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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='color:#1F497D'>I agree totally Catharine that we need a simple solution to a seemingly complex problem and I have been watching this for over seven years. I think we need a someone to digest the following<o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='color:#1F497D'><span style='mso-list:Ignore'>1.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='color:#1F497D'> Daughton’s latest publication<o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='color:#1F497D'><span style='mso-list:Ignore'>2.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='color:#1F497D'>The Study on the environmental risks of medicinal products (done by Deloitte for the European Commission)<o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='color:#1F497D'><span style='mso-list:Ignore'>3.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='color:#1F497D'>The World Health Organization Blue Book on healthcare waste management<o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='color:#1F497D'><span style='mso-list:Ignore'>4.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='color:#1F497D'>The NIOSH alert on Hazardous drugs<o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='color:#1F497D'><span style='mso-list:Ignore'>5.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='color:#1F497D'>The 2011 letter to every hospital in the country from OSHA, NIOSH and the Joint commission on Healthcare warning on hazardous drugs (all three on one letterhead)<o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='color:#1F497D'><span style='mso-list:Ignore'>6.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='color:#1F497D'>OSHA technical Manual on Hazardous Drugs (Zero exposure for Cytotoxic Drugs)<o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='color:#1F497D'><span style='mso-list:Ignore'>7.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='color:#1F497D'>Cytotoxic Drug Contamination in Hospital and Municipal Waste Water and its Transfer to Surface Water ( Dr. Theresa O’Keefe 2011)<o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='color:#1F497D'><span style='mso-list:Ignore'>8.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='color:#1F497D'>Guideline on Safe Handling of Cytotoxic Drugs and related Wastes for South Australian Health Services 2012<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>I have made an attempt and came to the conclusion that for some drugs such as cytotoxic chemotherapy drugs that pass through a patient un-altered in high concentrations that we need to collect, transport and destroy the drugs contained in the urine and feces long before the waste enters the toilet (urine sample, stool sample for two days).<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'>Check out <a href="http://www.cytotoxicsafety.org">www.cytotoxicsafety.org</a> and all of these studies are on the first page, just scroll down a bit and we welcome feedback. <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Any questions please send me a note <a href="mailto:jmullowney@pharma-cycle.com">jmullowney@pharma-cycle.com</a> or call me at 617-755-0883 <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'>Thanks <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'>Jim Mullowney <o:p></o:p></span></p><p class=MsoNormal><span style='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><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>Catherine Zimmer<br><b>Sent:</b> Tuesday, September 23, 2014 10:29 AM<br><b>To:</b> 'Tenace, Laurie'; pharmwaste@lists.dep.state.fl.us<br><b>Subject:</b> RE: [Pharmwaste] Fish lesions, other problems are cause for worry - PA article <o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='color:#1F497D'>How about more focus on preventing? I had hoped this article would literally move the discussion upstream, but instead its still waste management. We need someone to take Christian Daughton’s last publication, disseminate it widely to physicians and synthesize it to colloquial terms for use with the general public. Collection programs then need to hand this information out to participants. <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><div><p class=MsoNormal><span style='color:#1F497D'>Very truly yours,<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'>Catherine Zimmer, MS, BSMT<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Zimmer Environmental Improvement, LLC<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>St. Paul, MN <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Ph: 651.645.7509<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><a href="mailto:zenllc@usfamily.net"><span style='color:blue'>zenllc@usfamily.net</span></a><o:p></o:p></span></p></div><p class=MsoNormal><span style='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><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>Tenace, Laurie<br><b>Sent:</b> Tuesday, September 23, 2014 8:54 AM<br><b>To:</b> 'pharmwaste@lists.dep.state.fl.us'<br><b>Subject:</b> [Pharmwaste] Fish lesions, other problems are cause for worry - PA article <o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><b><span style='font-size:24.0pt;font-family:"Times New Roman","serif"'>Fish lesions, other problems are cause for worry<o:p></o:p></span></b></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><b><span style='font-family:"Times New Roman","serif"'><a href="http://www.goerie.com/article/20140923/NIE04/309239998/Fish-lesions-other-problems-are-cause-for-worry">http://www.goerie.com/article/20140923/NIE04/309239998/Fish-lesions-other-problems-are-cause-for-worry</a><o:p></o:p></span></b></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>By ANNA McCARTNEY, Erie Times-News <br>Contributing writer <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Something is very out of sync in aquatic ecosystems around the world.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'><o:p> </o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Evidence can be found in the unusually widespread frequency of fish lesions, excessive mortality and intersex fish. Male fish containing eggs in their testes have been found nationwide, including Pennsylvania's major watersheds, according to U.S. Geological Survey research. These problems plaguing fish and other aquatic life should be signs the water we rely on for drinking is also in trouble.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>The likely culprits are endocrine disrupting chemicals (EDCs) that upset the endocrine system, which regulates hormones and the reproductive system. The sources of these chemicals are complex mixtures from agricultural animal wastes, pesticides and herbicides, and human sources from wastewater treatment plant effluent and other sewage discharges, according to Vicki Blazer, fish biologist and lead Pennsylvania study author. Low-dose exposure to EDCs at sensitive life stages can have long-term effects, including reproductive impairment, reduced disease resistance and early mortality.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>These chemicals found in pharmaceuticals (human and veterinary) and personal care products (PPCPs), flame retardants, antibacterial products, plastics, pesticides and fertilizers are not currently regulated or commonly monitored. Since exposure to these EDCs has also been linked to conditions such as low sperm counts and testicular cancer in men, as well as breast cancer, obesity and autism, what's happening to aquatic animals should alert us to keep these chemicals out of the environment.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>In 2008, Pennsylvania Sea Grant began tackling the problem of disposal and education. Before its first PPCP collection, funded by the U.S. Environmental Protection Agency in April 2008, the only choices locally were to flush unused meds, put them in the trash or keep them indefinitely in home medicine chests. All these options create serious public health issues, from drug abuse to water contamination.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>In 2010, with an EPA Great Lakes Restoration grant and with Great Lakes Sea Grant partners in New York, Ohio, Indiana and Illinois, Pennsylvania Sea Grant expanded its campaign to prevent unnecessary PPCPs from entering the environment. Sea Grant has educated and involved the public, elected officials, health-care professionals and others in solutions. Its campaign has reached 1,227,057 people and safely disposed of 21,765 pounds of unused meds.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Pa Sea Grant's collection events, data and the partnerships formed with groups locally, throughout the Great Lakes and nationally picked up the steam needed to address PPCP use and disposal. Groups include the Lake Erie College of Osteopathic Medicine School of Pharmacy and UPMC Hamot, health departments, police departments, the American Veterinary Medical Association, universities and others. Sea Grant staff members are currently working with the National Sea Grant Network to reach and teach more people nationwide.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Pennsylvania and other states now have collection boxes at police departments that accept prescription and over-the-counter and pet medications. And during the past four years, upward of 4 million pounds have been collected in just 32 hours during eight National Prescription Drug Take-Back days sponsored by the U.S. Drug Enforcement Administration and law enforcement agencies.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>However, even these are not enough to keep drugs from every home, hospital, doctor's office, and long-term care facility out of the environment or the hands of abusers. The U.S. Department of Justice recently announced plans to authorize pharmacies and hospitals to serve as drop-off sites for unused meds and an option to mail them directly to an authorized collector. Until these rules go into effect, you can use the collection boxes or participate in the next National Prescription Drug Take Back Day this Saturday from 10 a.m. to 2 p.m. Visit <a href="http://www.paseagrant.org/"><span style='color:blue'>www.paseagrant.org</span></a> for sites or call (800) 882-9539.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:12.0pt;font-family:"Times New Roman","serif"'>Join us next week to learn more about PPCP problems and solutions.<o:p></o:p></span></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Laurie Tenace<o:p></o:p></p><p class=MsoNormal>Environmental Specialist<o:p></o:p></p><p class=MsoNormal>Waste Reduction Section<o:p></o:p></p><p class=MsoNormal>Florida Department of Environmental Protection<o:p></o:p></p><p class=MsoNormal>2600 Blair Stone Road, MS 4555<o:p></o:p></p><p class=MsoNormal>Tallahassee, FL 32399-2400<o:p></o:p></p><p class=MsoNormal>850.245.8759<o:p></o:p></p><p class=MsoNormal><a href="mailto:Laurie.Tenace@dep.state.fl.us">Laurie.Tenace@dep.state.fl.us</a><o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>