, and what percentage of residents could be expected to comply. The results surprised the team. "We didn't expect that landfilling would be the best option, because when you incinerate something, it's gone, and when it's in a landfill, it can remain for some time," said Nancy Love, a professor in the Department of Civil and Environmental Engineering and a co-author of the study. "However, once we considered all the environmental emissions for the three options, the results made sense." </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>The researchers encourage policymakers to focus on getting more people to get rid of medicines by trash, rather than take-back. "Trashing unused medications reduces the consumer's inconvenience relative to take-back, and if there is a clear message perhaps we could increase the percentage of people putting them in the trash," Cook said. Currently, about 60 percent of people already use trash disposal, while 40 percent of people still flush unused medication down the toilet. When discarding pills in the trash, the FDA recommends mixing them with an unpalatable substance such as coffee grounds in a plastic bag. This helps to deter would-be abusers from picking them out of the garbage. </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>References:</span> <br><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>The paper is titled, "Life Cycle Comparison of Environmental Emissions from Three Disposal Options for Unused Pharmaceuticals." </span><o:p></o:p></p><p style='margin-left:.5in'><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>University of Michigan <</span><a href="http://www.umich.edu/"><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>http://www.umich.edu/</span></a><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>> </span><o:p></o:p></p><p style='margin-left:.5in'><b><span style='font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon'>Donna Lotzer, Senior Clinical Pharmacist</span></b> <br><b><span style='font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon'>Poison Education Coordinator</span></b> <br><b><span style='font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon'>University of WI Hospital & Clinics</span></b> <br><b><span style='font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon'>Poison Prevention & Education Center</span></b> <br><b><span style='font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon'>600 Highland Avenue, MC # 9475</span></b> <br><b><span style='font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon'>Madison, WI 53792</span></b> <br><a href="mailto:dlotzer@uwhealth.org"><b><span style='font-size:7.5pt;font-family:"Tahoma","sans-serif"'>dlotzer@uwhealth.org</span></b></a> <br><b><span style='font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon'>Phone: 608-265-8160</span></b> <o:p></o:p></p></div></DIV></DIV></DIV></BODY></HTML>