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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">I'd still advocate to keep them separate. I’d have to withdraw my Agency’s signature if the concept is expanded to include eliminating off-label use of antibiotics in livestock
production because we do not regulate agriculture. The instructions to sewer that go home attached to the prescription bags confuse people about other pharms they have and likely lead to additional unnecessary sewering. We need to stop the mixed message now
and it is a very simple fix. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">Focus is critical to get this change and this letter has that focus. I also believe we'd get better success if we separate the large source reduction issues into separate
letters as well. You’ve mentioned eliminating off-label use of antibiotics in livestock; changing Medicare trial prescription language; promoting alternatives to pain relievers and buying less. Each one of those has a certain regulatory audience and different
supporting information to explain the importance of the issue and how to resolve it. Getting organizations to sign is dependent on the focus of the issue as well. I’m sure the IATP would be a large supporter of eliminating pharms in livestock production, but
they probably don’t have time to support this letter to FDA or buying less. Many people on this list serve would be happy to help bring these other critically important issues forward. I’m willing to help and I appreciate your energy on this issue, because
it is not my strongest area. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif""><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">Cheers,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif"">JV<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";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""> Catherine Zimmer [mailto:zenllc@usfamily.net]
<br>
<b>Sent:</b> Friday, January 08, 2016 9:28 AM<br>
<b>To:</b> 'Ed Gottlieb'; pharmwaste@lists.dep.state.fl.us<br>
<b>Cc:</b> 'Heidi Sanborn'; Volkman, Jennifer (MPCA)<br>
<b>Subject:</b> FDA letter and Vermont Gov calling for reduced rx. <o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Thanks Ed, and here we have it, FDA blamed for excess opiates and a governor calling for source reduction. Again, we need to include this language in the letter
to FDA. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Very truly yours,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Catherine Zimmer, MS, BSMT<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Zimmer Environmental Improvement, LLC<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.0pt;font-family:Pristina;color:#00B050">Reducing and managing healthcare related waste and costs for fifteen years.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">St. Paul, MN
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D">Ph: 651.645.7509<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";color:#00B050"><a href="mailto:zenllc@usfamily.net"><span style="color:#00B050">zenllc@usfamily.net</span></a><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri","sans-serif";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>Ed Gottlieb<br>
<b>Sent:</b> Friday, January 08, 2016 8:11 AM<br>
<b>To:</b> <a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a><br>
<b>Subject:</b> [Pharmwaste] Vermont Govenor Calls for Prescription Limits, Increased Take Back<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<h1><span style="font-size:12.0pt;font-family:"Tahoma","sans-serif";color:black">Remarks of Governor Peter Shumlin<br>
State House, Montpelier, January 7, 2016</span><span style="font-family:"Tahoma","sans-serif";color:black"><o:p></o:p></span></h1>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">Excerpt from Governor Shumlin's State of the State speech, [
<a href="http://www.2016stateofthestate.com/speech">http://www.2016stateofthestate.com/speech</a> ]:<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">· Second, let’s go after the source that led us into this mess in the first place. It’s difficult for me to find words that
adequately express my frustrations but I can find the three letters that are at the root of the problem: F.D.A. In the 1990s, the F.D.A. approved OxyContin, which lit the match that ignited America’s opiate and heroin addiction crisis. In 2010, we prescribed
enough OxyContin to keep every adult in America high for an entire month; by 2012 we issued enough prescriptions to give every American adult their own personal bottle of pills. On television, Americans now see commercials for drugs whose sole purpose is to
help relieve side effects from taking opiates – in other words there are now F.D.A. approved drugs to help you take more F.D.A. approved opiates. A few years ago, the F.D.A. approved Zohydro, which is OxyContin on steroids, against the recommendation of their
own advisory committee. Just a few months ago, the F.D.A. approved OxyContin for kids. You can’t make this stuff up. The $11 billion-dollar a year opiate industry in America knows no shame. Compassionate pain management has been transformed by big PHRMA into
drug promotion and profit. Until America is willing to have an honest conversation about the way we are dealing with pain our challenges will continue. In light of this, I am implementing the following:<o:p></o:p></span></p>
<p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">o First, we are putting an end to the system where doctors, dentists, and health care providers send patients home with 80 or 90 pills in their pocket. I am proposing a new system,
where a maximum of 10 pills will be the limit for minor procedures. We’re also looking at reasonable limits for more major procedures that provide pain relief without filling up our medicine cabinets with unused opiates. That’s just Vermont common sense.<o:p></o:p></span></p>
<p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"><o:p> </o:p></span></p>
<p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">o Second, we are partnering with pharmacies and local communities to expand drug take back programs, to get rid of Vermont’s Most Dangerous Leftovers.<o:p></o:p></span></p>
<p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"><o:p> </o:p></span></p>
<p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">o Third, we are partnering with neighboring states to upgrade the Prescription Monitoring System to prevent addicts from crossing state borders to go pill shopping. <o:p></o:p></span></p>
<p><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black">I ask for your support in these actions.<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:black"><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:black">Ed Gottlieb<br>
Chair, Coalition for Safe Medication Disposal<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:black">Industrial Pretreatment Coordinator<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:black">Ithaca Area Wastewater Treatment Facility<br>
525 3</span><sup><span style="color:black">rd</span></sup><span style="font-size:10.0pt;font-family:"Tahoma","sans-serif";color:black"> Street<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:black">Ithaca, NY 14850<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:black">(607) 273-8381<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:black">fax: (607) 273-8433<o:p></o:p></span></p>
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