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<p class="MsoNormal"><span style="color:#1F497D">Very good questions and keen observations from Jeff Hollar.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">In addition I presume that the nurses or clinicians would need to “unpack” the drugs from their receptacles or containers in order to use the Smart Sink. Wouldn’t one still have to deal with packaging, especially
if it contains protected patient information? Even if there is no patient information, a bottle or several, even if empty, of say Percocet or Dilaudid in the garbage could attract some unwanted scavengers. My apologies to the Cacti people, and I don’t question
their good intentions, but it seems the rebuttable presumption to claim that they are better for the environment and compliance seems untested from many points of view. Would really like to hear from the regulatory community on this.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal" align="center" style="text-align:center"><span style="font-size:12.0pt;font-family:"Times New Roman","serif";color:#1F497D"><img width="168" height="53" id="_x0000_i1027" src="cid:image001.jpg@01CF8EEB.379C90A0" alt="Clean Fuels of Florida, Inc. email signature"></span><span style="font-size:12.0pt;font-family:"Times New Roman","serif";color:#1F497D"><br>
<a href="http://www.clean-fuels.net"><span style="font-size:8.0pt;font-family:"Arial","sans-serif";color:#669933">www.clean-fuels.net</span></a><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:blue">Barry Fernandez,
</span></b><span style="font-size:8.0pt;font-family:"Arial","sans-serif";color:blue">President</span><span style="font-size:12.0pt;font-family:"Times New Roman","serif";color:#1F497D"><br>
</span><span style="font-size:8.0pt;font-family:"Arial","sans-serif";color:#009900">Mobile (305) 216-4941 barry@clean-fuels.net <br>
Office (954) 791-9588 Fax (954) 791-9366<br>
2635 NE 4th Avenue | Pompano Beach, Florida 33064</span><span style="font-size:12.0pt;font-family:"Times New Roman","serif";color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:8.0pt;font-family:"Arial","sans-serif";color:#005695">CONFIDENTIALITY NOTICE: This email, including any attachment, contains information which may be confidential. If you are not the intended recipient, you must not retransmit,
copy or use the contents of this transmission. If you have received this email in error, please notify the sender by telephone at (954) 791-9588 or by email at barry@clean-fuels.net and delete this message and any attached file(s). Thank you.</span><span style="font-size:12.0pt;font-family:"Times New Roman","serif";color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><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""> Jeff Hollar [mailto:jhollar@pwaste.com]
<br>
<b>Sent:</b> Sunday, June 22, 2014 1:59 PM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> [Pharmwaste] RE: Anyone using Cactus Sink?<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Let me start of by stating I believe the Smart Sink is a better environmental option than drain disposal for DEA Controls. I have two questions that primarily deal with the compliance of DEA’s current regulations.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Earlier this year I checked with our local (Des Moines) DEA office and they were very clear that for DEA Registrants, the Cactus Smart Sink, by itself, was not an acceptable technology for the disposal of DEA controls. It’s my understanding
that they received their direction from the St. Louis division. Any controlled substances in the cartridge were to be handled as if they were in their original final dosage form. Meaning, any transference to another DEA Registrant would be subject to DEA
regs (e.g., control inventory, DEA Form 222, etc) and in turn, any disposal would be subject to DEA regulations (e.g., control inventory, DEA Form 41). This makes sense to me because if the DEA felt the Smart Sink rendered the controlled substances unrecoverable,
then the facility would have the option of simply discarding their cartridge in their regular trash (with some exceptions). Question #1 - Are other DEA regional divisions consistent with this position?
<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Question #2 - If your facility takes the stance that the DEA controls being disposed of are owned by the patient (ultimate user) and not the DEA registrant (hospital), then under today’s current DEA regulations, how can you transfer DEA
controlled substances owned by non-DEA registrant (ultimate user) to a DEA registrant (reverse distributor) for disposal? In other words how can a DEA Registrant accept controlled substances from a non-DEA Registrant?<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">As far as the hazardous waste side... Introducing hazardous drugs into the cartridge may increase your hazardous waste generation which in turn could affect your generator status. Not to mention the EPA and DOT regulatory handling of
the resulting waste. Something to consider if you choose to discard hazardous drugs in the Smart Sink. In all the Cactus literature I reviewed, I could find no specific reference to RCRA hazardous drugs and usage in the Smart Sink.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Are there any representatives on this listserv from: Cactus LLC, EXP, DEA or EPA that could give us some insight?
<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#1F497D">Jeff Hollar</span><span style="color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#1F497D">President</span><span style="color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:navy">PharmWaste Technologies, Inc.</span></b><span style="color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#1F497D">4164 NW Urbandale Dr., Ste A</span><span style="color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#1F497D">Urbandale, IA 50322</span><span style="color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#1F497D">515-276-5302 (general)</span><span style="color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#1F497D">515-331-7310 (direct)<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:#1F497D">515-360-9785 (cell)</span><span style="color:#1F497D"><o:p></o:p></span></p>
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<p class="MsoNormal"><a href="http://www.pwaste.com/" title="http://www.pwaste.com/"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">www.pwaste.com</span></a><span style="color:#1F497D"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><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>Shield, Margaret<br>
<b>Sent:</b> Friday, June 20, 2014 10:06 AM<br>
<b>To:</b> Volkman, Jennifer (MPCA)<br>
<b>Cc:</b> <a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a><br>
<b>Subject:</b> Re: [Pharmwaste] RE: Anyone using Cactus Sink?<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">I have seen several presentations from Cactus Sink representatives and spoken to them at meetings. Fred's description of use of the product is great confirmation of what their rep's describe.<o:p></o:p></p>
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<p class="MsoNormal">One of the things I appreciate about Cactus Sink's business model and outreach is their understanding that proper disposal of their unit depends on local laws and regulations for the drugs being disposed. We have discussed how their unit
with captured drugs is often disposed as hazardous waste as Jennifer suggests. A refreshing change from some other companies promoting pill sequestration products as "safe" for other disposal methods that are not appropriate. Cactus Sink does seem to be a
better approach for clinical disposal of controlleds, and I hope it will reduce flushing of those drugs, including unused partial doses in syringes.<o:p></o:p></p>
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<p class="MsoNormal">Margaret Shield<o:p></o:p></p>
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<p class="MsoNormal">Local Hazardous Waste Management Program in King County<o:p></o:p></p>
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<div>
<p class="MsoNormal">cell 206-265-9732<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">iTyped with my iThumbs :-)<o:p></o:p></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><br>
On Jun 20, 2014, at 6:30 AM, "Volkman, Jennifer (MPCA)" <<a href="mailto:jennifer.volkman@state.mn.us">jennifer.volkman@state.mn.us</a>> wrote:<o:p></o:p></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;color:black">I think it would work in MN if the contents were managed as a hazardous waste, it wouldn't fit our interpretation of reverse distribution. It seems like the main value is making controlled substances
immediately unlikely to be diverted or sewered. <o:p></o:p></span></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">
</span><a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">pharmwaste-bounces@lists.dep.state.fl.us</span></a><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">
[</span><a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">pharmwaste-bounces@lists.dep.state.fl.us</span></a><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">]
on behalf of Massoomi, Fred [</span><a href="mailto:Fred.Massoomi@nmhs.org"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">Fred.Massoomi@nmhs.org</span></a><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">]<br>
<b>Sent:</b> Thursday, June 19, 2014 8:26 AM<br>
<b>To:</b> 'Lotzer Donna M'; '</span><a href="mailto:pharmwaste@lists.dep.state.fl.us"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">pharmwaste@lists.dep.state.fl.us</span></a><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">'<br>
<b>Subject:</b> [Pharmwaste] RE: Anyone using Cactus Sink?</span><span style="font-size:12.0pt;font-family:"Times New Roman","serif";color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="color:#1F497D">Donna-</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">We have used the Cactus Sink for about a year now on our patient care units. Almost two years in our IV room.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">We have limited its use for controlled substances waste only. Until we get updated regulations, this system offers a better solution than the alternative (sink or inappropriate use of sharps containers).</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Rational: </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Provides a good process to render unwanted controlled substances irretrievable (versus the sewer and sharps containers).
</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">The full cartridges can be picked up by a reverse distributor.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Our waste hauler for our hospital had no other solution to provide us</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Addresses solids, liquids and patches</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Issues:</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Other items end up in the sink, ie trash, attempts at syringes</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Cleaning, they get messy.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Only one reverse distributor is assigned to take the full cartridges back, however the company is great to work with.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Volume capacity for PCA and Epidurals</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Overall:</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Great point of waste system that is small and secure.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Nursing adaptation was quick and well received.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">The Cactus company has great videos and information to make the system successful.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D">Please let me know if you need any additional information.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Firouzan 'Fred' Massoomi, Pharm.D., FASHP</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family:"Arial","sans-serif";color:#1F497D">Nebraska Pharmacists Association</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">President 2014
</span></i><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial","sans-serif";color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-family:"Arial","sans-serif";color:#1F497D">Nebraska Methodist Hospital</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Pharmacy Operations Coordinator</span></i><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">Department of Pharmacy Services</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial","sans-serif";color:#1F497D">8303 Dodge St.</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-family:"Arial","sans-serif";color:#1F497D">Omaha, NE 68114</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><a href="mailto:fred.massoomi@nmhs.org" target="_blank" title="mailto:fred.massoomi@nmhs.org"><span style="font-size:10.0pt;font-family:"Arial","sans-serif"">fred.massoomi@nmhs.org</span></a><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"> </span><span style="font-size:10.0pt;font-family:"Arial","sans-serif";color:#1F497D">(402) 354-4340 office
</span><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span lang="EN-GB" style="font-size:18.0pt;font-family:Webdings;color:green">P</span></b><b><span lang="EN-GB" style="font-size:7.5pt;font-family:"Arial","sans-serif";color:green"> How do YOU dispose of unwanted drugs?</span></b><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="color:#1F497D"> </span><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">From:</span></b><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">
</span><a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">pharmwaste-bounces@lists.dep.state.fl.us</span></a><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">
[</span><a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">mailto:pharmwaste-bounces@lists.dep.state.fl.us</span></a><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">]
<b>On Behalf Of </b>Lotzer Donna M<br>
<b>Sent:</b> Thursday, June 19, 2014 8:11 AM<br>
<b>To:</b> '</span><a href="mailto:pharmwaste@lists.dep.state.fl.us"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif"">pharmwaste@lists.dep.state.fl.us</span></a><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">'<br>
<b>Subject:</b> [Pharmwaste] Anyone using Cactus Sink?</span><span style="color:black"><o:p></o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Comic Sans MS";color:navy">Just found out this morning our hospital is trialing Cactus Sink for controlled substance med disposal on two inpatient units and the emergency department – anyone
else using it? Any concerns/comments? Thanks…Donna Lotzer</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Comic Sans MS";color:navy"> </span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">Donna Lotzer, Clinical Pharmacist, Poison Education Coordinator</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">University of WI Hospital & Clinics Poison Prevention Center</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">600 Highland Avenue, MC # 9475, Madison, WI 53792</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><a href="mailto:dlotzer@uwhealth.org" target="_blank"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif"">dlotzer@uwhealth.org</span></b></a><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:maroon">
Phone: 608-265-8160</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:#002060">Please encourage others to save 800-222-1222 in both cell and home phones.
</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:#002060">This number will connect callers anywhere in the U.S. to a poison center.
</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:#002060">Calls are free, confidential and answered 24/7/365.
</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:#002060">Please help me educate your community about poison prevention.
</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:7.5pt;font-family:"Tahoma","sans-serif";color:#002060">Call or email me for materials or program opportunities.</span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Comic Sans MS";color:navy"> </span></b><span style="color:black"><o:p></o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;font-family:"Comic Sans MS";color:navy"> </span></b><span style="color:black"><o:p></o:p></span></p>
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This message and any included attachments are from Nebraska Methodist Health System and its affiliates and are intended only for the addressee. The message may contain privileged, confidential and/or proprietary information intended only for the person(s) named.
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