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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='color:#1F497D'>And what FDA is still recommending is in conflict with what DEA calls “irretrievable”. <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'>Seems it might be worth going back to FDA and getting them to update their recommendations. Or go through the APhA—one would think they would be more concerned about complying with DEA. I know most of my clients are. And we send all opioids for incineration. <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'>Very truly yours,<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'>Catherine Zimmer, MS, BSMT<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Executive Director, <a href="hearrtmidwest.org"><span style='color:blue'>HEARRT Midwest</span></a><o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Principal, Zimmer Environmental Improvement<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:14.0pt;font-family:"Brush Script MT";color:#1F497D'>Improving processes, minimizing waste and reducing costs.<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><a href="mailto:zenllc@usfamily.net"><span style='color:blue'>zenllc@usfamily.net</span></a><o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Ph: 651.645.7509<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><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><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 [mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>Volkman, Jennifer (MPCA)<br><b>Sent:</b> Thursday, January 2, 2020 10:18 AM<br><b>To:</b> 'Deborah DeBiasi'; Pharmwaste list<br><b>Subject:</b> Re: [Pharmwaste] Not sure how to get rid of extra opioids or antibiotics? The pharmacy may not know, either<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Calibri Light","sans-serif";color:#244061'>If they read the FDA guidance, flushing is what they still recommend for opioids. So, that part is not surprising. I do know we’ve addressed the availability of collection in a couple of the newsletters that the Board of Pharmacy sends to pharmacies, and we’ve also done a webinar for them. But, I just ran into a pharmacist that didn’t know about our extensive collection network. At this point, a pharmacist almost has to be hiding under a rock to not be aware of collection, especially given that so many chains now collect, and that disposal question seems to be a common one from households. It doesn’t surprise me though that they don’t follow state’s recommendations and still defer to FDA’s “guidance”. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Calibri Light","sans-serif";color:#244061'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Calibri Light","sans-serif";color:#244061'>I was curious to see the difference in opioids and antibiotics. It could be that the author doesn’t understand that most jurisdictions that have invested in capturing opioids through collection do not, in fact, recommend flushing. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Calibri Light","sans-serif";color:#244061'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Calibri Light","sans-serif";color:#244061'>Last time I checked in with FDA, they said they might change their guidance when collection infrastructure is more developed. So, that decision is entirely subjective. If they could at least refer people to states and to follow their recommendations, that would help. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Calibri Light","sans-serif";color:#244061'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Calibri Light","sans-serif";color:#244061'>Disappointing article pushing flushing. <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Calibri Light","sans-serif";color:#244061'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b>From:</b> Pharmwaste <pharmwaste-bounces@lists.dep.state.fl.us> <b>On Behalf Of </b>Deborah DeBiasi<br><b>Sent:</b> Wednesday, January 01, 2020 7:28 AM<br><b>To:</b> Pharmwaste list <pharmwaste@lists.dep.state.fl.us><br><b>Subject:</b> [Pharmwaste] Not sure how to get rid of extra opioids or antibiotics? The pharmacy may not know, either<o:p></o:p></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal style='margin-bottom:3.75pt'><span style='font-size:12.0pt;font-family:"Times New Roman","serif";color:#262626'>It’s surprising, and concerning that pharmacies are still giving out incorrect information. We still have work to do.</span><o:p></o:p></p><p class=MsoNormal style='margin-bottom:3.75pt'><b><span style='font-size:12.0pt;font-family:"Times New Roman","serif";color:#262626'> </span></b><o:p></o:p></p><p class=MsoNormal style='margin-bottom:3.75pt'><b><span style='font-size:16.5pt;font-family:CNN;color:#262626'>Not sure how to get rid of extra opioids or antibiotics? The pharmacy may not know, either</span></b><o:p></o:p></p><p class=MsoNormal style='margin-bottom:12.0pt;vertical-align:middle'><b><span style='font-size:9.0pt;font-family:CNN;color:#262626'>By Shelby Lin Erdman, CNN</span></b><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:3.75pt;margin-bottom:12.0pt;margin-left:0in;vertical-align:middle'><span style='font-size:9.0pt;font-family:CNN;color:#262626'>Updated 6:35 PM ET, Tue December 31, 2019 </span><o:p></o:p></p><p class=MsoNormal style='margin-bottom:11.25pt'><b><span style='font-size:13.5pt;font-family:CNN;color:#262626'> (CNN)</span></b><span style='font-size:13.5pt;font-family:CNN;color:#262626'>When it comes to getting rid of prescription drugs, fewer than half of the pharmacies surveyed for a new study gave accurate guidance that met US Food and Drug Administration standards for disposing of unused opioids and antibiotics.</span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'>Researchers from<a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.ucsf.edu%2Fnews&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218258757&sdata=E9Yq%2FqusBcwzK0HgvFLPKwQwKK0dkhmaEj1HwSlKcD0%3D&reserved=0" target="_blank"><span style='color:#006598;text-decoration:none'> the University of California at San Francisco </span></a>surveyed nearly 900 California pharmacies by phone over a two-month period in 2018 during the week and on weekends. For the study, published Monday in the journal <a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fannals.org%2Faim&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218268744&sdata=tyf5K4O800O2c2gz9PGhYqtIxWNKLaC0kzt4fz8W9L8%3D&reserved=0" target="_blank"><span style='color:#006598;text-decoration:none'>Annals of Internal Medicine</span></a>, researchers posed as parents with leftover opioids and antibiotics from a child's surgery.</span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'>They were looking for correct drug disposal instructions based on <a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fconsumers%2Fconsumer-updates%2Fwhere-and-how-dispose-unused-medicines&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218268744&sdata=tDjvXf16X3Yw0z3OL9B3W0%2Fg0fN9exERTcRONj3l3GA%3D&reserved=0" target="_blank"><span style='color:#006598;text-decoration:none'>US Food and Drug Administration guidelines</span></a>. </span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'>The agency recommends taking unused medications to drug disposal or takeback programs as the best way of getting rid of unused or unwanted drugs. If a disposal program is not available, the agency suggests mixing antibiotics with coffee grinds or kitty litter, sealing the mixture in a container and throwing it in the garbage. <span style='background:yellow'>It recommends flushing opioids</span>.</span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'> </span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'>Researchers found only 47% of pharmacies gave correct instructions on how to dispose of antibiotics and 34% provided correct information about opioid disposal. On weekends, only 15% correctly directed customers about safe antibiotic disposal and 7% gave the correct information about disposing of opioids.</span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'> </span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'>When asked about takeback programs at the 898 pharmacies, 91 said they had a program for antibiotic disposal and 82 said they had a program for opioid disposal.</span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'> </span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'>"This clearly points to the need for better dissemination of information on proper medication disposal," Hillary Copp, senior study author and associate professor of urology at UCSF, said in a statement. </span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'> </span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'>"The <a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fdrugs%2Fsafe-disposal-medicines%2Fdisposal-unused-medicines-what-you-should-know&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218278739&sdata=FiBUp4ZPxLKigR80vYg1tZNL4jRn7C5%2Fz%2FoXZv7RJxc%3D&reserved=0" target="_blank"><span style='color:#006598;text-decoration:none'>FDA has specific instructions</span></a> on how to dispose of these medications, and the American Pharmacists Association has adopted this as their standard. Yet it's not being given to the consumer correctly the majority of the time," Copp said.</span><o:p></o:p></p><p class=MsoNormal><span style='font-size:13.5pt;font-family:CNN;color:#262626'>The improper disposal of medication can result in antibiotic resistance, pollution, child and pet poisonings and drug misuse.</span><o:p></o:p></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif";color:#0000CC'> </span><o:p></o:p></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif";color:#0000CC'> </span><o:p></o:p></p><p class=MsoNormal style='background:white'><span style='font-size:9.0pt;font-family:"Times New Roman","serif";color:#0000CC'>Deborah L. DeBiasi<br><b>Email: <a href="mailto:Deborah.DeBiasi@deq.virginia.gov">Deborah.DeBiasi@deq.virginia.gov</a><i><br></i></b>WEB site address: <a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.deq.virginia.gov%2F&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218278739&sdata=iLdKcX46shgZUM4IDDh302vV%2FtTvcyYQX41i9bw1ScY%3D&reserved=0" target="_blank"><span style='color:#0000CC'>www.deq.virginia.gov</span></a><br>Virginia Department of Environmental Quality, Office of Water Permits <br>State Coordinator for Industrial Pretreatment/Whole Effluent Toxicity (WET) Programs<br>PPCPs, EDCs, and Microconstituents</span><o:p></o:p></p><p class=MsoNormal style='background:white'><span style='font-size:9.0pt;font-family:"Times New Roman","serif";color:#0000CC'><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.deq.virginia.gov%2FPrograms%2FWater%2FPermittingCompliance%2FPollutionDischargeElimination%2FMicroconstituents.aspx&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218288739&sdata=4%2F6vZrC9Qa2r7ZmEdB0b23wmm%2B2j9eP86hEQtU1g3ss%3D&reserved=0" target="_blank"><span style='color:#0000CC'>http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx</span></a></span><o:p></o:p></p><p class=MsoNormal style='background:white'><span style='font-size:9.0pt;font-family:"Times New Roman","serif";color:#0000CC'><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.deq.virginia.gov%2FDentalRule.aspx&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C3eee564deac3426f033f08d78ebe83ca%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637134821218288739&sdata=V%2FOm0lAGnMtoxXnqkFNdg1HnNQt5JwGA%2FiiHadaPdDk%3D&reserved=0" target="_blank"><span style='color:#0000CC'>http://www.deq.virginia.gov/DentalRule.aspx</span></a></span><o:p></o:p></p><p class=MsoNormal style='background:white'><span style='font-size:9.0pt;font-family:"Times New Roman","serif";color:#0000CC'>Mail: P.O. Box 1105, Richmond, VA 23218<br>Location: 1111 E. Main Street, Suite 1400 Richmond, VA 23219<br>PH: 804-698-4028</span><o:p></o:p></p><p class=MsoNormal> <o:p></o:p></p><p><span style='font-size:10.0pt;color:#999999'>NOTICE: This email (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521. This email may be confidential and may be legally privileged. If you are not the intended recipient, you are hereby notified that any retention, dissemination, distribution, or copying of this communication is strictly prohibited. Please reply back to the sender that you have received this message in error, then delete it. Thank you </span><o:p></o:p></p></div></body></html>