1. SFEnvironment.org SF’s Safe Medicine Disposal Program

2. SFEnvironment.org The problem Accidental PoisoningsDrug AbuseEnvironmental PollutionDrug resistance 2007: 255,732 cases of poisonings, 5000 among children under six 1 2010: 2.7% of 8 th graders, 7.7% of 10 th graders, 8% of 12 th graders has abused Vicodine in the year prior 2 1 2008 Annual Report on National Poison Control Centers 2 NIH National institute of Drug Abuse 2010 Study AP 2008 study detected antibiotics and other meds in urban drinking water Constant exposure to low level antibiotics might result in drug resistant microbes

3. SFEnvironment.org Where are they coming from? *Sales data for the 12 nations with the largest volume of prescription and over-the-counter sales in North America, Europe, Asia, Latin America and Oceania. Adapted from IMS Retail Drug Monitor 2008. **Kaiser Family Foundation, State Health Facts 2011 CA Market = 10.5% ~ 25 Billion

4. SFEnvironment.org Who’s using them? Medicine TypeBusinesses (healthcare facilities, pharmacies) Residents Unwanted medicine Sent to reverse distributor for credit with manufacturer Trash or drain Expired Medicine Medical or Hazardous Waste hauler; reverse distributor for sorting and disposal

5. SFEnvironment.org

6. Safe medicine disposal by hospitals SOURCE: http://practicegreenhealth.org/topics/waste/waste-categories-types/pharmaceutical-waste Required by JACHO: Standard EC. 3.10 (under the Environment of Care Standards)

7. SFEnvironment.org Medicines in households Survey of unused medication disposal practices. Over 7% of respondents did not dispose of their unused medications, creating a household stockpile that may lead to accidental or deliberate wrongful ingestions. King County 1996: 29% meds unused Sweden 1999: 33% meds unused Florida 2009: 11% meds unused Industry 2007: 2-3% meds unused Teleosis: 52% OTC & 45% prescription unused 2.5 billion prescriptions written in the US (RxList, 2007)

8. SFEnvironment.org HHW Collection Facility No controlled substances Inconvenient location

9. SFEnvironment.org Temporary Pharmacy Collection Convenient location No sustainable funding source Not permanent 2006: One day collection events More than 1,000 lbs. collected

10. SFEnvironment.org DEA Collection Events No sustainable funding source Not permanent DEA Collection events since 2010 More than 1,400 lbs. collected

11. SFEnvironment.org Mail-In Program No controlled substances No sustainable funding source Expensive -- $3.25 EACH Mail back envelopes: 2009-2011 More than 2,550 lbs. collected

12. SFEnvironment.org Barriers to Collection Sustainable Funding Source to educate, collect, transport, incinerate Federal Controlled Substances Act DEA law prohibits collection of controlled substances without presence of Law Enforcement

13. SFEnvironment.org A great candidate for EPR 1.Challenging waste streams to manage 2.Best candidate for point-of-purchase return/take- back 3.Concern for many areas (waste, water, public health) 4.Increased media attention on this issue in last 2 yrs 5.The one waste stream for which SF really doesn’t have a good collection program

14. SFEnvironment.org 2010: Safe Drug Disposal Ordinance SF develops a Stewardship Plan template with metrics Producers submit plan describing collection system, convenience, outreach and performance SF approves the plan Producers submit an annual report, including volumes Phased-In: Prescription, non-prescription, controlled substances INDEFINITELY SUSPENDED

15. SFEnvironment.org Voluntary Collaborative Pilot Collection Program Logistics Outreach Funding ($110,000) From PhRMA and Genetech

16. SFEnvironment.org Safe Drug Disposal Information Ordinance All pharmacies conduct outreach “…posted in an area visible to the public & adjacent to the area where prescription drugs are dispensed”

17. SFEnvironment.org 13 participating pharmacies in SF actively collecting unwanted medicine

18. SFEnvironment.org

19. Sharps Solutions collects unwanted medicine biweekly and coordinates incineration

20. SFEnvironment.org IMAGE OF POLICE STATION COLLECTING MEDS All 10 police stations collect unwanted medicine, including controlled substances

21. SFEnvironment.org Any business selling prescription drugs must post “…in an area visible to the public & adjacent to the area where prescription drugs are dispensed”

22. SFEnvironment.org Success to Date Total 6537 Local pharmacies have been integral to our success

23. SFEnvironment.org Outreach Team presents at senior centers

24. SFEnvironment.org Looking backSuccess: 1. Collaboration 2. Data on costs, demand 3. ConvenienceChallenges/Trends: 1.Temporary pilot 2. Inequitable responsibility: Heavy government involvement 3. Participation barriers

25. SFEnvironment.org Convenience: pharmacies Completeness: police depts. for controlled's Permanence: manufacturer involvement Metrics: Outreach/metrics - role for govt.? Lessons for future programs

26. SFEnvironment.org Thank you Sushma Bhatia SF Dept of Environment (415) 355.3758 Sushma.bhatia@sfgov.org

27. SFEnvironment.org Unmetabolized drugs A specific example that supports this claim is provided in a study published in the scientific journal, Chemosphere, by Klaus Kummerer (2001), which states that 90% of the drug, propofol found in anesthesia, is excreted unmetabolized. This is a very high percentage and it illustrates that large amounts of various unmetabolized pharmaceuticals are being released into wastewater where their environmental impacts are not well known.

28. SFEnvironment.org Pharmaceuticals in the drinking water United States Environmental Protection Agency (U.S. EPA) has added some pharmaceuticals to the most recent contaminant candidate list (CCL 3); however, only four of the compounds on this list are exclusively used as human pharmaceuticals: three birth control substances and one antibiotic (U.S. EPA, 2009a).