<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<meta name="Generator" content="Microsoft Word 15 (filtered medium)">
<!--[if !mso]><style>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style><![endif]--><style><!--
/* Font Definitions */
@font-face
{font-family:Wingdings;
panose-1:5 0 0 0 0 0 0 0 0 0;}
@font-face
{font-family:"Cambria Math";
panose-1:2 4 5 3 5 4 6 3 2 4;}
@font-face
{font-family:"Calibri Light";
panose-1:2 15 3 2 2 2 4 3 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Candara;
panose-1:2 14 5 2 3 3 3 2 2 4;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
@font-face
{font-family:"Brush Script MT";
panose-1:3 6 8 2 4 4 6 7 3 4;}
@font-face
{font-family:CNN;}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri",sans-serif;}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:#954F72;
text-decoration:underline;}
p
{mso-style-priority:99;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
font-size:12.0pt;
font-family:"Times New Roman",serif;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
{mso-style-priority:34;
margin-top:0in;
margin-right:0in;
margin-bottom:0in;
margin-left:.5in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri",sans-serif;}
p.msonormal0, li.msonormal0, div.msonormal0
{mso-style-name:msonormal;
mso-style-priority:99;
mso-margin-top-alt:auto;
margin-right:0in;
mso-margin-bottom-alt:auto;
margin-left:0in;
font-size:12.0pt;
font-family:"Times New Roman",serif;}
span.EmailStyle19
{mso-style-type:personal;
font-family:"Times New Roman",serif;
color:#0000CC;}
span.EmailStyle20
{mso-style-type:personal;
font-family:"Calibri Light",sans-serif;
color:#244061;}
span.EmailStyle21
{mso-style-type:personal;
font-family:"Calibri",sans-serif;
color:#1F497D;}
span.EmailStyle22
{mso-style-type:personal;
font-family:"Calibri",sans-serif;
color:windowtext;}
span.EmailStyle23
{mso-style-type:personal;
font-family:"Calibri",sans-serif;
color:windowtext;}
span.EmailStyle24
{mso-style-type:personal;
font-family:"Calibri",sans-serif;
color:windowtext;}
span.EmailStyle26
{mso-style-type:personal-reply;
font-family:"Calibri Light",sans-serif;
color:#244061;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
/* List Definitions */
@list l0
{mso-list-id:73819633;
mso-list-template-ids:1182019594;}
@list l0:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l0:level2
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l0:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l0:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l0:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l0:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l0:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l0:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l0:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l1
{mso-list-id:155267975;
mso-list-type:hybrid;
mso-list-template-ids:546576900 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l1:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:.75in;
text-indent:-.25in;
font-family:Symbol;}
@list l1:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:1.25in;
text-indent:-.25in;
font-family:"Courier New";}
@list l1:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:1.75in;
text-indent:-.25in;
font-family:Wingdings;}
@list l1:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:2.25in;
text-indent:-.25in;
font-family:Symbol;}
@list l1:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:2.75in;
text-indent:-.25in;
font-family:"Courier New";}
@list l1:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:3.25in;
text-indent:-.25in;
font-family:Wingdings;}
@list l1:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:3.75in;
text-indent:-.25in;
font-family:Symbol;}
@list l1:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:4.25in;
text-indent:-.25in;
font-family:"Courier New";}
@list l1:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:4.75in;
text-indent:-.25in;
font-family:Wingdings;}
@list l2
{mso-list-id:422798731;
mso-list-template-ids:-1418852216;}
@list l2:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level2
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:1.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level5
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:2.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:3.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level8
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.0in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l2:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:4.5in;
mso-level-number-position:left;
text-indent:-.25in;
mso-ansi-font-size:10.0pt;
font-family:Symbol;}
@list l3
{mso-list-id:850803419;
mso-list-type:hybrid;
mso-list-template-ids:1636465116 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;}
@list l3:level1
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:.75in;
text-indent:-.25in;
font-family:Symbol;}
@list l3:level2
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:1.25in;
text-indent:-.25in;
font-family:"Courier New";}
@list l3:level3
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:1.75in;
text-indent:-.25in;
font-family:Wingdings;}
@list l3:level4
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:2.25in;
text-indent:-.25in;
font-family:Symbol;}
@list l3:level5
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:2.75in;
text-indent:-.25in;
font-family:"Courier New";}
@list l3:level6
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:3.25in;
text-indent:-.25in;
font-family:Wingdings;}
@list l3:level7
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:3.75in;
text-indent:-.25in;
font-family:Symbol;}
@list l3:level8
{mso-level-number-format:bullet;
mso-level-text:o;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:4.25in;
text-indent:-.25in;
font-family:"Courier New";}
@list l3:level9
{mso-level-number-format:bullet;
mso-level-text:;
mso-level-tab-stop:none;
mso-level-number-position:left;
margin-left:4.75in;
text-indent:-.25in;
font-family:Wingdings;}
ol
{margin-bottom:0in;}
ul
{margin-bottom:0in;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]-->
</head>
<body lang="EN-US" link="#0563C1" vlink="#954F72">
<div class="WordSection1">
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Calibri Light",sans-serif;color:#244061">These rules apply to business generated pharms, not pharms voluntarily collected from HH.<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> Hudak, David R <dhudak@co.pinellas.fl.us> <br>
<b>Sent:</b> Thursday, January 02, 2020 8:03 PM<br>
<b>To:</b> Scott Cassel <scott@productstewardship.us>; Margaret Shield <margaret.shield@cehstrategies.com>; 'Catherine Zimmer' <zenllc@usfamily.net>; Volkman, Jennifer (MPCA) <jennifer.volkman@state.mn.us>; 'Deborah DeBiasi' <deborah.debiasi@deq.virginia.gov>;
'Pharmwaste list' <pharmwaste@lists.dep.state.fl.us><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></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Hi all,<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">I believe there is another twist to this issue with the recent EPA rule that went into effect August 21, 2019 that I believe negates anything from the FDA.
<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">The EPA has not done a good job getting the message out. <o:p>
</o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.epa.gov%2Fhwgenerators%2Ffinal-rule-management-standards-hazardous-waste-pharmaceuticals-and-amendment-p075&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637136137698616246&sdata=oajuGX9Lj5nvouIjj5n6Yxqcm%2FBysgG6ONlgVEImzVY%3D&reserved=0"><span style="color:blue">https://www.epa.gov/hwgenerators/final-rule-management-standards-hazardous-waste-pharmaceuticals-and-amendment-p075</span></a><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.federalregister.gov%2Fdocuments%2F2019%2F02%2F22%2F2019-01298%2Fmanagement-standards-for-hazardous-waste-pharmaceuticals-and-amendment-to-the-p075-listing-for&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637136137698616246&sdata=PpL3HFcHfNzN89S%2Fwh%2BH5hA71Ov1dtfUZRGyPHun4u8%3D&reserved=0"><span style="color:blue">https://www.federalregister.gov/documents/2019/02/22/2019-01298/management-standards-for-hazardous-waste-pharmaceuticals-and-amendment-to-the-p075-listing-for</span></a><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.epa.gov%2Fhwgenerators%2Ffrequent-questions-about-management-standards-hazardous-waste-pharmaceuticals-and&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637136137698626242&sdata=cZ3FF%2B%2F42K58%2F5KlGYrkEr356gwKOFtzrVI6eeQY5qU%3D&reserved=0"><span style="color:blue">https://www.epa.gov/hwgenerators/frequent-questions-about-management-standards-hazardous-waste-pharmaceuticals-and</span></a><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Just Google search Hazardous Waste Pharmaceuticals and you will see the impact of the new rule/law.
<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Compliance checks have already started within our County. <o:p>
</o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<div>
<p class="MsoNormal" style="margin-bottom:12.0pt"><b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black">David R. Hudak, Paramedic</span></b><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><br>
EMS Protocol & Equipment Coordinator<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black">Pinellas County EMS and Fire Administration<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black">12490 Ulmerton Road - Suite 134<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black">Largo, Florida 33774<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><br>
Phone (727) 582-5756<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black">Fax (727) 582-5759<br>
Cell (727) 336-9496<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><a href="mailto:dhudak@pinellascounty.org"><span style="color:blue">dhudak@pinellascounty.org</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><br>
Follow Pinellas County: <br>
</span><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Ftwitter.com%2Fpinellasconews&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698626242&sdata=VOJho8BJwwKDtoeroCBTWPVpAkF%2FOVy%2BJBBPpRTFPDo%3D&reserved=0" target="_blank"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:blue;text-decoration:none"><img border="0" width="26" height="26" style="width:.2708in;height:.2708in" id="_x0000_i1025" src="cid:image001.png@01D5C218.6BC1E310" alt="cid:image001.gif@01CD7AFD.E5B43700"></span></a><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.facebook.com%2FPinellasCountyNews&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698636234&sdata=YzY2Hzry%2FqZlsrnL8TpfaoZdAkA7mLe4jEKAePDM0%2FE%3D&reserved=0" target="_blank"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:blue;text-decoration:none"><img border="0" width="26" height="26" style="width:.2708in;height:.2708in" id="_x0000_i1026" src="cid:image002.png@01D5C218.6BC1E310" alt="cid:image002.gif@01CD7AFD.E5B43700"></span></a><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.youtube.com%2Fpcctv1&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698636234&sdata=bMGZt2Xcro2OMwtmKieMI1XQsHDwuQpWZY2mla1C3ic%3D&reserved=0" target="_blank"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:blue;text-decoration:none"><img border="0" width="26" height="26" style="width:.2708in;height:.2708in" id="Picture_x0020_3" src="cid:image003.png@01D5C218.6BC1E310" alt="cid:image003.gif@01CD7AFD.E5B43700"></span></a><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.pinellascounty.org%2Fsocial-networking.htm&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637136137698646228&sdata=La2MmYxK9SLy8EqhEzdXivvzAaCQE%2FRkES2d9PUmgZM%3D&reserved=0"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:blue;text-decoration:none"><img border="0" width="26" height="26" style="width:.2708in;height:.2708in" id="Picture_x0020_4" src="cid:image004.png@01D5C218.6BC1E310" alt="cid:image004.gif@01CD7AFD.E5B43700"></span></a><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><br>
<a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.pinellascounty.org%2F&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637136137698646228&sdata=d6%2FhdKarZ0rGo1YsOsHX%2F4LlrHpdCvQV5Ynaht92%2FsA%3D&reserved=0"><span style="color:blue">www.pinellascounty.org</span></a><br>
<a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.pinellascounty.org%2Fnews_subscription.htm&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637136137698646228&sdata=aFNfs%2B7BZsFBrRYAau9IYgNlwS5Na%2FDemC2%2Bu%2BvShfQ%3D&reserved=0"><i><span style="color:blue">Subscribe
to county updates and news</span></i></a><i><br>
<br>
</i></span><i><span style="font-size:8.0pt;font-family:"Arial",sans-serif;color:black">All government correspondence is subject to the public records law.</span></i><span style="color:black"><o:p></o:p></span></p>
</div>
<p class="MsoNormal"><o:p> </o:p></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 <<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">pharmwaste-bounces@lists.dep.state.fl.us</a>>
<b>On Behalf Of </b>Scott Cassel<br>
<b>Sent:</b> Thursday, January 2, 2020 5:09 PM<br>
<b>To:</b> Margaret Shield <<a href="mailto:margaret.shield@cehstrategies.com">margaret.shield@cehstrategies.com</a>>; 'Catherine Zimmer' <<a href="mailto:zenllc@usfamily.net">zenllc@usfamily.net</a>>; 'Volkman, Jennifer (MPCA)' <<a href="mailto:jennifer.volkman@state.mn.us">jennifer.volkman@state.mn.us</a>>;
'Deborah DeBiasi' <<a href="mailto:deborah.debiasi@deq.virginia.gov">deborah.debiasi@deq.virginia.gov</a>>; 'Pharmwaste list' <<a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a>><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></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<table class="MsoNormalTable" border="0" cellspacing="0" cellpadding="0" style="border-collapse:collapse">
<tbody>
<tr>
<td style="border:solid black 1.0pt;border-right:none;background:#F00000;padding:.75pt .75pt .75pt .75pt">
<p class="MsoNormal"><b>CAUTION:<span style="color:black"> </span><o:p></o:p></b></p>
</td>
<td style="border:solid black 1.0pt;border-left:none;background:#FFD11C;padding:3.0pt 3.0pt 3.0pt 3.0pt">
<p class="MsoNormal"><span style="font-size:10.0pt;color:black">This message has originated from
<b>Outside of the Organization</b>. <b>Do Not Click</b> on links or open attachments unless you are expecting the correspondence from the sender and know the content is safe.</span><span style="font-size:10.0pt;font-family:"Times New Roman",serif"><o:p></o:p></span></p>
</td>
</tr>
</tbody>
</table>
<div>
<p class="MsoNormal">PSI developed a one-pager that eliminates the flushing option altogether, since our members thought it would be too confusing to the public. Here is the link to the document and you are free to use it if you like:
<a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fcdn.ymaws.com%2Fwww.productstewardship.us%2Fresource%2Fresmgr%2Fpharms_reports_factsheets%2FPSI_Pharms_Disposal_Info_She.pdf&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C1%7C637136137698656223&sdata=8FR3Le7A1eGdaA26hmE51nvsRvBXbW9%2B4kxE%2BO72OBQ%3D&reserved=0">
https://cdn.ymaws.com/www.productstewardship.us/resource/resmgr/pharms_reports_factsheets/PSI_Pharms_Disposal_Info_She.pdf</a><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<div>
<p class="MsoNormal"><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:navy">_______________________________________________________________</span><span style="font-size:10.0pt;font-family:"Arial",sans-serif;color:black"><br>
</span><b><span style="font-size:10.0pt;color:black">Scott Cassel</span></b><b><span style="font-size:10.0pt;color:#404040">
</span></b><span style="font-size:10.0pt;color:#404040">▪ </span><span style="font-size:10.0pt;color:black">Chief<b>
</b>Executive Officer/Founder </span><span style="font-size:10.0pt;color:#404040">▪
</span><i><span style="font-size:10.0pt;color:black">Product Stewardship Institute, Inc.</span></i><b><span style="font-size:10.0pt;color:#404040"><o:p></o:p></span></b></p>
<p class="MsoNormal"><span style="font-size:10.0pt;color:black">One Beacon Street, Suite 1500, Boston, MA 02108</span><b><span style="color:#0070C0">
</span></b><span style="font-size:10.0pt;color:#404040">▪ </span><span style="font-size:10.0pt;color:black">617-236-4822 (ph)
<o:p></o:p></span></p>
<p class="MsoNormal"><a href="mailto:scott@productstewardship.us"><span style="font-size:10.0pt;color:blue">scott@productstewardship.us</span></a><span style="font-size:10.0pt;color:black">
</span><b><span style="font-size:10.0pt;color:#404040"> </span></b><span style="font-size:10.0pt;color:#404040">▪
</span><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.productstewardship.us%2F&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698666217&sdata=5hHP1Bjec4vVBXYq8FTZKyAX%2FLl%2FvcEhVrjlI1bFCdA%3D&reserved=0"><span style="font-size:10.0pt;color:blue">www.productstewardship.us</span></a><span style="font-size:10.0pt;color:black">
</span><span style="font-size:10.0pt;color:#404040">▪ </span><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.facebook.com%2Fpages%2FProduct-Stewardship-Institute%2F224328115936%3Fref%3Dts&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698666217&sdata=5lZdAItnUyy4m1WSgpLVCFQnX9RIa2JGajwp2ebFLtM%3D&reserved=0"><b><span style="font-size:10.0pt;color:#4F81BD">Facebook</span></b></a><b><span style="font-size:10.0pt;color:gray">
</span></b><span style="font-size:10.0pt;color:#404040">▪ </span><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Ftwitter.com%2Fproductsteward&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698676212&sdata=bgNhic7gSnuvykbVPxO%2FB2sz%2Bbq5hquWcaQXBeKS7gY%3D&reserved=0"><b><span style="font-size:10.0pt;color:#4F81BD">Twitter</span></b></a><span style="font-size:10.0pt;color:#1F497D">
</span><span style="font-size:10.0pt;color:#404040">▪ </span><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fproductstewardshipinstitute.wordpress.com%2F&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698676212&sdata=Hw7YgE%2FUwpsr6xcKvGQoU90Uny7WErihGSheiZPaFWY%3D&reserved=0"><b><span style="font-size:10.0pt;color:#4F81BD">Blog</span></b></a><b><span style="color:#4F81BD">
<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-size:10.0pt;color:black">Skype address:</span></b><span style="font-size:10.0pt;color:black">
</span><span style="font-size:10.0pt;color:#C00000">scott.cassel1<o:p></o:p></span></p>
</div>
<p class="MsoNormal"><o:p> </o:p></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 <<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">pharmwaste-bounces@lists.dep.state.fl.us</a>>
<b>On Behalf Of </b>Margaret Shield<br>
<b>Sent:</b> Thursday, January 2, 2020 1:18 PM<br>
<b>To:</b> 'Catherine Zimmer' <<a href="mailto:zenllc@usfamily.net">zenllc@usfamily.net</a>>; 'Volkman, Jennifer (MPCA)' <<a href="mailto:jennifer.volkman@state.mn.us">jennifer.volkman@state.mn.us</a>>; 'Deborah DeBiasi' <<a href="mailto:deborah.debiasi@deq.virginia.gov">deborah.debiasi@deq.virginia.gov</a>>;
'Pharmwaste list' <<a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a>><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></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Hi all, I think important to note that FDA’s guidance on flushing opioids has changed. The article’s statement that “FDA recommends flushing opioids” is only accurate when combined with the earlier statement “If a disposal program is not
available”.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">FDA now recommends use of medicine take-back programs as the first and best option, for opioids and all other drugs. The “flush list” is only if a drug take-back program is not readily available.
<o:p></o:p></p>
<p class="MsoNormal">FDA’s messaging could be improved to be more clear and logical. Their new Remove the Risk campaign does a better job of this. However, the FDA needs to scrub all of its webpages and materials of older drug disposal messaging that is no
longer consistent. <o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">Here are examples of FDA’s current drug disposal messaging which is highlighted in FDA’s REMOVE THE RISK campaign:<o:p></o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:.75in;text-indent:-.25in;mso-list:l1 level1 lfo3">
<![if !supportLists]><span style="font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]>Dispose of Unused Medicines: What You Should Know: <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%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698686206&sdata=5j7zR2yXOK%2BfiSqggMVQ00ck4Eq87DAlPwRe%2FKM6LvA%3D&reserved=0">https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</a>
(Tip: a short link to this page is <a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.fda.gov%2FDrugDisposal&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698686206&sdata=gVksxcYbiPFE5js5j%2BFBwOCsoPcbUmNAVfG7ueAyFIE%3D&reserved=0">
www.fda.gov/DrugDisposal</a> )<o:p></o:p></p>
<p class="MsoNormal" style="margin-left:.75in;text-indent:-.25in;mso-list:l1 level1 lfo3">
<![if !supportLists]><span style="font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]>PDF fact sheet from the Remove the Risk campaign on safe opioid disposal:
<a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fmedia%2F123330%2Fdownload&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698696200&sdata=4BewLdkdUXWggQtbvpJtAhMeaG6Y02Qzvf4zskHXJ6w%3D&reserved=0">
https://www.fda.gov/media/123330/download</a> (main resource page is: <a href="https://gcc01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.fda.gov%2Fdrugs%2Fensuring-safe-use-medicine%2Fsafe-opioid-disposal-remove-risk-outreach-toolkit&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698696200&sdata=jO9L58KgfNncM7Ewjl%2BtIa%2FUPmmhSdc%2FSVhKFN6yvvU%3D&reserved=0">
https://www.fda.gov/drugs/ensuring-safe-use-medicine/safe-opioid-disposal-remove-risk-outreach-toolkit</a>)<br>
Here’s a screen shot from part of the FDA fact sheet that is clear in flushing being the 2<sup>nd</sup> choice:<o:p></o:p></p>
<p class="MsoNormal" style="margin-left:1.5in"><img border="0" width="414" height="275" style="width:4.3125in;height:2.8645in" id="Picture_x0020_2" src="cid:image005.jpg@01D5C218.6BC1E310"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal" style="mso-margin-top-alt:0in;margin-right:0in;margin-bottom:12.0pt;margin-left:.75in;text-indent:-.25in;mso-list:l3 level1 lfo6">
<![if !supportLists]><span style="font-family:Symbol"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]>An image from another FDA webpage on drug disposal. It’s a great example of how FDA needs to match the right images with the text message. The text gets the disposal message correct, but in not the most straightforward right order.
But from a quick glance at the toilet, pills, and WARNING! heading will a viewer think this recommends flushing or warns against flushing.<o:p></o:p></p>
<p class="MsoNormal" style="margin-left:1.5in"><img border="0" width="475" height="115" style="width:4.9479in;height:1.1979in" id="Picture_x0020_1" src="cid:image006.jpg@01D5C218.6BC1E310"><o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">All of the FDA’s materials still suffer from the significant omission that some local jurisdictions do not allow any flushing of pharmaceuticals into the sewer system.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal">The UCSF survey results certainly show there is more work to do with the pharmacy community. My ongoing belief from experience is that consistency of messaging improves dramatically once a comprehensive drug take-back system is established,
such as through the manufacturer responsibility laws in Washington and California.<o:p></o:p></p>
<p class="MsoNormal"><o:p> </o:p></p>
<div>
<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</span></i><o:p></o:p></b></p>
<p class="MsoNormal"><i><u><span style="font-size:10.0pt;font-family:"Candara",sans-serif;color:blue"><a href="mailto:margaret.shield@CEHstrategies.com">margaret.shield@CEHstrategies.com</a></span></u></i><o:p></o:p></p>
<p class="MsoNormal"><i><span style="font-size:10.0pt;font-family:"Candara",sans-serif">mobile: 206-499-5452</span></i><o:p></o:p></p>
<p class="MsoNormal"><b><i><span style="font-size:10.0pt;font-family:"Candara",sans-serif"><a href="https://gcc01.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.cehstrategies.com%2F&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698706193&sdata=1H6BRbq9Yprljjrow3UzoHmPCKE6571Ji%2BJaJnIUfL8%3D&reserved=0"><span style="color:blue">www.CEHstrategies.com</span></a>
<o:p></o:p></span></i></b></p>
</div>
<p class="MsoNormal"><o:p> </o:p></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 <<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">pharmwaste-bounces@lists.dep.state.fl.us</a>>
<b>On Behalf Of </b>Catherine Zimmer<br>
<b>Sent:</b> Thursday, January 2, 2020 9:10 AM<br>
<b>To:</b> 'Volkman, Jennifer (MPCA)' <<a href="mailto:jennifer.volkman@state.mn.us">jennifer.volkman@state.mn.us</a>>; 'Deborah DeBiasi' <<a href="mailto:deborah.debiasi@deq.virginia.gov">deborah.debiasi@deq.virginia.gov</a>>; 'Pharmwaste list' <<a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a>><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></p>
</div>
</div>
<p class="MsoNormal"><o:p> </o:p></p>
<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="https://gcc01.safelinks.protection.outlook.com/?url=hearrtmidwest.org&data=02%7C01%7Cjennifer.volkman%40state.mn.us%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698706193&sdata=zs%2Blu8QDx19X3oJwTr6nES46W5FBRvUdzBtJqByrXME%3D&reserved=0">
<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 [<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">mailto:pharmwaste-bounces@lists.dep.state.fl.us</a>]
<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 <<a href="mailto:pharmwaste-bounces@lists.dep.state.fl.us">pharmwaste-bounces@lists.dep.state.fl.us</a>>
<b>On Behalf Of </b>Deborah DeBiasi<br>
<b>Sent:</b> Wednesday, January 01, 2020 7:28 AM<br>
<b>To:</b> Pharmwaste list <<a href="mailto:pharmwaste@lists.dep.state.fl.us">pharmwaste@lists.dep.state.fl.us</a>><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%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698716187&sdata=bpkXILXiG9IIjqi9pJGkJw%2BEDceEGBN9RmEzHB2t7Nw%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%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698716187&sdata=umZz50%2FK95NbbjZV24swRJmMbrxec62L8iAhxElqNPw%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%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698726181&sdata=CEfPoPhl4XoEMKlbgHpDoRrffNRZ3ao8f9dh5jiK%2Byc%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%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698726181&sdata=958BZDg6wXaReZ70R4xL0ulXA2Xa34wKARuBU4dAZUs%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%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698736176&sdata=doe9D4TuLTr%2FkDNxWd189merPySQB%2FYYlvxvUCNjLP4%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%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698736176&sdata=Usno05IAgE8oua2Y3GswYmU5Pa40zjQww5bH1CHZh8Q%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%7C253778515de940e6a56a08d78ff107b1%7Ceb14b04624c445198f26b89c2159828c%7C0%7C0%7C637136137698746170&sdata=KYYhvJF7dUF4XTLaYs3wTn%2FG4Kb7twiu8lrzuK3jG1c%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>
</div>
</body>
</html>