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HomeMy WebLinkAboutcopy-of-approved-med-project-for-unwanted-drugs-2025A Product Stewardship Plan for Unwanted Medicine from Households Alameda County, California Date: September 5, 2025 2 Contents Executive Summary ...................................................................................................... 4 I. Introduction .............................................................................................................. 5 II. Contact Information ................................................................................................. 6 III. Plan Definitions ........................................................................................................ 7 IV. Unwanted Medicine ................................................................................................. 9 V. Collection of Unwanted Medicine ......................................................................... 10 A. Unwanted Medicine Collection Program ............................................................. 10 1. Convenience ................................................................................................. 10 2. Services ........................................................................................................ 10 B. Kiosk Drop-Off Sites ........................................................................................... 10 1. Kiosk Drop-Off Site Locations ....................................................................... 10 2. Drop-Off Site Kiosk Placement and Maintenance Program .......................... 11 3. Kiosk Specifications ...................................................................................... 11 4. Kiosk Collection ............................................................................................. 12 5. Collection Method ......................................................................................... 13 6. Kiosk Service ................................................................................................ 13 C. Disposal of Unwanted Medicine from Kiosk Drop-Off Sites ................................ 14 D. Mail-Back Services for Unwanted Medicine ....................................................... 14 1. Standard Mail-Back Services for Unwanted Medicine ................................... 14 2. Inhaler Mail-Back Services for Inhalers ......................................................... 15 3. Injector Mail-Back Services for Pre-Filled Injector Products .......................... 15 4. Mail-Back Package Availability ...................................................................... 15 5. Mail-Back Package Collection and Disposal ................................................. 15 VI. Goals ....................................................................................................................... 17 VII. Patient Privacy ................................................................................................... 18 VIII. Call Center ......................................................................................................... 19 IX. Kiosk Drop-Off Site Training ................................................................................. 20 X. Vendor, Reverse Distributor, Transporter, Disposal, and Transfer Facility Information ............................................................................................................. 21 A. Vendors .............................................................................................................. 21 B. Reverse Distributor ............................................................................................. 22 C. Carriers and Transporters .................................................................................. 22 D. Disposal Facilities ............................................................................................... 23 E. Transfer Facility .................................................................................................. 24 XI. Unwanted Medicine Educational and Outreach Programming .......................... 25 A. Overview ............................................................................................................ 25 B. Audiences ........................................................................................................... 25 C. Messages ........................................................................................................... 25 D. Tools/Communications Channels ....................................................................... 26 1. Phone ............................................................................................................ 26 3 2. Materials........................................................................................................ 26 3. Social Media .................................................................................................. 27 E. Survey ................................................................................................................ 27 F. Disclaimer ........................................................................................................... 27 XII. Compliance with Applicable Laws, Regulations, and other Legal Requirements ......................................................................................................... 28 A. DEA Controlled Substances Act and Implementing Regulations ........................ 28 1. DEA Modification ........................................................................................... 29 B. United States Department of Transportation (DOT) ........................................... 29 C. California Board of Pharmacy ............................................................................. 29 XIII. Annual Report .................................................................................................... 31 Appendix A .................................................................................................................. 32 MED-Project Participating Producers ....................................................................... 32 Appendix B .................................................................................................................. 33 Participating Kiosk Drop-Off Sites ............................................................................ 33 Appendix C .................................................................................................................. 38 Sample Kiosk Mock-Up ............................................................................................ 38 Sample Kiosk Signage ............................................................................................. 39 Appendix D .................................................................................................................. 42 Sample Mail-Back Packages ................................................................................... 42 Appendix E .................................................................................................................. 45 Penalty Records....................................................................................................... 45 Appendix F ................................................................................................................... 55 Sample MED-Project Website Pages ...................................................................... 55 Appendix G .................................................................................................................. 70 Sample Bi-Fold Brochure ......................................................................................... 70 4 Executive Summary MED-Project LLC (“MED-Project”) develops, implements, and operates stewardship programs for unwanted medicine from households on behalf of hundreds of participating Producers. MED-Project has substantial, practical, on-the-ground experience implementing unwanted medicine takeback programs in jurisdictions across the country, including the County. MED-Project currently administers an approved Product Stewardship Plan in the County, which has been in operation since 2015 and has served Residents by collecting over 430,000 pounds of Unwanted Medicine. Further, MED-Project’s outreach and education efforts have thus far resulted in over 90 million impressions to Residents. 5 I. Introduction MED-Project, on behalf of the participating companies identified in Appendix A, submits this Product Stewardship Plan (“Plan”) for Unwanted Medicine to the Alameda County Department of Environmental Health (“Department”) in compliance with the Alameda County Safe Drug Disposal Ordinance, Title 6 of the Alameda County Health and Safety Code Sections 6.53.010 through 6.53.120, as amended February 2, 2016 (“Ordinance”) and the Alameda County Safe Drug Disposal Regulations, as amended October 16, 2013 (“Regulations”). The Ordinance requires pharmaceutical Producers1 to develop a Product Stewardship Program to finance and manage the collection, transportation, and disposal of Unwanted Medicine from County households. Upon Department approval, this Plan will supersede MED-Project’s previously approved plans in their entirety, including, without limitation, their associated notices of determination or conditions of approval. 1 All capitalized terms used but not otherwise defined herein shall have their respective meanings set forth in the Ordinance and Regulations. 6 II. Contact Information The Plan Liaison for MED-Project is: Dr. Victoria Travis, PharmD, MS, MBA National Program Director MED-Project LLC 4096 Piedmont Ave Unit 174 Oakland, CA 94611 Phone: 1 (833) 633-7765 Fax: 1 (866) 633-1812 Email: alamedacounty@med-project.org 7 III. Plan Definitions Board of Pharmacy is the California State Board of Pharmacy. Call Center is the MED-Project call center for Residents, which can be reached by callers at the toll-free number of 1-844-MED-PROJECT or 1-844-633-7765. Carrier is the common carrier used to transport Unwanted Medicine. County means Alameda County, California. DEA is the U.S. Drug Enforcement Administration. DEA Rule is the DEA Final Rule, “Disposal of Controlled Substances,” 79 Fed. Reg. 53,520 et seq., adopted on September 9, 2014. DOT is the U.S. Department of Transportation. FDA is the U.S. Food and Drug Administration. Help Desk is the MED-Project call center and email-in database for Kiosk Drop-Off Sites and Mail-Back Distribution Locations that can be reached by callers at a toll-free number and/or by email at alamedacounty@med-project.org. Inhaler Mail-Back Services is the provision of pre-paid, pre-addressed packages for the collection and disposal of inhalers (“Inhaler Mail-Back Packages”) by Vendor. Injector Mail-Back Services is the provision of pre-paid, pre-addressed, FDA-cleared sharps containers for the collection and disposal of pre-filled injector products (“Injector Mail-Back Packages”) by Vendor. Kiosk Drop-Off Site is a location that is accessible to the public, hosting a MED-Project kiosk for the collection of Unwanted Medicine. Kiosk Drop-Off Site Host is the designated contact person or persons at the Kiosk Drop-Off Site. Law Enforcement Agency or LEA is a federal, state, tribal, or local law enforcement office or agency. Mail-Back Distribution Location is a site that is accessible to the public, such as a fire station or library, which provides Standard Mail-Back Packages to Residents. Mail-Back Services is the provision of pre-paid, pre-addressed containers, envelopes, or packages (“Mail-Back Packages”) to Residents for the collection and disposal of Unwanted Medicine by Vendor. MED-Project Website is the Internet website located at www.med-project.org or www.medproject.org. 8 Plan or Product Stewardship Plan is the product stewardship plan presented in this submittal by MED-Project. Pre-filled Injector Products are pre-filled injector products with a retractable or otherwise securely covered needle where medicine cannot be removed from them or where they contain more than trace amounts of Covered Drugs. Program or Product Stewardship Program is the product stewardship program set forth in this Product Stewardship Plan. Residents means human beings residing in the County. “Residents” does not include nonresidential generators of pharmaceutical waste, such as businesses, hospitals, clinics, doctor’s offices, veterinary clinics, pharmacies, or airport security and law enforcement drug seizures. Specified Languages are English, Spanish, Chinese, Vietnamese, and Tagalog (Filipino). Standard Mail-Back Services is the provision of pre-paid, pre-addressed envelopes for the collection and disposal of Unwanted Medicine (“Standard Mail-Back Packages”) by Vendor. Unwanted Medicine is defined in Section IV of this Plan. Vendor is any vendor retained by MED-Project to carry out its obligations under the Program. 9 IV. Unwanted Medicine2 For the purposes of the Plan, “Unwanted Medicine” includes all materials identified as “Covered Drugs” under Ordinance § 6.53.030(3) that qualify as “Unwanted Products” under Ordinance § 6.53.030(21). According to the Ordinance, Covered Drugs means “a Drug sold, offered for sale, or dispensed in Alameda County in any form including prescription and nonprescription drugs, drugs in medical devices and combination products, brand name and generic drugs, and drugs for veterinary use.” Unwanted Medicine does not include the following: i. Expired and/or undispensed samples direct from physicians’ offices; ii. Unused or expired drugs from hospitals and institutions; iii. Bulk animal pharmaceuticals from farms (business use); iv. Vitamins or supplements; v. Herbal-based remedies and homeopathic drugs, products, or remedies; vi. Compressed cylinders and mercury-containing thermometers; vii. Cosmetics, shampoos, sunscreens, toothpaste, lip balm, antiperspirants, or other personal care products that are regulated as both cosmetics and nonprescription drugs under the federal Food, Drug, and Cosmetic Act (Title 21 U.S.C. Chapter 9); viii. Hard surface and toilet disinfectant cleaners; ix. Drugs administered in a healthcare setting; x. Drugs for which Producers provide a pharmaceutical product stewardship or take-back program as part of an FDA managed risk evaluation and mitigation strategy (Title 21 U.S.C. Sec. 355-1); xi. Drugs that are biological products, as defined by 21 C.F.R. 600.3(h) as it existed on February 2, 2016, if the Producer already provides a pharmaceutical product stewardship or take-back program; xii. Medical devices or their component parts or accessories; xiii. Used, empty containers, vials, and pouches; xiv. Sharps (e.g., needles) xv. Schedule I or other illicit drugs. See Section XII.A for collection limitations imposed by the DEA Rule. 2 Unwanted Medicine collected at Kiosk Drop-Off Sites does not include Pre-filled Injector Products. Unwanted Medicine collected in Standard Mail-Back Packages does not include inhalers or Pre-filled Injector Products. 10 V. Collection of Unwanted Medicine The Plan provides services to collect Unwanted Medicine, including controlled substances. The Program accepts Unwanted Medicine regardless of who produced it unless excused from this requirement by the Department. The collection methods and any applicable legal requirements are described below. A. Unwanted Medicine Collection Program 1. Convenience MED-Project has established a network of convenient Kiosk Drop-Off Sites that adequately meets the needs of the Residents in the County. See Appendix B for a list of participating sites. Mail-Back Services are available upon request for all Residents, including disabled and/or home-bound Residents or persons providing services to such Residents, via the Call Center and MED-Project Website, thereby offering more opportunities to dispose of Unwanted Medicine. If the number of Kiosk Drop-Off Sites falls below 50 locations, distributed jointly, in combination with all other approved stewardship organizations, Mail-Back Distribution Locations will be used to supplement Kiosk Drop-Off Sites on a one-for-one basis. 2. Services MED-Project routinely assesses performance, gauges feedback, and revises its approach to services and convenience as appropriate. The Program is implemented in a flexible manner, offering coverage to Residents through a combination of Kiosk Drop-Off Sites and Mail-Back Services. Agreements outlining the responsibilities of the involved parties are reviewed by appropriate entities and signed by the parties before participation in the Program. Mail-Back Services are available to Residents via the Call Center and MED-Project Website. See Section V.D. for more information about the availability of Mail-Back Services. B. Kiosk Drop-Off Sites Kiosk Drop-Off Sites are conveniently placed across the County. 1. Kiosk Drop-Off Site Locations Kiosk Drop-Off Sites that are participating in the Program are identified in Appendix B. As required under Ordinance § 6.53.070(E), MED-Project will include as a Kiosk Drop- Off Site eligible LEA or retail pharmacy sites willing to serve voluntarily who submit a written expression of interest to participate to MED-Project, and who are able to meet all applicable laws, regulations, and other legal requirements. Locations currently serving 11 as a kiosk drop-off site may participate in the Program by signing agreements with MED-Project and modifying their DEA registrations, if required. 2. Drop-Off Site Kiosk Placement and Maintenance Program Kiosk installation shall be the responsibility of MED-Project at LEAs and pharmacy Kiosk Drop-Off Sites when the Kiosk Drop-Off Site Host has identified a compliant placement location. All kiosks in the Program must be securely placed and maintained inside a collector’s registered location or LEA’s physical location in accordance with DEA Rule §§ 1317.75(d)(1) and 1317.35(a). At pharmacies, kiosks are placed in the immediate proximity of a designated area where controlled substances are stored and at which an employee is present (i.e., can be seen from the counter), pursuant to DEA Rule § 1317.75(d)(2). Kiosk placement will also comply with any applicable Board of Pharmacy requirements. Costs associated with installation and maintenance are paid by MED-Project per the agreements with the Kiosk Drop-Off Site Hosts. The maintenance program addresses items such as: − Monitoring the kiosk for proper functioning; and − Reporting issues regarding the kiosk to the MED-Project Help Desk. All Kiosk Drop-Off Site Hosts are able to notify MED-Project of the need for kiosk service or maintenance via the Help Desk. 3. Kiosk Specifications A kiosk is offered to eligible host locations. Pursuant to DEA Rule § 1317.75, MED- Project kiosks at pharmacies must: − Be securely fastened to a permanent structure; − Be securely locked, substantially constructed containers with a permanent outer container and removable inner liner; − Include a small opening in the outer container that allows contents to be added to the inner liner, but does not allow removal of the inner liner’s contents; − Prominently display a sign indicating that only Schedule II-V controlled and non-controlled substances are acceptable to be placed in the kiosk; and − Have the small opening in the outer container locked or made inaccessible to the public when a Kiosk Drop-Off Site employee is not present. The design of the pharmacy kiosk and signage (Appendix C) satisfies these requirements through the use of heavy gauge steel; multiple locking mechanisms, including a locking mechanism on the drop-slot; a tamper-resistant chute; and commercial hinges. The design increases the likelihood of consumer participation by providing easy access to wheelchair users. The locking mechanism on the drop-slot prevents kiosk overflow once the container has reached its maximum level and is locked by the Kiosk Drop-Off Site employee. MED-Project pharmacy kiosks come with appropriate regulatory signage and instructions, including an instruction to remove personal information from any Unwanted Medicine and packaging before depositing 12 them and language required under the DEA Rule3 and by the Board of Pharmacy. Kiosk signage provides information about what is and is not accepted in the kiosk. Additionally, under DEA Rule § 1317.60(a), MED-Project kiosk inner liners will: − Be waterproof, tamper-evident, and tear-resistant; − Be removable and sealable immediately upon removal without emptying or touching kiosk contents; − When sealed, make the contents of the inner liner not viewable from the outside; − Clearly indicate the size of the inner liner; and − Bear a permanent, unique identifier for tracking purposes. MED-Project kiosks and inner liners will also comply with the Board of Pharmacy requirements. While the DEA Rule does not require LEA kiosks to meet these same requirements, MED-Project will offer these kiosks and inner liners to LEAs. See Disposal of Controlled Substances, 79 Fed. Reg. 53,520, 53,531 (Sept. 9, 2014). 4. Kiosk Collection Under DEA Rule § 1317.05(c)(2)(iv), pharmacy Kiosk Drop-Off Site Hosts must dispose of sealed inner liners and their contents either on-site, through common or contract carrier delivery to, or pick-up by a reverse distributor or distributor, or with DEA assistance. DEA Rule § 1317.75(c) prohibits the counting, sorting, inventorying, or individual handling of any substances deposited into a pharmacy kiosk. Additionally, DEA Rule § 1317.60 limits inner liner access to employees of the collector and requires two employees to immediately seal the inner liner upon its removal from the pharmacy kiosk’s permanent outer container. See DEA Rule § 1317.60(b), (c). DEA Rule § 1317.75(g) provides that pharmacy kiosk inner liner installation or removal shall be performed “by or under the supervision of at least two employees of the authorized collector.” The pharmacy kiosk sealed inner liner must not be opened, x-rayed, analyzed, or otherwise penetrated. See DEA Rule § 1317.60(c). LEA Kiosk Drop-Off Sites, Vendor and/or LEA will maintain any records of removal, storage, or destruction of the collected Unwanted Medicine in a manner consistent with the LEAs’ recordkeeping requirements for illicit controlled substances evidence pursuant to DEA Rule § 1317.35. LEAs will record the unique identifier and size of the sealed inner liner. See DEA Rule § 1317.35. Additionally, any Unwanted Medicine will be stored in a manner to prevent the diversion of controlled substances and consistent 3 Specifically, as required under DEA Rule § 1317.75(e)(4), all kiosks will prominently display a sign stating that: “Only Schedule II-V controlled and non-controlled substances that are lawfully possessed by the ultimate user are acceptable to be placed in the kiosk. Schedule I controlled substances, illicit or dangerous substances, and any controlled substances not lawfully possessed by the ultimate user may not be placed in the kiosk.” 13 with the LEA’s standard procedures for storing illicit controlled substances. Collected Unwanted Medicine will be transferred to the disposal facility in a manner to prevent the diversion of Unwanted Medicine and consistent with the LEA’s standard procedures for transferring illicit controlled substances. See DEA Rule § 1317.35. MED-Project’s Kiosk Drop-Off Site collection system complies with these DEA requirements for pharmacy and LEA Kiosk Drop-Off Sites. Vendor, pharmacies, and LEAs participating in the Program will keep all records required under the DEA Rule, including those required under DEA Rule §§ 1304 and 1317.35. Pharmacies participating in the Program will also keep all records required under Board of Pharmacy requirements. Pharmacy Kiosk Drop-Off Sites and Vendor will be instructed never to count, sort, inventory, or individually handle kiosk contents. MED-Project’s Kiosk Drop- Off Site collection system will also comply with all applicable Board of Pharmacy requirements. 5. Collection Method MED-Project provides for the collection, transport, and disposal of Unwanted Medicine at no cost to the Kiosk Drop-Off Site. Kiosk Drop-Off Site Hosts are provided with instructions for the management of the Unwanted Medicine collection box and inner liner in accordance with the Kiosk Drop-Off Site Host agreement. Guidance materials are available to the Kiosk Drop-Off Sites, including instructions on how to safely pack and seal the inner liner for shipping as soon as it is full. This method enables the Kiosk Drop-Off Site employees to avoid disruptions to operations and service the kiosk at the time of their choosing. The Kiosk Drop-Off Site employees prepare the inner liner for shipment and schedule a Carrier to pick up the packaged inner liner through MED-Project systems or offer the packaged inner liner during a regular Carrier pick-up. 6. Kiosk Service When servicing a kiosk at a Kiosk Drop-Off Site, Kiosk Drop-Off Site employees will: − Check the kiosk for any damage; − Remove the inner liner and box from the kiosk and seal them at once, following procedures meeting all DEA requirements; − Replace the removed inner liner and box with a replenishment inner liner and box provided by Vendor; − Match the unique identifier of the inner liner to the tracking number on the shipping label; − Package the inner liner for transport; − Prepare the materials for shipment and perform applicable pre-transportation functions following the DOT HMR; and − Schedule a pick-up from the Carrier to be completed within a few business days or offer the packaging holding the sealed inner liner for pick-up by routine Carrier service at the Kiosk Drop-Off Site. 14 The Kiosk Drop-Off Site employees store the inner liner in compliance with all applicable laws, regulations, and other legal requirements until Carrier pick-up. C. Disposal of Unwanted Medicine from Kiosk Drop-Off Sites Kiosk Drop-Off Site employees, Vendor, and Carrier shall manage the Unwanted Medicine from Kiosk Drop-Off Sites in compliance with all applicable laws, regulations, and other legal requirements. Carrier shall deliver Unwanted Medicine collected from Kiosk Drop-Off Sites to the respective facilities identified in Section X. Each sealed inner liner and box containing Unwanted Medicine will be weighed at the receiving facility. Unwanted Medicine is destroyed in accordance with all applicable laws, regulations, and other legal requirements at the disposal facilities identified in Section X. D. Mail-Back Services for Unwanted Medicine MED-Project will provide three types of Mail-Back Services: − Standard Mail-Back Services for the collection of Unwanted Medicine as described in Section V.D.1.; − Inhaler Mail-Back Services for the collection of inhalers as described in Section V.D.2.; and − Injector Mail-Back Services for the collection of Pre-filled Injector Products as described in Section V.D.3. Mail-Back Packages will be pre-paid and pre-addressed, and Mail-Back Services shall comply with all applicable laws, regulations, and other legal requirements. 1. Standard Mail-Back Services for Unwanted Medicine For Unwanted Medicine, MED-Project offers Standard Mail-Back Services at no cost to Residents, via the Call Center and MED-Project Website. The pre-paid shipping label directs the Standard Mail-Back Package to an approved facility identified in Section X. Standard Mail-Back Packages for Unwanted Medicine shall comply with all applicable laws, regulations, and other legal requirements. Pursuant to DEA Rule § 1317.70(c), the Standard Mail-Back Packages are: − Nondescript and without any markings or information potentially indicating that they contain Unwanted Medicine, including controlled substances; − Water and spill-proof, tamper-evident, tear-resistant, and sealable; − Pre-addressed with and delivered to Vendor’s registered address; − Pre-paid; − Provided with a unique identifier enabling tracking; and − Provided with instructions indicating the process for mailing back the packages, accepted substances, a notice about mailing restrictions, and a notice that only packages provided by Vendor will be accepted for destruction. 15 Standard Mail-Back Packages will not be opened, x-rayed, analyzed, or otherwise penetrated upon receipt by Vendor. See DEA Rule § 1317.70(f). Vendor will keep all records required under the DEA Rule, including those identified in DEA Rule § 1304.22(f). See Appendix D for a Standard Mail-Back Package image and package specifications. 2. Inhaler Mail-Back Services for Inhalers For inhalers, MED-Project offers Inhaler Mail-Back Services at no cost to Residents via the Call Center and MED-Project Website. The pre-paid shipping label directs the Inhaler Mail-Back Packages to an approved facility identified in Section X. An instruction sheet is included with the Inhaler Mail-Back Package that describes how to properly dispose of inhalers, explains what materials may be placed in the Inhaler Mail-Back Package, and how to return the Inhaler Mail-Back Package. See Appendix D for an Inhaler Mail-Back Package image and package specifications. 3. Injector Mail-Back Services for Pre-Filled Injector Products For Pre-filled Injector Products, MED-Project offers Injector Mail-Back Services at no cost to Residents, via the Call Center and MED-Project Website. The pre-paid shipping label directs the Injector Mail-Back Packages to an approved facility identified in Section X. An instruction sheet is included with the Injector Mail-Back Package that describes how to properly dispose of the Pre-filled Injector Products, explains what materials may be placed in the Injector Mail-Back Package, and how to return the Injector Mail-Back Package. See Appendix D for an Injector Mail-Back Package image and package specifications. 4. Mail-Back Package Availability Residents may request Standard Mail-Back Packages, Inhaler Mail-Back Packages, and/or Injector Mail-Back Packages by calling the Call Center or through a link on the MED-Project Website. If the number of Kiosk Drop-Off Sites falls below 50 locations, distributed jointly, in combination with all other approved stewardship organizations, Mail-Back Distribution Locations that disseminate Standard Mail-Back Packages will be used to supplement Kiosk Drop-Off Sites on a one-for-one basis. Each Mail-Back Package contains an insert with instructions for use and information about other options for disposing of Unwanted Medicine in the Specified Languages. See Appendix D for Mail-Back Package images. 5. Mail-Back Package Collection and Disposal Requests to receive Mail-Back Packages are taken through the Call Center and the MED-Project Website. Residents are directed to follow the instructions provided in the Mail-Back Package and to place their Unwanted Medicine in the pre-addressed, pre- 16 paid package. The Mail-Back Package is sent to an approved disposal facility in compliance with all applicable laws, regulations and other legal requirements. Each Mail-Back Package has a unique identifier for tracking. For Standard Mail-Back Packages, upon arriving at the disposal facility, the Mail-Back Packages are scanned for receipt verification and incinerated at the disposal facilities listed in Section X. Any storage of filled Standard Mail-Back Packages by Vendor complies with the applicable security requirements of DEA Rule § 1317, including the requirement that Unwanted Medicine is securely stored in a manner consistent with the security requirements for Schedule II Controlled Substances. Unwanted Medicine in Standard Mail-Back Packages is weighed and destroyed promptly at the receiving facility. The total amount by weight collected through Mail-Back Services may be provided using an actual or an average weight per Mail-Back Package, as provided by Vendor. 17 VI. Goals The short-term and long-term goals of the Plan are described generally as follows. Goal Area Short-Term and Long-Term Goals: Collection reasonably convenient access for Residents as follows: • If the number of Kiosk Drop-Off Sites falls below 50 locations (distributed jointly, in combination with all other approved stewardship organizations), Mail-Back Distribution Locations will be used to supplement Kiosk Drop-Off Sites on a one-for-one basis. • Additionally, MED-Project may send a letter to potential Kiosk Drop- Off Site Hosts outlining the opportunity to participate in the Program. Maintain Mail-Back Services via the MED-Project Website and Call Center. Education & Public Outreach Continue media program consistent with Regulations § 8.A.viii via the following: • MED-Project Website. • Call Center. • Media campaigns (for example, digital display, connected TV, streaming audio, or social media). 18 VII. Patient Privacy Instructions at each Kiosk Drop-Off Site inform Residents who deposit Unwanted Medicine that they should completely cross out, remove, or otherwise make unreadable any and all personally identifiable information on the containers and packaging before depositing them in the kiosk. In cases where people follow the instructions, there will be no personally identifiable information. In addition to kiosk signage, MED-Project promotional and educational materials encourage Residents to protect their information by removing identifiable information before depositing containers into kiosks or Mail-Back Packages. As an added protection, inner liners for the kiosks are opaque rather than clear, in compliance with DEA Rule. 19 VIII. Call Center MED-Project has established a toll-free telephone number for Residents to obtain information about Kiosk Drop-Off Sites, Mail-Back Services, educational materials, and other aspects of the Program. Callers with medical emergencies are directed to call 911. Patients with medication-related questions are directed to contact their health care provider(s). The Call Center provides information about: − Items that can be disposed of; − Disposal options; − Kiosk Drop-Off Sites and disposal options in the caller’s specified ZIP code; − The MED-Project Website; and − How to obtain Mail-Back Packages. To increase access to the Program for Residents, MED-Project has included dialing options for TTY and 711 services. 20 IX. Kiosk Drop-Off Site Training At a Kiosk Drop-Off Site, operational procedures, including training, are the responsibility of the Kiosk Drop-Off Site Host. Included in the training materials are documents that address: − Permit requirements; − Management of kiosks, including cleanliness, monitoring the kiosk for proper functioning, and how to report issues regarding the kiosk to MED-Project; and − Proper inner liner setup and closure, preparation of shipment, and timely removal of the packaged inner liner from the site. MED-Project provides a system that allows Kiosk Drop-Off Site Hosts to request resources or support anytime. MED-Project also provides a 24/7 Help Desk to answer questions, monitor comments, and fulfill requests from participating Kiosk Drop-Off Sites and Mail-Back Distribution Locations. 21 X. Vendor, Reverse Distributor, Transporter, Disposal, and Transfer Facility Information All Vendors, transporters, and disposal facilities utilized by the Program will operate in accordance with all applicable laws, regulations, and other legal requirements. A. Vendors Record Compliance, Inc. 16225 Park Ten Place, Suite 830, Houston, 3030 com Stericycle, Inc. Waukegan Road, Bannockburn, 5910 e.com 22 B. Reverse Distributor Permits Record (5 years) Inc. Warren, Ohio Facility 1901 Pine Avenue, SE, 44483 0370 cle.com/ Registered Collector and Reverse No: RS0498130 See Appendix E C. Carriers and Transporters Permits Record (5 Harbors Environme ntal Services 1021 Berryessa Road, San Jose, CA 95113 0962 arbors.com Waste Transporter 180743 Appendix E Sharps Solutions, LLC 23575 Cabot Blvd., Ste 205, Hayward, 8449 s-solutions.com/contact/ Carrier 2810784 Stericycle Inc. 2355 Waukegan Road, Bannockbur 5910 cle.com Waste Transporter 397962 United Parcel Service, 55 Glenlake Parkway UPS om/ 21800 23 Name Address Phone Website Type Issued Permits Record (5 States Postal Service 475 L’Enfant Plaza SW, Washington 2000 .com/ See SEC filings D. Disposal Facilities Permits Record (5 Harbors Aragonite, LLC 11600 North Aptus Rd, Grantsville, UT 84029 8900 arbors.com/ Waste Incinerator UTD981552 177 Title V Operating Permit No: 450004800 See Appendix E Curtis Bay Energy, LP 3200 Hawkins Point Road, Baltimore, MD 21226 1715 aymws.com Waste Incinerator MDD98540 4318 Refuse Disposal Permit No: 2017-WMI- SeeAppendix E Arcwood Environmental – East Liverpool, Inc. (Formerly Heritage Thermal Services – 1250 Saint George Street, East Liverpool, OH 43920 7655 arcwoodenviro.com/ Waste Incinerator OHD980613541 Title V Operating Permit No: OH0000000215020233 See Appendix E 24 Name Address Phone Website Type Issued Permits Record (5 Inc., Warren, Ohio Facility 1901 Pine Avenue SE, 44483 6275 .stericycle.com Waste Incinerator OHD980795280 Title V Operating Permit No: See Appendix E E. Transfer Facility Permits Record (5 Harbors Environmental 1021 Berryessa Rd. San Jose, CA 3379 arbors.com Medical Waste Transfer Waste Permit TS-51 Appendix E 25 XI. Unwanted Medicine Educational and Outreach Programming A. Overview MED-Project will perform public education and outreach to educate Residents about the collection and disposal of Unwanted Medicine from households. B. Audiences A comprehensive communications campaign featuring both general awareness strategies and targeted outreach to audiences directly involved in the distribution and use of medicines to Residents will educate the public about the Program. These audiences may include: − General public; − Pharmacies, including education for dispensers of Covered Drugs; − Retailers of Covered Drugs; − Health care providers and their patients; and − Veterinary providers and animal owners. The Program will include efforts designed to reach a broad range of diverse audiences. The Program will make available a multilingual Call Center (Section XI.D.1.) and will make available educational information through a range of media platforms. C. Messages MED-Project’s messaging will: − Educate Residents about the appropriate use, storage, and disposal of Unwanted Medicine; − Educate Residents about available Mail-Back Services; and − Provide Residents with information about available Kiosk Drop-Off Sites and Mail-Back Distribution Locations in their area that offer disposal of Unwanted Medicine. Key points of emphasis might include: − The importance of properly and securely storing medicines; − The importance of promptly and properly disposing of Unwanted Medicine; − How to find and use Kiosk Drop-Off Sites; − How to properly dispose of Unwanted Medicine; and − Privacy information (removing personally identifiable information from labeled prescription containers). 26 D. Tools/Communications Channels The Program will include a number of components designed to reach consumers and provide consistent access to timely and relevant information. MED-Project will execute a measurable public education and outreach strategy aimed at driving awareness of take-back of Unwanted Medicine and in accordance with Ordinance §§ 6.53.050 (A) (8) and 6.53.070. MED-Project will use a combination of the following tools and communication channels: 1. Phone The Program provides a Call Center for Residents to obtain information about Kiosk Drop-Off Sites, Mail-Back Services, Mail-Back Distribution Locations, educational materials, and other aspects of the Program for the take back of Unwanted Medicine from households. The Call Center provides: − Assistance in the Specified Languages; − Information about how the Program works, and how to obtain more information (e.g., the MED-Project Website); − An option to speak with an agent to locate Kiosk Drop-Off Sites and/or Mail-Back Distribution Locations, if applicable, in the Resident’s ZIP code or local area; and − Information about Mail-Back Services, including how to request a pre-paid and pre-addressed Mail-Back Package. The Call Center also provides a recorded call script directing callers with medical emergencies to call 911 and directing callers with medication-related questions to contact their health care provider(s). MED-Project will provide a mobile-friendly MED-Project Website with translations available in the Specified Languages. The MED-Project Website allows Residents to request Mail-Back Packages, provides information on locations of Kiosk Drop-Off Sites and, if applicable, Mail-Back Distribution Locations, and provides access to educational materials and answers to frequently asked questions. Promotional and educational materials will be provided on the MED-Project Website, including brochures and Mail- Back Package inserts, with translations available in the Specified Languages. Public interest groups will be encouraged to use these resources to promote the Program. Appendix F contains a sample mockup of the MED-Project Website and supporting pages. 2. Materials Educational materials about the Program and how to properly dispose of Unwanted Medicine are provided for dissemination, upon request, through the MED-Project Website and the Call Center, to interested parties, including healthcare facilities, 27 pharmacies, and Kiosk Drop-Off Sites. The educational brochure is provided in Appendix G. 3. Social Media MED-Project uses social media to communicate outreach information about Kiosk Drop- Off Sites and Mail-Back Services. Posts are made as needed to reflect the most up-to- date information. E. Survey MED-Project will conduct a biennial survey of Residents in the County to measure awareness of the take-back of Unwanted Medicine from households. F. Disclaimer The written and verbal educational materials and public outreach tools that are required by the Ordinance and disseminated under this Product Stewardship Plan may include a disclaimer similar to the following: “This material has been provided for the purpose of compliance with legislation and does not necessarily reflect the views of MED-Project or the Producers participating in the MED-Project Product Stewardship Plan.” 28 XII. Compliance with Applicable Laws, Regulations, and other Legal Requirements As described in more detail below, the Plan is designed such that all entities participating in the Program shall comply with all applicable laws, regulations, and other legal requirements. A. DEA Controlled Substances Act and Implementing Regulations On October 12, 2010, the United States Congress enacted the Secure and Responsible Drug Disposal Act of 2010 (“Disposal Act”) as amendments to the Controlled Substances Act (“CSA”). The Disposal Act amended the CSA to allow for the expansion of entities to which users can deliver pharmaceutical controlled substances for disposal, subject to regulations to be promulgated. On September 9, 2014, the DEA adopted a rule entitled “Disposal of Controlled Substances” (referred to herein as the “DEA Rule”) to implement the Disposal Act. Under the DEA Rule, collection of controlled substances is limited to Schedule II, III, IV, or V controlled substances that are lawfully possessed by an ultimate user or person entitled to dispose of an ultimate user decedent’s property. See DEA Rule §§ 1317.75(b) (Kiosk Drop-Off Sites),41317.70(b) (Mail-Back Services). Schedule I controlled substances, controlled substances that are not lawfully possessed as described above, and other illicit or dangerous substances will not be collected. Additionally, as these provisions of the DEA Rule limit collection of controlled substances to those lawfully possessed by an ultimate user or certain other persons, pharmacies are prohibited from disposing their own inventory or stock through the Program. See also DEA Rule § 1317.05. The DEA Rule provides that LEAs can continue to accept controlled substances for disposal. However, the DEA Rule also provides that pharmacies, reverse distributors, hospitals/clinics with on-site pharmacies, and certain other entities, can register with the DEA as “collectors” and become authorized at their discretion on a voluntary basis to accept controlled substances. The DEA Rule: − Provides for the collection of controlled substances at Kiosk Drop-Off Sites at LEAs, pharmacies, and hospitals with on-site pharmacies; − Provides for the use of mail-back programs to collect controlled substances; − Allows for the commingling of controlled and non-controlled substances; 4 For Kiosk Drop-Off Site collection, only certain substances “that are lawfully possessed by an ultimate user or other authorized non-registrant person may be collected.” DEA Rule § 1317.75(b). This language is similar to, but slightly different than, provisions limiting collection through Mail-Back Services to ultimate users or other persons (lawfully) entitled to dispose of an ultimate user decedent’s property. See DEA Rule §§ 1317.65(d); 1317.70(b). 29 − Establishes detailed collection, recordkeeping, security, and other measures for all approved collection methods; and − Provides that all collected pharmaceutical products be destroyed so that the products are rendered non-retrievable. The Plan is designed such that all entities that are part of the Program, including Vendor, are individually responsible to comply with their respective compliance obligations under the DEA Rule. The collection, transportation, and disposal of Unwanted Medicine collected from Kiosk Drop-Off Sites and Mail-Back Services, including controlled substances, will comply with applicable DEA requirements. Controlled substances collected pursuant to the Plan may be commingled with non- controlled substances at Kiosk Drop-Off Sites and through Mail-Back Services per the DEA Rule. See DEA Rule §§ 1317.75(b) (Kiosk Drop-Off Sites); 1317.70(b) (Mail-Back Services). 1. DEA Modification Pursuant to DEA Rule § 1301.51(b), pharmacies may modify their registrations to become authorized collectors by submitting a written request to the DEA or online at www.DEAdiversion.usdoj.gov. This request must contain: − The registrant’s name, address, and registration number (as printed on the registration certificate); − The collection methods the registrant intends to conduct; and − A signature in accordance with 21 C.F.R. § 1301.13(j). See DEA Rule § 1301.51(b). MED-Project will consult with participating pharmacies, as requested, regarding how to modify DEA registrations to become authorized collectors. B. United States Department of Transportation (DOT) The transporting of Unwanted Medicine will comply with the U.S. DOT HMR and other applicable DOT requirements. C. California Board of Pharmacy On June 8, 2017, the Board of Pharmacy adopted the Board of Pharmacy Regulations, Article 9.1 of Division 17 of Title 16 of the California Code of Regulations. Largely based on the DEA Rule, the Board of Pharmacy Regulations establish requirements applicable to pharmacies, hospitals/clinics with on-site pharmacies, distributors, and reverse distributors conducting certain drug take-back services. Among other things, the Board of Pharmacy Regulations provide: − That California-licensed pharmacies and hospitals/clinics with on-site pharmacies must be in good standing with, and notify, the Board of Pharmacy to host a drug kiosk. See 16 CCR §§ 1776, 1776.1(i); 30 − That pharmacies must “know and adhere” to all applicable “federal, state, and local requirements governing the collection and destruction of dangerous drugs” when operating a drug take-back program. See 16 CCR § 1776.1(b); − Drug kiosk placement and monitoring requirements. See 16 CCR §§ 1776.3(b)–(d). − Drug kiosk inner liner, container, and signage requirements. See 16 CCR §§ 1776.3(f), (h), (m); − Inner liner handling, storage, and destruction requirements for drug kiosks. See, e.g., 16 CCR §§ 1776.3(h)–(j), 1776.5(a)–(c); − Pharmacy and reverse distributor recordkeeping requirements. See 16 CCR §§ 1776.5(e)–(f), 1776.6; and − Pharmacy drug mail-back program requirements. See 16 CCR § 1776.2. The Plan is designed such that all entities that are part of the Program, including Vendor, are individually responsible for complying with their respective compliance obligations under the Board of Pharmacy Regulations. 31 XIII. Annual Report An annual report will be provided to the Director on or before the date set by the Department and annually thereafter (Ordinance § 6.53.080). This report will be provided in the format required by the Ordinance § 6.53.080 and Regulations §15. 32 Appendix A MED-Project Participating Producers The list of participating Producers in the Program in the County is provided to the County on a periodic basis to satisfy Ordinance requirements. The County was provided with an updated list on July 14, 2025. 33 Appendix B Participating Kiosk Drop-Off Sites 2693 Fruitvale Ave Oakland 94601 System - San 13855 East 14th Street Alameda Hospital BART Police Department Berkeley Police Department California State University, East 25800 Carlos Bee Boulevard Capsmart Pharmacy Clover Pharmacy Community a Walgreens 3009 Broadway Oakland 94611 7201 Regional Street Dublin 94568 7200 Bancroft Avenue Oakland 94605 4020 Fremont Hub Fremont 94538 2314 Santa Clara Avenue Alameda 94501 175 41st Street Oakland 94611 3320 Fruitvale Avenue Oakland 94602 34 Site Name Address City Zip Code CVS Pharmacy 09234 CVS Pharmacy 09251 CVS Pharmacy 09378 CVS Pharmacy 09397 CVS Pharmacy 09494 CVS Pharmacy 09600 CVS Pharmacy 09622 CVS Pharmacy 09635 CVS Pharmacy 09678 CVS Pharmacy 09876 CVS Pharmacy 09904 CVS Pharmacy 09941 CVS Pharmacy 09942 CVS Pharmacy 10119 CVS Pharmacy 10121 CVS Pharmacy 10199 CVS Pharmacy 10924 35 Site Name Address City Zip Code Dublin Police Services Emeryville Police Department Haller's Pharmacy and 37323 Fremont Boulevard Highland Hospital Outpatient 1411 East 31st Street Jade Pharmacy Kaiser Alameda MOB OP 2417 Central Ave. Alameda 94501 OP Pharmacy 2621 Tenth Street Berkeley 94710 MOB Pharmacy 3100 Dublin Blvd Fl 1 Kaiser Fremont Ohlone OP 39400 Paseo Padre Pkway Kaiser Livermore OP Pharmacy 3000 Las Positas Road Kaiser Oak Broadway 1Fl OP 3701 Broadway Fl 1 Kaiser Oak Fabiola A 1Fl OP 3801 Howe Street Oakland 94611 Main Pharmacy 3600 Broadway Fl 1 36 Site Name Address City Zip Code Kaiser Pleasanton South 1 7601 Stoneridge Pleasanton 94588 Leandro Discharge 2500 Merced Street, Bldg. H, FL 1, Room 1436 Kaiser Union City Main MOB 2 3553 Whipple Rd. Union City 94587 22138 Mission Boulevard Hayward 94541 1999 Mowry Avenue, Suite A-2 Fremont 94538 Pharmacy - Lake 250 East 18th Street, 3rd Floor New Oakland Pharmacy 1 New Oakland Pharmacy 2 Piedmont Police Department Pleasanton Police 4833 Bernal Avenue Teds Drugs Tennyson Pharmacy Walgreens 00101 Walgreens 01537 37 Site Name Address City Zip Code Walgreens 02150 Walgreens 02306 Walgreens 02314 Walgreens 02366 Walgreens 02426 Walgreens 02660 Walgreens 04050 Walgreens 04517 Walgreens 04614 Walgreens 06502 Walgreens 09248 Walgreens 10526 Walgreens 13595 Walgreens 15163 Wellspring Pharmacy 38 Appendix C Sample Kiosk Mock-Up 39 Sample Kiosk Signage Kiosk Drop-Slot Panel 11” x 5” Kiosk Drop-Slot Panel 6” x 2” 40 Kiosk Front Door Panel 15” x 16.5” 41 Kiosk Side Panel 19” x 24” 42 Appendix D Sample Mail-Back Packages Sample Standard Mail-Back Package Description: Plastic envelope with return label, instructional flyer, and unique identifier enabling tracking from collection through disposal. Package Size: Outer Dimensions: 8.25” x 12” Inner Dimensions: 7.375” x 10.375” MED-Project may choose to change its Vendor for Mail-Back Services at any time, subject to requirements in the Ordinance and Regulations. 43 Sample Inhaler Mail-Back Package Description: Inhaler Mail-Back Package including container with mail-back packaging, return label, instructional flyer and unique identifier enabling tracking from collection through disposal. Package Size: Outer dimensions: 5” x 5” x 9” Inhaler Mail-Back Services are an example of complete, turnkey systems to provide for the safe return of inhaler waste through Carrier. MED-Project may choose to change its Vendor for Mail-Back Services at any time, subject to the requirements of the Ordinance and Regulations. 44 Sample Injector Mail-Back Package Description: Injector Mail-Back Package includes an FDA-cleared sharps container with mail-back packaging, return label, instructional flyer, and unique identifier enabling tracking from collection through disposal. Package Size: 1.4-quart mail-back system MED-Project may choose to change its Vendor for Injector Mail-Back Services at any time, subject to requirements in the Ordinance and Regulations 45 Appendix E Penalty Records Arcwood Environmental – East Liverpool, Inc. (Formerly Heritage Thermal Services – Ohio) 46 47 48 Clean Harbors Aragonite, LLC 49 50 51 Clean Harbors Environmental Services, Inc. 1 reported case closed on 7/16/2024 Case# MA-2024-0054-US1624 52 Curtis Bay Energy, LP 53 54 Stericycle Inc. Warren Ohio Facility 55 Appendix F Sample MED-Project Website Pages 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 Appendix G Sample Bi-Fold Brochure 71