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<p>Thanks Carlos!  </p>
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<p>Alternately, if prescription renewal for controlled was easy, it could be written for "5 pills", with up to four renewals.</p>
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<div><font size="2"><span style="FONT-SIZE: 10pt; 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><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma","sans-serif"; COLOR: blue"><a href="tel:(607)%20273-8381" target="_blank"><font color="#0000ff">(607) 273-8381</font></a><br>
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<div id="divRpF484569" style="DIRECTION: ltr"><font color="#000000" size="2" face="Tahoma"><b>From:</b> Carlos Chavez [cchavez@HWMA.net]<br>
<b>Sent:</b> Thursday, November 08, 2018 5:23 PM<br>
<b>To:</b> Ed Gottlieb; pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> RE: [Pharmwaste] Overprescribing Documented, only 27% used<br>
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<p class="MsoNormal"><span style="FONT-SIZE: 12pt; FONT-FAMILY: "Times New Roman",serif">Hi Ed,</span></p>
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<p class="MsoNormal"><span style="FONT-SIZE: 12pt; FONT-FAMILY: "Times New Roman",serif">I would add patient empowerment over their medication purchases.  Rather than prescriptions being written for set quantities such as “30 pills”, prescriptions could be
 written as ranges up to set limits, such as “Up to 30 pills” and have the patient choose the quantity they want to receive which would then cause a pharmacy to charge a prorated price based on their chosen quantity. 
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<p class="MsoNormal">Carlos</p>
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<p class="MsoNormal"><b>From:</b> Ed Gottlieb <EGottlieb@cityofithaca.org> <br>
<b>Sent:</b> Thursday, November 08, 2018 6:04 AM<br>
<b>To:</b> pharmwaste@lists.dep.state.fl.us<br>
<b>Subject:</b> [Pharmwaste] Overprescribing Documented, only 27% used</p>
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<p><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">Medication take-back is one of many ways to help stop the opioid epidemic.  Unlike other approaches, it also addresses accidental poisonings and environmental contamination. 
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<p><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">When asked about take-back, I say it is one of the easiest, and low cost, solutions to implement.  There are many other approaches that also need to be pursued, including:</span></p>
<p><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">Less over prescribing [see story below], alternatives to opioids, expanding t<a rel="noopener noreferrer" href="https://urldefense.proofpoint.com/v2/url?u=http-3A__scholar.google.com_scholar-5Furl-3Furl-3Dhttps-3A__cloudfront.escholarship.org_dist_prd_content_qt0kg4v8c8_qt0kg4v8c8.pdf-26hl-3Den-26sa-3DX-26scisig-3DAAGBfm2aTKZwDfxS1GYDv-5FqLecSeoTHhHQ-26nossl-3D1-26oi-3Dscholarr&d=DwMF-g&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=52UlWrWMYpEvPhUsE4m0-Q&m=z3H24qA9MzyFxThu4NMbpBWftt0R7cYoly9Ww7NeN5U&s=Co6Z037N6PbyCCYUGxlBWZEQv_5t23BN-4mgM6kKSe0&e=" target="_blank"><span style="TEXT-DECORATION: none; BACKGROUND: white; COLOR: black">reatment<span class="apple-converted-space"> </span>of<span class="apple-converted-space"> </span>opioid-use
 disorders</span></a>, alternatives to incarceration, stricter enforcement (and more sever penalties) for deceptive marketing by drug makers, & ???  What would you add to this list?  Thanks!</span></p>
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<p><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black"><a rel="noopener noreferrer" href="https://urldefense.proofpoint.com/v2/url?u=https-3A__jamanetwork.com_journals_jamasurgery_article-2Dabstract_2712855-3Futm-5Fsource-3DSTAT-26-2343-3BNewsletters-26amp-3Butm-5Fcampaign-3D52db5b192a-2DMR-5FCOPY-5F08-26amp-3Butm-5Fmedium-3Demail-26amp-3Butm-5Fterm-3D0-5F8cab1d7961-2D52db5b192a-2D149620549&d=DwQF-g&c=euGZstcaTDllvimEN8b7jXrwqOf-v5A_CdpgnVfiiMM&r=52UlWrWMYpEvPhUsE4m0-Q&m=z3H24qA9MzyFxThu4NMbpBWftt0R7cYoly9Ww7NeN5U&s=xDq-A6fuUnH8dFgzqR-4yv3SWZzjg76KLN7jjCeIEDs&e=" target="_blank">https://jamanetwork.com/journals/jamasurgery/article-abstract/2712855?utm_source=STAT+Newsletters&utm_campaign=52db5b192a-MR_COPY_08&utm_medium=email&utm_term=0_8cab1d7961-52db5b192a-149620549</a></span></p>
<p><strong><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">Question</span></strong><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">  What factors are associated with opioid consumption after surgery?</span></p>
<p><strong><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">Findings</span></strong><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">  In this population-based study of patients undergoing surgery in
 Michigan, 2392 patients used only 27% of the opioids prescribed to them. Prescription size had the strongest association with opioid consumption after surgery, with patients using an additional 5 pills for every 10 extra pills prescribed.</span></p>
<p><strong><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">Meaning</span></strong><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">  Excessive opioid prescribing is associated with higher opioid consumption
 after surgery. Using patient-reported opioid consumption will improve postoperative opioid prescribing to better match patient opioid requirements.</span></p>
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<p class="MsoNormal"><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: black">Ed Gottlieb
<br>
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><span style="FONT-SIZE: 10pt; FONT-FAMILY: "Tahoma",sans-serif; COLOR: blue"><a href="tel:(607)%20273-8381" rel="noopener noreferrer" target="_blank">(607) 273-8381</a></span></p>
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