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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal>“<b>Medicine Disposal Products: an overview of products & performance questions</b>”, a report examining available information about medicine disposal products, is now available online. A PDF of this March 2019 report is linked from the <u>In-Home Medicine Disposal Products Review</u> section on this webpage: <a href="https://sfenvironment.org/safe-medicine-disposal-policy-resources">https://sfenvironment.org/safe-medicine-disposal-policy-resources</a>. <o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>The report reviews eight medicine disposal products that are marketed for use by consumers, healthcare facilities, law enforcement and others. It also reviews two products marketed solely to healthcare facilities. The products are: Cactus Smart Sink, CsRx System, Deterra, DisposeRx, Drug Buster, Element MDS, NarcX, Pill Catcher, Pill Terminator, and Rx Destroyer (also sold as Narc Gone HD). The report was produced through funding from the San Francisco Department of the Environment, and updates an earlier version released in April 2017. The March 2019 report reviews two additional products and summarizes additional product testing information that was provided by six of ten product manufacturers in response to a direct query to each of the manufacturers.<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>The report is designed to assist readers in making their own determinations about appropriate use of the products by presenting available information, examining key performance questions, and describing relevant regulatory and policy considerations. Further research needs and recommended actions for both manufacturers and governmental entities are also suggested. <o:p></o:p></p><p class=MsoNormal><span style='font-size:12.0pt'><o:p> </o:p></span></p><p class=MsoNormal>Recommendations in the report include:<o:p></o:p></p><ul style='margin-top:0in' type=disc><li class=MsoNormal style='mso-list:l0 level1 lfo3'><b>Additional independent laboratory analysis is needed to verify performance claims</b>. The medicine disposal products do appear likely to act as deterrents to diversion of leftover medicines and/or pharmaceutical wastage. The available product testing data, however, is not sufficient to verify claims that medicines are made non-retrievable through chemical or physical action of the products. For the eight products marketed for solid waste disposal, additional testing is also needed to verify claims that the used product-drug mixture is non-hazardous and appropriate for solid waste disposal. The regulatory context for disposal of pharmaceuticals must also be considered, and depends on the type of generator of the waste as well as the jurisdiction in which the waste is disposed.<o:p></o:p></li><li class=MsoNormal style='mso-list:l0 level1 lfo3'><b>“Real world” testing of mixtures of medicines and dosage forms is needed</b>. Overall, product testing disclosed by different manufacturers examines treatment of only a small number of pharmaceuticals. Most analysis was conducted on a single medicine at a time, rather than a combination of different types of pharmaceuticals as these products would likely be used.<o:p></o:p></li><li class=MsoNormal style='mso-list:l0 level1 lfo3'><b>Instructions for consumers should be improved to address spills and other safety risks.</b> Warning labels should be expanded to caution about any exposure to the product-drug mixture, including through dermal exposure to dissolved pharmaceuticals. Instructions should also be provided for safe clean-up if the product container spills or leaks.<o:p></o:p></li><li class=MsoNormal style='mso-list:l0 level1 lfo3'><b>Product use directions for consumers should be aligned with federal disposal guidelines for household medicines.</b> The DEA, FDA, and EPA’s medicine disposal guidelines recommend secure medicine take-back programs as the best disposal option. Trash disposal of medicines is recommended only in situations where a secure medicine take-back program is not available. <o:p></o:p></li><li class=MsoNormal style='mso-list:l0 level1 lfo3'><b>Products in liquid form need solidifying agents or absorbents for solid waste disposal.</b> Many of the products designed for solid waste disposal are in liquid form after use. Product containers are likely to burst and release a liquid pharmaceutical waste mixture in the household trash can, garbage truck, or waste transfer station. <o:p></o:p></li><li class=MsoNormal style='mso-list:l0 level1 lfo3'><b>Use in healthcare settings may be most appropriate for diversion prevention, rather than final disposal.</b> Regulated generators of pharmaceutical waste should take care to review applicable regulations to determine appropriate final disposal methods based on the pharmaceuticals to be disposed and the facility’s jurisdiction. In the healthcare setting, use of these products may be most appropriate for management of pharmaceutical wastage of controlled substances.<o:p></o:p></li><li class=MsoNormal style='mso-list:l0 level1 lfo3'><b>Appropriate regulatory oversight of medicine disposal products needs to be defined.</b> None of the medicine disposal products are approved by any federal agency despite some marketing language that suggests a product has undergone review or meets federal standards. Use of medicine disposal products is expanding, including through distribution of products for consumer use by major retail pharmacies. Federal review and regulation of medicine disposal products is needed, while maintaining existing state and local authority for more stringent solid waste management regulation and policies.<o:p></o:p></li></ul><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>Questions and comments on the report may be directed to me at <a href="mailto:margaret.shield@CEHstrategies.com">margaret.shield@CEHstrategies.com</a> or to Maggie Johnson, Senior Residential Toxics Reduction Coordinator, San Francisco Department of the Environment at <a href="mailto:margaret.johnson@sfgov.org">margaret.johnson@sfgov.org</a>. We hope the information and analysis in this report is valuable to you.<o:p></o:p></p><p class=MsoNormal>Best regards,<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif'>Margaret Shield, PhD<o:p></o:p></span></i></p><p class=MsoNormal><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif'>(pronouns: she/her/hers)<o:p></o:p></span></i></p><p class=MsoNormal><b><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif'>Community Environmental Health Strategies, LLC<o:p></o:p></span></i></b></p><p class=MsoNormal><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif'>Smart Science & Policy for Our Health and Environment<o:p></o:p></span></i></p><p class=MsoNormal><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif'>Seattle, WA <o:p></o:p></span></i></p><p class=MsoNormal><a href="mailto:margaret.shield@CEHstrategies.com"><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif;color:blue'>margaret.shield@CEHstrategies.com</span></i></a><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif'><o:p></o:p></span></i></p><p class=MsoNormal><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif'>mobile: 206-499-5452<o:p></o:p></span></i></p><p class=MsoNormal><i><span style='font-size:10.0pt;font-family:"Candara",sans-serif'><a href="http://www.cehstrategies.com/"><span style='color:blue'>www.CEHstrategies.com</span></a> <o:p></o:p></span></i></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>