1. PHARMACEUTICAL TAKE-BACK PROGRAM MODELS International programs U.S. programs Program attributes Public need Essential program elements

2. SPAIN MEDICINE TAKE-BACK Spain Integrated Waste Management System (SIGRE) ∑ Packaging and leftover medicines accepted. ∑ Citizens return medicine to pharmacies across Spain. ∑ Free service. ∑ SIGRE is a non-profit organization funded by the pharmaceutical industry based on sales volume. ∑ In place since 2002. ∑ Collection is taken to a central processing facility for recycling or destruction. Statistics: ∑ Population: 40.3 million. ∑ Number of pharmacies: 261. ∑ Diversion rate: 0.057 kg / capita in 2006.

3. FRANCE MEDICINE TAKE-BACK Run in a collaborative manner between manufacturers (265), wholesalers (6), and community pharmacies (22,590). Run by an association, Cyclamed, with both environmental and humanitarian aims. Industry-funded system. Households are invited to return all unused medicines and packaging. Bags and leaflets are handed out at the time of dispensing; window stickers and posters reinforce this message. Program established in 1995.

4. PHARMACEUTICAL MANUFACTURERS PARTICIPATING IN B.C. TAKEBACK PROGRAM ** Includes Branded R&D, Generic and Over-the-Counter Manufacturers**

5. B.C. Program Poster

6. ONE DAY/ SHORT TERM COLLECTION EVENTS Attendance hard to predict. Must arrange for law enforcement for controlled substances. Expectations raised that can’t be met. Doesn’t address continuous generation of material. Location may not be convenient or intuitive. Many lessons learned from Northeast Recycling Council (NERC) Pilot. Photo: DNR Wisconsin: dnr.wi.gov/org/aw/wm/pharm/household.htm Unwanted medicines should be as easy to return as they are to buy. (We are not expected to purchase our medicines one day a month between 12 and 5 at a single location, overseen by a police officer.)

7. LAW ENFORCEMENT COLLECTION One example: Controlled substances go to sheriff’s offices : –Heat sealed in a plastic bag. –Placed in locked container. –Sheriff’s Property Officers pick up bags. –Sheriff’s office opened and logged items by chemical name, dose and quantity. ===================== –An interim program for controlled’s. –Collected volumes are low (One example: 350 pounds since 2003). –Not widely replicable. –Inconvenient locations, uncomfortable atmosphere. –Logging requirement is not sustainable.

8. MAIL-BACK COLLECTION –Legal structure established in Maine. –Permanent financing not available; EPA grant recently received for $150K. –Waiver received from US Post Office. –Anticipate high cost for mailers and for mailing fees. –Pharmacies could provide mailers and use advertising space.

9. HOUSEHOLD HAZARDOUS WASTE COLLECTION Limitations: –Sparse, inconvenient locations. –Irregular hours. –Can’t accept controlled substances. –Expensive processing and staffing. –Unfair to put staff at risk of temptation (some HHW sites use corrections labor). –Tax-payer funded, rather than consumer or industry funded.

10. BEST OF INTENTIONS Some chain pharmacies are already taking back meds, but without an organized program, and with some of the meds simply put in the dumpster. Some pharmacists take back meds and put them in their sharps containers - thinking these will be incinerated. (In WA sharps containers are microwaved and put in a landfill.) There are an increasing number of expensive, local, one-day events with law enforcement trying to take in all medications. Hazardous waste facilities are taking in drugs and mixing them with liquids such as water or oil. Pharmacists are having to count and catalogue each pill returned. In all of these cases, there is a higher potential for diversion, or for chemical reactions between drugs, or for low collection rates and high expenses.

12. 1,300 PHARMACY LOCATIONS IN WASHINGTON STATE

14. ELEMENTS OF A COMPREHENSIVE PROGRAM Convenience in terms of hours of operation and geographic location. Security in terms of staffing, transport and disposal. Comprehensive in terms of accepting controlled substances. Sustainable in terms of having an equitable and long-term funding mechanism.