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<P class=MsoNormal><SPAN style="FONT-FAMILY: 'Cambria','serif'; FONT-SIZE: 12pt"><FONT face=Tahoma><FONT size=2>Meika,<o:p></o:p></FONT></FONT></SPAN></P>
<DIV> </DIV>
<DIV>If you are looking at funding, ditto going with Product Stewardship!</DIV>
<DIV> </DIV>
<DIV>For large programs that could be possible models, check out what is being done in other countries. </DIV>
<DIV>Jennifer V. provided you with great links which include descriptions of some of these programs. </DIV>
<DIV>Many are referenced in a 2008 paper from the PSI. I don't think that paper was among the links Jennifer sent.</DIV>
<DIV> </DIV>
<DIV>Doing a quick search of the PSI website, I couldn't find this 2008 paper. Can someone provide Meika with a link? </DIV>
<DIV>I'm pasting an excerpt from it below.</DIV>
<DIV> </DIV>
<DIV>
<P style="MARGIN: 5pt 0in; mso-pagination: none; mso-layout-grid-align: none" class=MsoNormal><SPAN style="FONT-FAMILY: Tahoma; FONT-SIZE: 10pt">Ed Gottlieb<BR>Chair, Coalition for Safe Medication Disposal <BR>Industrial Pretreatment Coordinator <BR>Ithaca Area Wastewater Treatment Facility<BR>525 3<SUP>rd</SUP> Street<BR>Ithaca, NY 14850<BR>(607) 273-8381<BR>fax: (607) 273-8433<o:p></o:p></SPAN></P> <BR>
<P style="MARGIN: 0in 0in 0pt; mso-layout-grid-align: none" class=MsoNormal><?xml:namespace prefix = st1 ns = "urn:schemas-microsoft-com:office:smarttags" /><st1:country-region w:st="on"><st1:place w:st="on"><B style="mso-bidi-font-weight: normal"><FONT size=3 face="Times New Roman">Canada</FONT></B></st1:place></st1:country-region><A style="mso-footnote-id: ftn1" title="" href="#_ftn1" name=_ftnref1><SPAN class=MsoFootnoteReference><B style="mso-bidi-font-weight: normal"><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><B style="mso-bidi-font-weight: normal"><SPAN style="FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[1]</FONT></SPAN></B></SPAN></SPAN></SPAN></B></SPAN></A><SPAN style="FONT-FAMILY: Arial; FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-tab-count: 1"> </SPAN><o:p></o:p></SPAN></P>
<P style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none" class=MsoNormal><FONT size=3 face="Times New Roman">The Canadian pharmaceutical return programs are established on the principles of convenience for customers, public awareness through advertising, and funding for waste disposal. The program accepts controlled, OTC and prescription medications. The program is supported by professional associations and their partners/sponsors, and thus enjoys wide participation throughout the provinces.</FONT></P>
<P style="TEXT-INDENT: 0.25in; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none" class=MsoNormal><o:p><FONT size=3 face="Times New Roman"> </FONT></o:p></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><I style="mso-bidi-font-style: normal">Post Consumer Pharmaceutical Stewardship Association</I> (PCPSA) was created as a response to regulations requiring industry stewardship programs in certain provinces of <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region>. PCPSA represents various pharmaceutical and natural health product industries, who fund 80 percent of the program, where the self-care health sector provides the remaining 20 percent of funding. The program is free to those returning their medications to participating pharmacies. When a container is full, the pharmacy contacts the program administrator so it can be picked up, and the quantity of pharmaceuticals collected is recorded. Final steps in the program include storage and incineration of the pharmaceuticals. In 2007, 23,284 kg of medications, or 2,129 containers were collected from pharmacies in <st1:State w:st="on"><st1:place w:st="on">British Columbia</st1:place></st1:State> through this program.</FONT></FONT><A style="mso-footnote-id: ftn2" title="" href="#_ftn2" name=_ftnref2><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[2]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A><FONT size=3 face="Times New Roman"> More information is available at: </FONT><A href="http://www.medicationsreturn.ca/index.html"><FONT size=3 face="Times New Roman">http://www.medicationsreturn.ca/index.html</FONT></A><FONT size=3 face="Times New Roman"> </FONT></P>
<P style="TEXT-INDENT: 0.25in; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none" class=MsoNormal><SPAN style="FONT-FAMILY: Arial; FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><o:p> </o:p></SPAN></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><st1:State w:st="on"><st1:place w:st="on"><I style="mso-bidi-font-style: normal">British Columbia</I></st1:place></st1:State><I style="mso-bidi-font-style: normal"> </I>has a Medications Return Program which allows residents to return expired or unused medications at no charge to participating community pharmacies throughout the province.<SPAN style="mso-spacerun: yes"> </SPAN>The program was established voluntarily by the pharmaceutical industry in 1996 and subsequently regulated by the Post-Consumer Residual Stewardship Program Regulation in 1997.<SPAN style="mso-spacerun: yes"> </SPAN>The program is financed and managed by the Post Consumer Pharmaceuticals Stewardship Association, a consortium of branded, generic and OTC drug makers.<SPAN style="mso-spacerun: yes"> </SPAN>Pharmaceuticals collected through this program are incinerated.<SPAN style="mso-spacerun: yes"> </SPAN>In 2006, the most recent year for which data is available, there was a 92% participation rate by licensed community pharmacies; this translates into over 800 takeback pharmacy locations in the province. A total of 19,995 kg of medicines in 1,709 containers was returned. This represented an 11% increase in volume over the previous calendar year 2005. Total cost for managing the program during the calendar year 2005, including pharmaceutical incineration, was $257,000 CN. Annual reports for the program through 2006 are available at: </FONT></FONT><A href="http://www.env.gov.bc.ca/epd/epdpa/ips/meds/reports/index.html"><FONT size=3 face="Times New Roman">http://www.env.gov.bc.ca/epd/epdpa/ips/meds/reports/index.html</FONT></A></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><o:p><FONT size=3 face="Times New Roman"> </FONT></o:p></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><st1:State w:st="on"><I style="mso-bidi-font-style: normal">Alberta</I></st1:State><I style="mso-bidi-font-style: normal"> Pharmaceutical Association & <st1:State w:st="on">British Columbia</st1:State> Pharmacy Association</I><BR>The ENVIRx program encourages consumers to take unused medications back to <st1:State w:st="on"><st1:place w:st="on">Alberta</st1:place></st1:State> pharmacies for environmentally safe disposal. Ultimately the unused drugs are transported to incinerators. The program provides posters, brochures, a pharmacist information guide and warning labels for waste containers. </FONT></FONT></P>
<P style="MARGIN: 0in 0in 0pt; mso-layout-grid-align: none" class=MsoNormal><o:p><FONT size=3 face="Times New Roman"> </FONT></o:p></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><st1:State w:st="on"><st1:place w:st="on"><I style="mso-bidi-font-style: normal">Prince Edward Island</I></st1:place></st1:State><B style="mso-bidi-font-weight: normal"> <o:p></o:p></B></FONT></FONT></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><FONT size=3 face="Times New Roman">The province has a voluntary program where residents drop off unwanted medicines at pharmacies. Pharmacies transport the drugs to the solid waste management company, which pays for proper disposal.</FONT></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><o:p><FONT size=3 face="Times New Roman"> </FONT></o:p></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><st1:State w:st="on"><st1:place w:st="on"><I style="mso-bidi-font-style: normal">Saskatchewan</I></st1:place></st1:State><I style="mso-bidi-font-style: normal"> Pharmaceutical Association</I><U> </U><BR>SPhA works with Biomed Recovery and Disposal, a company that collects and disposes pharmaceutical waste directly from community pharmacies. The program includes posters reminding consumers to return all outdated, expired and unwanted drugs and sharps.</FONT></FONT></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><o:p><FONT size=3 face="Times New Roman"> </FONT></o:p></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><st1:City w:st="on"><I style="mso-bidi-font-style: normal">Ontario</I></st1:City><I style="mso-bidi-font-style: normal">, <st1:State w:st="on">Manitoba</st1:State> and <st1:State w:st="on">British Columbia</st1:State></I></FONT></FONT><B style="mso-bidi-font-weight: normal"><BR></B><FONT size=3 face="Times New Roman">Browning Ferris Industries (BFI) offers a contract waste disposal system in <st1:place w:st="on"><st1:City w:st="on">Ontario</st1:City>, <st1:State w:st="on">Manitoba</st1:State></st1:place> and BC. The company takes returned medications and/or sterile preparation waste collected in pharmacies and incinerates them. For information on packaging instructions, see: </FONT><A href="http://www.napra.ca/practice/toolkits/toolkit9/package.pdf"><FONT size=3 face="Times New Roman">http://www.napra.ca/practice/toolkits/toolkit9/package.pdf</FONT></A></P>
<P style="MARGIN: 0in 0in 0pt; mso-layout-grid-align: none" class=MsoNormal><B style="mso-bidi-font-weight: normal"><o:p><FONT size=3 face="Times New Roman"> </FONT></o:p></B></P>
<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><st1:City w:st="on"><st1:place w:st="on"><I style="mso-bidi-font-style: normal">Sudbury</I></st1:place></st1:City><I style="mso-bidi-font-style: normal"> and District Pharmacists' Association</I><U> </U><BR>The region offers a cleanup campaign, and has published data collected as part of the campaign. Extrapolated, the total cost of waste across <st1:country-region w:st="on"><st1:place w:st="on">Canada</st1:place></st1:country-region> is estimated to be as high as $113,381,687. The data collected supports the effectiveness of these campaigns.</FONT></FONT></P>
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<P style="MARGIN: 0in 0in 0pt 0.25in; mso-layout-grid-align: none" class=MsoNormal><st1:place w:st="on"><st1:City w:st="on"><I style="mso-bidi-font-style: normal"><FONT size=3 face="Times New Roman">Ottawa</FONT></I></st1:City></st1:place><FONT size=3><FONT face="Times New Roman"><I style="mso-bidi-font-style: normal"> Carleton Pharmacists' Association<U> </U><BR></I>This region offers a Medicine Clean Up Campaign that includes letters to patients, data collection sheet for medicine cabinet cleanup month and commitment to participate form.</FONT></FONT><A style="mso-footnote-id: ftn3" title="" href="#_ftn3" name=_ftnref3><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[3]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A></P>
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<P><FONT size=3><B style="mso-bidi-font-weight: normal"><SPAN style="FONT-FAMILY: 'Times New Roman'">Other Canadian Resources and Programs</SPAN></B><SPAN style="FONT-FAMILY: 'Times New Roman'"><o:p></o:p></SPAN></FONT></P>
<P style="MARGIN-LEFT: 0.25in"><FONT size=3><I style="mso-bidi-font-style: normal"><SPAN style="FONT-FAMILY: 'Times New Roman'">Apotex's "Time to talk"</SPAN></I><B style="mso-bidi-font-weight: normal"><SPAN style="FONT-FAMILY: 'Times New Roman'"> </SPAN></B></FONT><SPAN style="FONT-FAMILY: 'Times New Roman'"><BR><FONT size=3>This program includes a "brown bag medication review form" to assist in identifying medications for return and disposal.<o:p></o:p></FONT></SPAN></P>
<P style="MARGIN-LEFT: 0.25in"><I style="mso-bidi-font-style: normal"><SPAN style="FONT-FAMILY: 'Times New Roman'"><FONT size=3>Canadian Feed the Children and Canadian Medicine Aid Program</FONT></SPAN></I><SPAN style="FONT-FAMILY: 'Times New Roman'"><BR><FONT size=3>Unused drugs can be made available to third world countries through various programs including CANMAP. The World Health Organization has published guidelines for drug donations, which outline acceptable contributions in terms of shipping medications to third world countries. The guidelines are supported by four core principles: <o:p></o:p></FONT></SPAN></P>
<P style="TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l1 level1 lfo1; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; tab-stops: list .75in" class=MsoNormal><FONT face="Times New Roman"><SPAN style="mso-list: Ignore"><FONT size=3>1.</FONT><SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN><FONT size=3>A drug donation should benefit the recipient to the maximum extent possible. </FONT></FONT></P>
<P style="TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l1 level1 lfo1; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; tab-stops: list .75in" class=MsoNormal><FONT face="Times New Roman"><SPAN style="mso-list: Ignore"><FONT size=3>2.</FONT><SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN><FONT size=3>A donation should be given with full respect for the wishes and authority of the recipient, and be supportive of existing government policies and administrative arrangements. </FONT></FONT></P>
<P style="TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l1 level1 lfo1; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; tab-stops: list .75in" class=MsoNormal><FONT face="Times New Roman"><SPAN style="mso-list: Ignore"><FONT size=3>3.</FONT><SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN><FONT size=3>There should be no double standards in quality: if the quality of an item is unacceptable to the donor country, it is also unacceptable as a donation. </FONT></FONT></P>
<P style="TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 0.75in; mso-list: l1 level1 lfo1; mso-margin-top-alt: auto; mso-margin-bottom-alt: auto; tab-stops: list .75in" class=MsoNormal><FONT face="Times New Roman"><SPAN style="mso-list: Ignore"><FONT size=3>4.</FONT><SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN><FONT size=3>There should be effective communication between the donor and the recipient; donations should be sent on expressed need and should not be sent unannounced. </FONT></FONT></P>
<P style="MARGIN: 0in 0in 0pt 0.5in"><SPAN style="FONT-FAMILY: 'Times New Roman'"><FONT size=3>The World Health Organization guidelines also state that only drugs that have not been previously dispensed and with at least a year remaining before the expiration date is considered acceptable. <o:p></o:p></FONT></SPAN></P>
<P style="MARGIN: 0in 0in 0pt" class=MsoNormal><B style="mso-bidi-font-weight: normal"><o:p><FONT size=3 face="Times New Roman"> </FONT></o:p></B></P>
<P style="MARGIN: 0in 0in 0pt" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><st1:country-region w:st="on"><st1:place w:st="on"><B style="mso-bidi-font-weight: normal">Australia</B></st1:place></st1:country-region><B style="mso-bidi-font-weight: normal"><o:p></o:p></B></FONT></FONT></P>
<P style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in 0pt" class=MsoNormal><FONT size=3><FONT face="Times New Roman"><st1:country-region w:st="on"><st1:place w:st="on">Australia</st1:place></st1:country-region>’s Department of Health and Family Services funded a program for the collection and destruction of unwanted and out-of-date medicines, known as the Return Unwanted Medicines (RUM) Project in 1998. In 2005, 501,000 pounds of unwanted pharmaceuticals were collected. For more information, see: </FONT></FONT><A href="http://www.returnmed.com.au/"><FONT size=3 face="Times New Roman">http://www.returnmed.com.au/</FONT></A></P>
<P style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in 0pt" class=MsoNormal><B style="mso-bidi-font-weight: normal"><o:p><FONT size=3 face="Times New Roman"> </FONT></o:p></B></P>
<P style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in auto" class=top0><SPAN style="FONT-FAMILY: 'Times New Roman'; FONT-SIZE: 12pt; mso-bidi-font-size: 10.5pt; mso-bidi-font-family: Arial">Citizens bring their unwanted pharmaceuticals to participating community pharmacies and convey them to pharmacists.<SPAN style="mso-spacerun: yes"> </SPAN>RUM Project-approved containers with Rum Project- approved liner and seal are located in sight, but out of reach to the public locations within the pharmacy. Pharmacists are required to record the substances as they are returned and are not reimbursed for their collection services. Five thousand pharmacies participate in the RUM Project. <o:p></o:p></SPAN></P>
<P style="TEXT-INDENT: 0.5in"><SPAN style="FONT-FAMILY: 'Times New Roman'"><FONT size=3>When full, containers are collected by the wholesalers and taken to the wholesaler depot where they must be stored in a quarantined area. The containers are then palletized for collection by an appointed waste disposal company. That company delivers the containers to an approved high temperature incinerator. <o:p></o:p></FONT></SPAN></P>
<P style="TEXT-INDENT: 0.5in"><SPAN style="FONT-FAMILY: 'Times New Roman'"><FONT size=3>The Australian government funds the RUM Project at the cost of approximately $737,000 annually. The concept of Extended Producer Responsibility (EPR) has been discussed with drug manufacturers, but no understanding has been reached with the manufacturers to date. RUM will continue to pursue this issue. <o:p></o:p></FONT></SPAN></P>
<H4 style="TEXT-ALIGN: left; MARGIN: 0in 0in 0pt" align=left><SPAN style="LINE-HEIGHT: 150%; FONT-FAMILY: 'Times New Roman'; FONT-SIZE: 12pt; mso-bidi-font-size: 10.0pt">European Union <o:p></o:p></SPAN></H4>
<P style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none" class=MsoNormal><FONT size=3 face="Times New Roman">Eleven of the twenty-seven European Union countries have pharmaceutical return programs in place serving 90% of European citizens. These programs allow citizens to return their unwanted pharmaceuticals at local pharmacies. </FONT></P>
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<P style="TEXT-INDENT: 0.5in; MARGIN: 0in 0in 0pt; mso-layout-grid-align: none" class=MsoNormal><FONT size=3 face="Times New Roman">The EU national systems are operated and funded in various ways. More than half of the programs are funded by the pharmaceuticals industry or by retail pharmacies only. The balance is funded by municipal or national taxpayers. The operation of the pharmaceutical takeback systems may be the responsibility of the retail pharmacies or that of public or private waste contractors. Three examples:</FONT></P>
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<P style="TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 1in; mso-list: l0 level1 lfo2" class=MsoNormal><SPAN style="FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN style="mso-list: Ignore"><FONT size=3>·</FONT><SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN></SPAN><FONT face="Times New Roman"><FONT size=3><st1:country-region w:st="on"><st1:place w:st="on"><B style="mso-bidi-font-weight: normal">Spain</B></st1:place></st1:country-region><B style="mso-bidi-font-weight: normal">. </B>The Spanish program collects waste packaging as well as the leftover medicines and is operated by SIGRE (Spain Integrated Waste Management System) as a free service.<SPAN style="mso-spacerun: yes"> </SPAN>Logos appear on medications indicating that they can be returned to pharmacies for collection.<SPAN style="mso-spacerun: yes"> </SPAN>Citizens may return their medications to over 260 pharmacies across the country which serve a population of 40 million.<SPAN style="mso-spacerun: yes"> </SPAN>The pharmaceutical industry originated the program in 2002, and funds the system through fees based on volumes of sales.<SPAN style="mso-spacerun: yes"> </SPAN>Collected materials are shipped to a central facility for destruction.<SPAN style="mso-spacerun: yes"> </SPAN>In 2006 the diversion rate was estimated at .057 kg/ capita, and collected volumes have increased every year since inception. </FONT></FONT></P>
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<P style="TEXT-INDENT: -0.25in; MARGIN: 0in 0in 0pt 1in; mso-list: l0 level1 lfo2" class=MsoNormal><SPAN style="FONT-FAMILY: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol"><SPAN style="mso-list: Ignore"><FONT size=3>·</FONT><SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN></SPAN><FONT size=3><FONT face="Times New Roman"><st1:country-region w:st="on"><st1:place w:st="on"><B style="mso-bidi-font-weight: normal">France</B></st1:place></st1:country-region><B style="mso-bidi-font-weight: normal">. </B>The French program, Cyclamed, was fully established in 1995, is authorized by a federal decree, and is run in a collaborative manner between manufacturers (265), wholesalers (6), and community pharmacies (22,590). <SPAN style="mso-spacerun: yes"> </SPAN>Manufacturers fund the program through fees based on prior year’s sales. Households may return all unused medicines and packaging. Promotional efforts include bags and leaflets handed out at the time of dispensing, as well as window stickers, posters and TV advertising. <SPAN style="mso-spacerun: yes"> </SPAN>The program also includes an element to separate and redistribute medications to charity.<SPAN style="mso-spacerun: yes"> </SPAN>All residual materials are sent to waste-to-energy facilities across the country. </FONT></FONT></P>
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<P style="TEXT-INDENT: -0.25in; MARGIN: 0in 0in auto 1in; mso-list: l0 level1 lfo2" class=top0><SPAN style="FONT-FAMILY: Symbol; FONT-SIZE: 12pt; mso-fareast-font-family: Symbol; mso-bidi-font-size: 10.5pt; mso-bidi-font-family: Symbol"><SPAN style="mso-list: Ignore">·<SPAN style="FONT: 7pt 'Times New Roman'"> </SPAN></SPAN></SPAN><SPAN style="FONT-FAMILY: 'Times New Roman'; FONT-SIZE: 12pt; mso-bidi-font-size: 10.5pt; mso-bidi-font-family: Arial">In <st1:country-region w:st="on"><st1:place w:st="on">Sweden</st1:place></st1:country-region>, retail pharmacies must take back unwanted pharmaceuticals. The pharmacies are owned by the government, which fully funds the return program. <st1:country-region w:st="on"><st1:place w:st="on">Sweden</st1:place></st1:country-region> estimates that 65% of consumers' unwanted medications are ultimately captured through the return system. Most pharmaceuticals are incinerated. </SPAN><A style="mso-footnote-id: ftn4" title="" href="#_ftn4" name=_ftnref4><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.5pt"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="COLOR: black; FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.5pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[4]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A><SPAN style="FONT-FAMILY: 'Times New Roman'; FONT-SIZE: 12pt; mso-bidi-font-size: 10.5pt; mso-bidi-font-family: Arial"><o:p></o:p></SPAN></P>
<P style="MARGIN: 0in 0in auto 1in" class=top0><st1:country-region w:st="on"><st1:place w:st="on"><SPAN style="FONT-FAMILY: 'Times New Roman'; FONT-SIZE: 12pt; mso-bidi-font-size: 10.5pt; mso-bidi-font-family: Arial">Sweden</SPAN></st1:place></st1:country-region><SPAN style="FONT-FAMILY: 'Times New Roman'; FONT-SIZE: 12pt; mso-bidi-font-size: 10.5pt; mso-bidi-font-family: Arial"> is also making an effort to address pharmaceutical contamination in the environment at the source. Medicines are assessed and classified according to their impact on the environment through their document “Environmentally Classified Pharmaceuticals.” The goal is to encourage manufacturers to move toward producing pharmaceuticals that have reduced toxicity, persistence and bioaccumulation in the environment. </SPAN><A style="mso-footnote-id: ftn5" title="" href="#_ftn5" name=_ftnref5><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.5pt"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="COLOR: black; FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.5pt; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[5]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A><SPAN style="FONT-FAMILY: 'Times New Roman'; FONT-SIZE: 12pt; mso-bidi-font-size: 10.5pt; mso-bidi-font-family: Arial"><o:p></o:p></SPAN></P>
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<P style="MARGIN: 0in 0in 0pt" class=MsoFootnoteText><A style="mso-footnote-id: ftn1" title="" href="#_ftnref1" name=_ftn1><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="LETTER-SPACING: -0.25pt; FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[1]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A><FONT face=Garamond> More information is available at: </FONT><A href="http://www.napra.org/docs/0/97/194/184.asp"><FONT face=Garamond>http://www.napra.org/docs/0/97/194/184.asp</FONT></A></P></DIV>
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<P style="MARGIN: 0in 0in 0pt" class=MsoFootnoteText><A style="mso-footnote-id: ftn2" title="" href="#_ftnref2" name=_ftn2><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="LETTER-SPACING: -0.25pt; FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[2]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A><FONT face=Garamond> Vanasse, Ginette. Post Consumer Pharmaceutical Stewardship Association. Presentation from PSI’s 1<SUP>st</SUP> Pharmaceutical Dialogue Meeting, <st1:City w:st="on"><st1:place w:st="on">Sacramento</st1:place></st1:City>, CA. June 19, 2008, </FONT></P></DIV>
<DIV style="mso-element: footnote" id=ftn3>
<P style="MARGIN: 0in 0in 0pt" class=MsoFootnoteText><A style="mso-footnote-id: ftn3" title="" href="#_ftnref3" name=_ftn3><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="LETTER-SPACING: -0.25pt; FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[3]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A><FONT face=Garamond> For more information, see: </FONT><A href="http://www.napra.ca/practice/toolkits/toolkit9/takeback.pdf"><FONT face=Garamond>http://www.napra.ca/practice/toolkits/toolkit9/takeback.pdf</FONT></A></P></DIV>
<DIV style="mso-element: footnote" id=ftn4>
<P style="MARGIN: 0in 0in 0pt" class=MsoFootnoteText><A style="mso-footnote-id: ftn4" title="" href="#_ftnref4" name=_ftn4><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="LETTER-SPACING: -0.25pt; FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[4]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A><FONT face=Garamond> <U>Environment and Pharmaceuticals</U><SPAN style="mso-spacerun: yes"> </SPAN><st1:City w:st="on">Apoteket</st1:City> <st1:State w:st="on">AB</st1:State> (The National Corporation of Swedish Pharmacies) <st1:City w:st="on">Stockholm</st1:City> County Council and <st1:place w:st="on"><st1:PlaceName w:st="on">Stockholm</st1:PlaceName> <st1:PlaceType w:st="on">University</st1:PlaceType></st1:place>, pub. 04-03-07. p. 14 accessed March 20, 2007 </FONT><A href="http://www.janusinfo.se/imcms/servlet/GetDoc?meta_id=9564"><FONT face=Garamond>http://www.janusinfo.se/imcms/servlet/GetDoc?meta_id=9564</FONT></A></P></DIV>
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<P style="MARGIN: 0in 0in 0pt" class=MsoFootnoteText><A style="mso-footnote-id: ftn5" title="" href="#_ftnref5" name=_ftn5><SPAN class=MsoFootnoteReference><SPAN style="FONT-SIZE: 11pt; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'"><SPAN style="mso-special-character: footnote"><SPAN class=MsoFootnoteReference><SPAN style="LETTER-SPACING: -0.25pt; FONT-SIZE: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-size: 10.0pt; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA"><FONT face=Arial>[5]</FONT></SPAN></SPAN></SPAN></SPAN></SPAN></A><FONT face=Garamond> More information is available at: </FONT><SPAN style="FONT-FAMILY: 'Times New Roman'"><A href="http://www.janusinfo.se/imcms/servlet/GetDoc?meta_id=10205">http://www.janusinfo.se/imcms/servlet/GetDoc?meta_id=10205</A></SPAN></P></DIV></DIV></DIV></BODY></HTML>