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<p class="MsoNormal"><span style="color:#1F497D">Jan and All, <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">The issue of whether or not “inventory” or counting can be done has been hotly debated. However, this excerpt is directly from the Federal Register, Vol. 79, No. 174, p. 53539.
<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"> “</span>Pursuant to § 1317.65, law enforcement may continue to conduct take-back events when a law enforcement officer maintains control and custody of collected substances at take-back events
and only the ultimate user transfers controlled substances to law enforcement control and custody. However, non-law enforcement personnel may assist the law enforcement officer, and the final rule does not prohibit healthcare professionals from voluntarily
polling ultimate users about the substances they are discarding or from assisting ultimate users to separate pharmaceutical controlled substances from noncontrolled substances during the disposal process, and inventorying the non-controlled substances.
<o:p></o:p></p>
<p class="MsoNormal" style="text-indent:.5in">Furthermore, nothing in this rule prohibits law enforcement from partnering with authorized collectors or other entities to inventory or sort substances that have been collected by law enforcement provided that
the collected substances remain under the control and custody of law enforcement. This final rule in § 1317.65(b) requires that law enforcement maintain control and custody of the collected substances from the time the substances are collected until secure
transfer, storage, and destruction has occurred. Therefore, if law enforcement opts to inventory or sort collected substances within their possession, law enforcement should provide adequate security to prevent diversion or theft of controlled substances within
their possession and control as a result of, or during, inventorying or sorting.”<o:p></o:p></p>
<p class="MsoNormal" style="text-indent:.5in"><o:p> </o:p></p>
<p class="MsoNormal"><span style="color:#1F497D">Title 21 of the Code of Federal Regulations is the codification of the full version of the Federal Register…which is 52 pages of text in about font size 6 or 8.
<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">That being said, the decision to log or inventory items cannot be taken lightly. It’s not an easy undertaking and measures should be taken to prevent diversion. The law enforcement entity that is maintaining
control and custody of the controlled substances needs to work closely with whomever is assisting to ensure that diversion is not occurring. Interestingly, if you think about where the meds that are brought to a take back event would be … if that event were
not being conducted, chances are they’d be somewhere ripe for diversion.<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">Also, it should be mentioned that meds collected via “authorized collectors”/ drop boxes not within law enforcement agencies, cannot be logged or inventoried per the rule.<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">It is my belief as a licensed health care professional that we should be taking action to begin addressing the problems associated with unused medications (both controlled and non-controlled) from the front end
in addition to the back end (i.e. disposal). Right now most of us are simply bailing water out of a leaky boat while the hole just keeps getting bigger! This is more than a diversion issue. This problem is bigger than “just the medical field” and bigger than
the DEA. These disciplines need to work together to address the problem. Too many drugs are being prescribed, dispensed, refilled, mailed, purchased, etc without a good system of checks and balances. The result is abuse and addiction, misuse, intentional (suicide
attempts) and unintentional poisonings, and environmental contamination. In the medical field, evidence based medicine is practiced and we need evidence (data) to substantiate the need for change.
<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">Sorry, Jan…something about soap and a box….Counting IS permitted as long as rigid steps by law enforcement are taken and “non-law enforcement personnel may assist”. Rant over.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><i><span style="color:#1F497D">Dr. Jeanie Jaramillo-Stametz<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D">Managing Director, Texas Panhandle Poison Center<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D">Asst. Professor, Pharmacy Practice<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D">Director, Medication Cleanout<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D">Texas Tech University Health Sciences Center<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D">School of Pharmacy<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D"><a href="mailto:jeanie.jaramillo@ttuhsc.edu"><span style="color:#0563C1">jeanie.jaramillo@ttuhsc.edu</span></a><o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D">Office: (806) 414-9402<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D">Voice mail: (806) 414-9299<o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="color:#1F497D">Mobile: (806) 376-0039<o:p></o:p></span></i></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>
<p class="MsoNormal"><span style="color:#1F497D"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b>From:</b> Jan Harris [mailto:jharris@sharpsinc.com] <br>
<b>Sent:</b> Tuesday, August 29, 2017 9:27 PM<br>
<b>To:</b> Jaramillo, Jeanie <Jeanie.Jaramillo@ttuhsc.edu><br>
<b>Cc:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> Re: [Pharmwaste] Med Take Back Data Publication<o:p></o:p></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal">Thank you for this data. Since we now can't "count pills", it's invaluable.<span style="font-size:12.0pt"><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"><br>
<span style="color:black">Jan Harris</span><span style="color:gray"> | Director, Regulatory Compliance</span>
<o:p></o:p></p>
<p><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:black">Sharps Compliance, Inc.</span><br>
<span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:gray">d- 713-927-9956 | o- 800-772-5657 | f- 713-660-3596</span><br>
<br>
<a href="mailto:jharris@sharpsinc.com"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:gray;text-decoration:none">jharris@sharpsinc.com</span><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:black;text-decoration:none">
| </span></a><a href="http://www.sharpsinc.com"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:gray;text-decoration:none">http://www.sharpsinc.com</span></a>
<o:p></o:p></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt">On Aug 29, 2017, at 9:14 PM, Jaramillo, Jeanie <<a href="mailto:Jeanie.Jaramillo@ttuhsc.edu">Jeanie.Jaramillo@ttuhsc.edu</a>> wrote:<o:p></o:p></p>
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<p class="MsoNormal">Hello All,<o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal">I am happy to finally share with you all that a manuscript on controlled substance medication take back data from 2011-2015 prepared by my colleagues and me, has now been published in the
<i>Journal of Substance Use</i>. This includes results from data that was collected from multiple states including Arkansas, Florida, Maine, Missouri, Pennsylvania, and Texas.
<o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal">If I had to sum up the take home message from the article, I would say it is that ‘more than 50% of the controlled medications that are prescribed remain unused across the board’. The major limitation is that this analysis is based on meds
brought to take back programs. It is likely that there is a population that uses all of their medications and therefore, do not have need for take back and that is not included in the analysis.
<o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal">The article is open access, no embargo. I am hoping this hyperlink will work. Let me know if it does not!<o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:"Arial",sans-serif;color:#333333"><a href="http://cp.mcafee.com/d/2DRPowrhvKNtCXPwUTsSCyMyUUqejhO-Yrjhohs7nKqemjqqb2bzxEVd7bVEVdETKUYqem7xNEVdyfX2nY8X7lp7DR1kVJAWmXQ6PsVJAWmXQ6PqpEVKgvQQsLZvDTT7ANPTnKnjp7fsqem7AkXTWyaqRQRrIKsG7DR8OJMddLCQn3t-spujhhoKMedTdw0FX11SI3Vg_BYgHb7mPPYhLOdTHUyMU-qenzhOzOtQhT8IIzDAQjsZwwWn8lrxrW0E-k_zISRqMfB3-ndFLIc3zo9QIvm9Ewqd40L7omBgQgqTcDm9EwrmgSvF6y2Ro4oXdI_pOH2w1Cy0JlK9EwScVmfYQgiEq88lc6y1pIwvaxfQ3h065Lwq812RLFgQgCPhOyrxAmp">Multi-state
medication take back initiative: Controlled substances collected from 2011 to 2015</a></span>
<o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
<p class="MsoNormal"><i>Dr. Jeanie Jaramillo-Stametz</i><o:p></o:p></p>
<p class="MsoNormal"><i>Managing Director, Texas Panhandle Poison Center</i><o:p></o:p></p>
<p class="MsoNormal"><i>Asst. Professor, Pharmacy Practice</i><o:p></o:p></p>
<p class="MsoNormal"><i>Director, Medication Cleanout</i><o:p></o:p></p>
<p class="MsoNormal"><i>Texas Tech University Health Sciences Center</i><o:p></o:p></p>
<p class="MsoNormal"><i>School of Pharmacy</i><o:p></o:p></p>
<p class="MsoNormal"><i><a href="mailto:jeanie.jaramillo@ttuhsc.edu">jeanie.jaramillo@ttuhsc.edu</a></i><o:p></o:p></p>
<p class="MsoNormal"><i>Office: (806) 414-9402</i><o:p></o:p></p>
<p class="MsoNormal"><i>Voice mail: (806) 414-9299</i><o:p></o:p></p>
<p class="MsoNormal"><i>Mobile: (806) 376-0039</i><o:p></o:p></p>
<p class="MsoNormal"> <o:p></o:p></p>
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<p class="MsoNormal"><strong><span style="font-size:12.0pt;font-family:"Calibri",sans-serif;color:#99CC33">As a leader in healthcare waste management, Sharps Compliance strives to reduce, recycle and repurpose treated materials for a better and sustainable
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