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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;background:white'><span style='font-size:11.0pt;font-family:"Verdana",sans-serif;color:#333333'>CARA (S. 524 / H.R. 953) seems likely to me to move forward given strong support from substance abuse prevention advocates of the overall approach. And given Congress’ desire to do something to address our terrible epidemic of prescription opioid abuse which is fueling a heroin epidemic. It’s a crisis in our communities that is devastating families, so I am glad to see this focus. But I am dismayed by the bill’s policy on expanding drug take-back (which is in Section 203) because it really does so little and not in the most constructive way.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;text-indent:-.25in;mso-list:l0 level1 lfo1;background:white'><![if !supportLists]><span style='font-size:11.0pt;font-family:Symbol;color:#333333'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Calibri",sans-serif;color:#1F497D'>See the full bill info and text on CARA S. 524 / H.R. 953 on Congress.gov: <a href="http://hdl.loc.gov/loc.uscongress/legislation.114s524">http://hdl.loc.gov/loc.uscongress/legislation.114s524</a> </span><span style='font-size:11.0pt;font-family:"Verdana",sans-serif;color:#333333'><o:p></o:p></span></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Symbol;color:#1F497D'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Calibri",sans-serif;color:#1F497D'>Link to 1/27/16 Senate Judiciary Committee hearing, and statements of speakers: <a href="http://www.judiciary.senate.gov/meetings/attacking-americas-epidemic-of-heroin-and-prescription-drug-abuse">http://www.judiciary.senate.gov/meetings/attacking-americas-epidemic-of-heroin-and-prescription-drug-abuse</a><o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;background:white'><span style='font-size:11.0pt;font-family:"Verdana",sans-serif;color:#333333'>CARA’s federal medicine take-back grant program is perhaps best viewed as temporary start-up funding that could aid a transition to more sustainable programs that are industry-financed. The amount of $2.5 million for the entire nation is woefully inadequate to solve the problems our communities face with finding sustainable funding for robust, convenient medicine take-back systems.. And each grant is limited to $250,000 for term of 2 years, which leaves law enforcement and local governments in the familiar bind of applying for a grant, spending lots of time on grant administration, and then losing the grant support in a short amount of time.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;text-indent:-.25in;mso-list:l1 level1 lfo2;background:white'><![if !supportLists]><span style='font-size:11.0pt;font-family:Symbol;color:#333333'><span style='mso-list:Ignore'>·<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-size:11.0pt;font-family:"Verdana",sans-serif;color:#333333'>As comparison, a cost estimate I did while staffing the King County Board of Health was that a pharmaceutical extended producer responsibility (EPR) program for King Co WA would cost manufacturers roughly $1 million per year, depending on program design and amount of medicines collected. $1 million annually for 1 county of ~ 2 million population. And that’s a EPR program, which I believe is less costly to administer and operate in a number of ways than a grant-funded/government-operated program.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;background:white'><span style='font-size:11.0pt;font-family:"Verdana",sans-serif;color:#333333'>It is also inappropriate in my view to make federal grants from taxpayers available to drug manufacturers, and perhaps even to other entities in the supply chain, who already receive revenues and profits from pharmaceutical sales. These federal bills have simply copied the list of potential authorized collectors of controlled substances from the DEA Rule and made them all eligible to receive taxpayer support. Not a very thoughtful approach about who actually needs the support at the community level. Our law enforcement and local government agencies have been holding the bag on medicine take-back for years, and they need to be relieved by a transition to a public-private partnership financed by the pharmaceutical industry.<o:p></o:p></span></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;background:white'><span style='font-size:11.0pt;font-family:"Verdana",sans-serif;color:#333333'>I encourage medicine take-back advocates to work together to improve some details of this proposal, such as targeting the grants to appropriate recipients other than multibillion dollar pharmaceutical companies. I also think a block grant approach to states would probably also be preferable to a competitive grant program that pits communities against each other for a tiny pot of funds.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Candara",sans-serif'>Margaret Shield, PhD<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Candara",sans-serif'>Community Environmental Health Strategies<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Candara",sans-serif'>Seattle, WA <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Candara",sans-serif'><a href="mailto:margaret.shield@CEHstrategies.com"><span style='color:windowtext'>margaret.shield@CEHstrategies.com</span></a><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Candara",sans-serif'>mobile: 206-499-5452<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Candara",sans-serif;color:#1F497D'>https://www.linkedin.com/in/margaretshield<o:p></o:p></span></p><p class=MsoNormal><a name="_MailEndCompose"><span style='font-size:11.0pt;font-family:"Calibri",sans-serif;color:#1F497D'><o:p> </o:p></span></a></p><div><div style='border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Calibri",sans-serif'>From:</span></b><span style='font-size:11.0pt;font-family:"Calibri",sans-serif'> pharmwaste-bounces@lists.dep.state.fl.us [mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>Ed Gottlieb<br><b>Sent:</b> Thursday, January 28, 2016 6:19 AM<br><b>To:</b> pharmwaste@lists.dep.state.fl.us<br><b>Subject:</b> [Pharmwaste] Congress considering an intigrated stratagy to address opioid crisis.<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma",sans-serif;color:black'>The Senate Judiciary Committee is considering "the <b>Comprehensive Addiction and Recovery Act (CARA)</b>, which would invest approximately <b>$70 million a year</b> to enhance opioid abuse prevention and education nationwide, expand the availability of Narcan and fund treatment programs for incarcerated addicts.<br>The bill <b>also expands drug take-back programs</b>, strengthens prescription drug monitoring and launches a prescription opioid and heroin treatment program. <br>Democratic Sen. Jeanne Shaheen, a CARA co-sponsor, took advantage of the hearing to voice support for Ayotte’s legislation, and to promote two bills of her own — an <b>Opioid and Heroin Crisis Supplemental Appropriation of $600 million, and a separate grant program to reduce the backlog of heroin and Fentanyl cases at state police crime labs across the country.</b>"<br><br><a href="http://www.unionleader.com/NH-senators-Manchester-chief-testify-on-drug-crisis-heavy-toll">http://www.unionleader.com/NH-senators-Manchester-chief-testify-on-drug-crisis-heavy-toll</a><o:p></o:p></span></p><div><p class=MsoNormal><span style='font-size:10.0pt;font-family:"Tahoma",sans-serif;color:black'><o:p> </o:p></span></p><div><div><div><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></div><div><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></div><div><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></div><div><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></div><div><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></div><div><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></div></div></div></div></div></div></body></html>