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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D">Happy Friday! Maybe we’ll get back to knowing what day of the week it is, ay?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D">Minnesota established new prescribing guidelines for opioids/controlled substances. I think doctors are following them, or beginning to.
<a href="https://mn.gov/dhs/assets/mn-opioid-prescribing-guidelines_tcm1053-337012.pdf">
https://mn.gov/dhs/assets/mn-opioid-prescribing-guidelines_tcm1053-337012.pdf</a> Mayo has been and has gotten more strict in particular. The pendulum appears to have swung fully to the ultra-conservative side from the “free for all” side. My concern is that
 it will resort in “hoarding” them vs. turning in the leftovers. Anecdotally, that seems to be the case when I bring it up in different groups.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D">There is also an effort named “One Health Antibiotic Stewardship” that is working on better targeted and less prescription of antibiotics. We are doing
 some good work that I sure hope reduces the prescribing of those. <a href="http://www.health.state.mn.us/onehealthabx/">
http://www.health.state.mn.us/onehealthabx/</a>   This might also be a program that other states are working on. I believe there were national dollars available to support it, but that might have come through the University.<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D">We don’t collect much during the annual events. It could be because we have a lot of permanent sites, but I believe WI is sitting good there as well. It
 could also be due to the effort, or lack thereof, of associated advertising. I don’t see much here, other than city/local paper level.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D">It is my understanding that DEA will pay for volume collected during the year if a permanent site collects on the event date/s and disposes of their annual
 volume during/right after the event. DEA gets more credit for doing good and it <b>
is</b> good that they cover disposal. Not all MN collection sites take advantage of that for reasons I haven’t investigated, other than our metro sites are large enough that they have to keep up with disposal. So it could be that the volume isn’t reflective
 of just a one day event, but the event volume plus 6 months of volume collected by permanent sites. I know that for us, the overlap creates a potential double count issue when we collect data on the total collected annually. Our amounts keep climbing as we
 continue to add sites. We’re looking forward to a downward trend, but I figure that is years away yet.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri Light",sans-serif;color:#1F497D">A large benefit of product stewardship legislation is that the program plans are required to include an education effort. The State doesn’t have a dedicated
 educational effort, except through leveraging some of the opioid related grants and the antibiotic work. If we could afford our own commercial after every new fabulous drug commercial…<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:11.0pt;font-family:"Calibri",sans-serif">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> Pharmwaste <pharmwaste-bounces@lists.dep.state.fl.us>
<b>On Behalf Of </b>Catherine Zimmer<br>
<b>Sent:</b> Friday, January 4, 2019 10:19 AM<br>
<b>To:</b> 'Miller, Christine M.' <Chris.Miller@outagamie.org>; 'Ed Gottlieb' <EGottlieb@cityofithaca.org>; pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> Re: [Pharmwaste] Wisconsin has another take-back record<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">Hi Christine and all,<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">Christine, I couldn’t agree more.  There is no longer anyone taking the reins on source reduction of pharmaceuticals.  Steven Gressitt and I were trying to work
 that angle, but unfortunately Steven died and I am a consultant in private practice.  While I’ve tried to find grants to pursue this type of work, there really aren’t any that are viable.  As you know, grants take a lot of administrative effort and must be
 fairly large to be economically viable.  <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">In 2012 the Center for Medicaid Services (CMS) enacted legislation that would allow trial doses of rx without requiring a copay (I think it was), but that has
 not been widely enacted.  I also did work on vouchers rather than samples.  The other point of course is we are a drug oriented society and most people demand a pill rather than other options to address ailments.  Lastly, in addition, we really need MD to
 push the change to less drugs and better health.  <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>
<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:"Brush Script MT";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">Executive director,
</span><a href="http://www.hearrtmidwest.wildapricot.org/"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">HEARRT Midwest</span></a><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">Principal,
<u>Zimmer Environmental Improvement<o:p></o:p></u></span></p>
<p class="MsoNormal"><span style="font-family:Pristina;color:#1F497D">Improving processes, minimizing and managing waste and, reducing costs. 
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif;color:#1F497D">T:  651.645.7509<o:p></o:p></span></p>
<p class="MsoNormal"><a href="mailto:zenllc@usfamily.net"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">zenllc@usfamily.net</span></a><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>
<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"> Pharmwaste [</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">]
<b>On Behalf Of </b>Miller, Christine M.<br>
<b>Sent:</b> Friday, January 4, 2019 9:57 AM<br>
<b>To:</b> Ed Gottlieb; </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"><br>
<b>Subject:</b> Re: [Pharmwaste] Wisconsin has another take-back record<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:10.0pt;font-family:"Century Gothic",sans-serif">Not sure if I’m happy about this news??? A double edge sword once again in the world of waste.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif">On one hand people in WI are doing the right thing and dropping meds at collection boxes vs. flushing, but I’m sad that we are the #1 Wasters of pharmaceuticals!  I
 doubt waste reduction will ever be the topic of concern when it comes to medications, safety will always take top bill.  
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif">At lease our water is staying cleaner</span><span style="font-size:10.0pt;font-family:Wingdings">J</span><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif">
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif;color:#222A35">Christine Miller<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif;color:#222A35">Recycling Coordinator<i><o:p></o:p></i></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif;color:#222A35">Outagamie County Recycling & Solid Waste<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:10.0pt;font-family:"Century Gothic",sans-serif;color:#222A35">1419 Holland Rd Appleton, WI 54911<br>
920.968.5721</span><span style="font-size:9.0pt;font-family:"Century Gothic",sans-serif;color:#0F243E"><br>
</span><span style="font-size:5.0pt;font-family:"Century Gothic",sans-serif;color:#336600"><br>
</span><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#00AEEF">Follow us on
</span><a href="https://www.facebook.com/OutagamieCountyRecycling/"><b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#00AEEF">FACEBOOK</span></b></a><b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#336600">
</span></b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#50B948">Visit our<b>
</b></span><a href="http://www.recyclemoreoutagamie.org/"><b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#50B948">WEBSITE</span></b></a><b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#50B948">
</span></b><b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#336600"><br>
</span></b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#C45911">Download our<b>
</b></span><a href="https://play.google.com/store/apps/details?id=net.recollect.outagamiecountywi.waste"><b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#C45911">MOBILE APP</span></b></a><b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#C45911"><br>
</span></b><b><span style="font-size:10.0pt;font-family:"Gotham Medium";color:#C45911"><img border="0" width="45" height="30" style="width:.4666in;height:.3083in" id="Picture_x0020_1" src="cid:image001.jpg@01D4A429.4217AFD0" alt="OCRSW-Logo-Icon-compressed"></span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"><o:p></o:p></span></p>
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<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 [</span><a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">mailto:pharmwaste-bounces@lists.dep.state.fl.us</span></a><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">]
<b>On Behalf Of </b>Ed Gottlieb<br>
<b>Sent:</b> Friday, January 04, 2019 8:20 AM<br>
<b>To:</b> </span><a href="mailto:pharmwaste@lists.dep.state.fl.us"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">pharmwaste@lists.dep.state.fl.us</span></a><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"><br>
<b>Subject:</b> [Pharmwaste] Wisconsin has another take-back record<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:black">Way to go Wisconsin!<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">"</span><span style="font-size:10.0pt;font-family:"Helvetica",sans-serif;color:#4A4A4A;background:white">Wisconsin collected a record-breaking 68,016 pounds of unused medications
 at drug disposal boxes and October Take Back events in 2018.</span><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif;color:black"><o:p></o:p></span></p>
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<span style="font-size:10.0pt;font-family:"Helvetica",sans-serif;color:#4A4A4A;background:white">The state collected more unused medications than 48 other states, and only falling in second place to California.</span><span style="font-size:10.5pt;font-family:"Helvetica",sans-serif;color:#4A4A4A;background:white"><o:p></o:p></span></p>
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<span style="font-size:10.0pt;font-family:"Helvetica",sans-serif;color:#4A4A4A;background:white">Since 2015, Wisconsin has consistently been in the top three in the country, collecting and disposing of 469,785 lbs. of unused and unwanted medications."</span><span style="font-size:10.5pt;font-family:"Helvetica",sans-serif;color:#4A4A4A;background:white"><o:p></o:p></span></p>
<p><a href="https://www.wearegreenbay.com/news/local-news/drug-take-back-program-record-announced-in-midst-of-nation-award/1685259881"><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif">https://www.wearegreenbay.com/news/local-news/drug-take-back-program-record-announced-in-midst-of-nation-award/1685259881</span></a><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
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Chair, Tompkins County Coalition for Safe Medication Disposal<br>
Industrial Pretreatment Coordinator<br>
Ithaca Area Wastewater Treatment Facility<br>
525 3<sup>rd</sup> Street<br>
Ithaca, NY  14850<br>
</span><a href="tel:(607)%20273-8381" target="_blank"><span style="font-size:10.0pt;font-family:"Tahoma",sans-serif">(607) 273-8381</span></a><span style="font-family:"Tahoma",sans-serif;color:black"><o:p></o:p></span></p>
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