HomeMy WebLinkAboutalamedaco-safemeddisposal-assessment-final-l-archiveAlameda County Safe Medication
Disposal Initiative Assessment
Teleosis Institute
863 Arlington Avenue
Berkeley, CA 94707
2007–2014
S U B M I T T E D TO :
Alameda County Health Care Services Agency
P R E PA R E D BY:
Joel Kreisberg
July 11, 2014 • Version 2.1
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE2
Teleosis Institute completed this study under contract with the
Alameda County Health Care Services Agency (HCSA)
with services that conform to the Measure A Ordinance.
Teleosis Institute maintained full editorial control
and the conclusions expressed here are those of the author.
TABLE OF CONTENTS
Executive Summary ...................................................................................................................................................................5
Introduction .................................................................................................................................................................................7
Initiative Outline ........................................................................................................................................................................9
History............................................................................................................................................................................9
......• Bringing Diverse Stakeholders Together – Linda Pratt ....................................................................................9
......• Take-Back Events Or Take-Back Sites – Bill Pollock .......................................................................................11
The Alameda County Safe Drug Disposal Ordinance And Regulations ................................................................12
......• We Will Continue Working To Make This Successful – Supervisor Nat Miley..............................................14
Agency Oversight ........................................................................................................................................................14
Location Of Take-back Sites.......................................................................................................................................15
Take-Back Collection System and Waste Collections..............................................................................................17
Waste Disposal Services.............................................................................................................................................18
......• What Happens To The Medicines That Are Returned – Larry McCarty........................................................18
Results ........................................................................................................................................................................................19
Total Collected Waste .................................................................................................................................................19
......• I Thought It Was A Good Fit For Our Hospital – Christine Graham ..............................................................21
Costs Of Disposal ......................................................................................................................................................22
Educational Outreach ..............................................................................................................................................................22
......• Getting It Out There Is The Next Step – Mike Auer .......................................................................................24
Who Uses The Program ..........................................................................................................................................................24
Characteristics Of Users ............................................................................................................................................25
Number Of Persons Represented By The Returned Medicine ...............................................................................27
Characteristics Of The Collection Data ....................................................................................................................28
Assessment and Recommendations ....................................................................................................................................30
Agency Oversight .......................................................................................................................................................30
Location And Access...................................................................................................................................................31
Costs of Disposal ........................................................................................................................................................32
Educational Outreach .................................................................................................................................................32
Program Users: Socio-Demographics.......................................................................................................................33
......• I Consider It A Success – Liz Jimenez ............................................................................................................34
Next Steps .................................................................................................................................................................................34
......• Nobody Would Have Taken This On At The State Level – Heidi Sanborn ...................................................35
Conclusion .................................................................................................................................................................................36
Appendices
1. Agencies Operating Take-Back Sites .....................................................................................................................37
2. Take-Back Sites With Contact Information .........................................................................................................39
3. Waste Disposal Services Companies ....................................................................................................................42
4. Websites and Promotion ........................................................................................................................................42
5. Alameda County Safe Drug Disposal Ordinance .................................................................................................43
6. Alameda County Safe Drug Disposal Regulations ..............................................................................................60
7. Alameda County Safe Drug Disposal Fee Schedule And Cost Recovery ...........................................................80
8. Survey Questions ....................................................................................................................................................81
3ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
LIST OF TABLES
TABLE 1. Take-Back Sites in Operation...............................................................................................................................12
TABLE 2. Types Of Agencies With Fiscal Oversight ...........................................................................................................14
TABLE 3. Take-Back Site Locations By Type ......................................................................................................................16
TABLE 4. Total Medication Collected: 2009-2013 ..............................................................................................................19
TABLE 5. Total Medication Collected: 2013 .......................................................................................................................20
TABLE 6. Sites With Largest Collection By Weight ..........................................................................................................20
TABLE 7. Sites With Smallest Collection By Weight .........................................................................................................20
TABLE 8. Costs Of Disposal .................................................................................................................................................22
TABLE 9. Age Of Respondent .............................................................................................................................................26
TABLE 10. Gender Of Respondents ......................................................................................................................................26
TABLE 11. Annual Household Income Of Respondents ......................................................................................................26
TABLE 12. Health Insurance Status Of Respondents ..........................................................................................................26
TABLE 13. Number Of Persons Represented By Medicine Returned.................................................................................27
TABLE 14. Number Of Persons in Household Of Respondents ..........................................................................................27
TABLE 15. Percentage Returning Medication For A Deceased Person ..............................................................................28
TABLE 16. Respondents By Site ............................................................................................................................................28
TABLE 17. Zip Codes Represented By Respondents ...........................................................................................................29
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE4
EXECUTIVE SUMMARY
The Alameda County Safe Medication Disposal Initiative was founded in response to a growing need for preventative
strategies that address substance abuse in seniors citizens in 2007. Focus groups, organized by Community Prevention
of Alcohol & Drug Related Program (COMMPRE), revealed that a leading issue is the challenge of the mix of prescrip-
tion drugs and alcohol. A workgroup was established devoted to preventative public health solutions. These entailed
access to safe medication disposal sites and a sustainable funding mechanism. The Safe MEDS Workgroup brought
together over 30 diverse stakeholders to establish and implement program goals. This report summarizes the work
from 2007-2014 on this initiative. Also included are an assessment of the results and recommendations for ongoing
improvement.
In 2009, once the Alameda County Safe Medication Workgroup (Safe MEDS Workgroup) clarified the emergence of
safe medicine disposal as the primary issue, the workgroup then turned to the task of identifying locations for take-
back sites and coordinating a countywide effort. At that time, only 10 sites were operating within the Safe MEDS Work-
group jurisdiction. As of 2014, 31 take-back sites are currently in operation in the county, fiscally overseen by 11 local
agencies. These take-back sites include pharmacies, household hazardous waste centers, medical clinics, hospitals,
senior centers, recycling centers, fire stations, police stations, office buildings, and a public works center. Six medical
waste disposal companies are responsible for collecting the medicines accumulated in the take-back bins and safely
transporting this waste for disposal in approved incinerators.
In terms of total volume of medicines collected and disposed, in 2009 just 473 pounds were reported from one site.
By 2013, the most recent year accounted for, 12,564 pounds were collected and disposed, with an average of 449
pounds per site. Since not all sites report total pounds collected, this average weight per site was used to extrapolate
the total collection weight, 13,919 pounds for the program in 2013. The largest collection sites are the Alameda County
Sheriff’s Station (1100 pounds), Eden Medical Center (1036 pounds), Washington Hospital (960 pounds) and Ted’s
Pharmacy (936 pounds). The sites reporting the smallest weight collected were the City of San Leandro Public Works
(56 lbs) and Medical Arts Pharmacy (169 lbs). Total costs of disposal grew annually as larger accumulations of med-
icine were collected. In 2013, the extrapolated costs of disposal are $27,838, with an average costs per pound of $2.00,
down from $2.51 per pound in 2009.
Educational outreach was assessed through a survey and follow-up phone calls. As more sites opened, program
operators provided consumers with announcements and direct mailing outreach. On-going promotion relies heavily
on website listings with occasional annual notification in newsletters inserted in monthly bills mailed to local residents.
In an effort to assess who is using the program, a voluntary survey was completed by site users. With 62 responses
to the survey received from nine sites, the take-back participants identified by age as this: 20% aged 26 and 40, 40%
aged 41 to 65, and 40% over 65. 65% of respondents were women, 22% male and 13% declined to identify their gen-
der. Household annual income was reported as 28% earned under $30,000; 21% earned income between $31,000
and $50,000; 4% reported earning an annual household income between $51,000 and $70,000; 28% earned between
$71,000 and $105,000; and 19% of users earned an annual income above $105,000. 98% of respondents currently
have health insurance.
5ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
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Another survey result indicated how many persons are represented in relations to the medicine delivered in a single
return. 56% of the respondents were returning medicine for only one person; 27% were returning medicine for two
people; 15% were returning for three persons; and 7% were returning for four or more than four persons. The number
of persons in the household returning medicine was as follows: 24% with a single person household; 29% for two
persons household; 8% have three persons in the household; and 10% have four members in their household. The
percentage of respondents returning for a deceased person was 23%.
Other program deliverables included two educational conference events, one in 2011 and another in 2013. In 2012,
the Alameda County Safe Medicine Disposal Ordinance was adopted by the Alameda County Board of Supervisors,
which became law in May 2014. While a legal challenge is pending in the United States Court of Appeals 9th Circuit,
currently approximately 180 pharmaceutical manufacturers have adopted the newly formed Pharmaceutical Product
Stewardship Work Group (PPSWG) as the agency responsible for working with the Alameda County Environmental
Health Department to create and implement a stewardship plan that complies with the regulatory framework developed
for the Alameda County Safe Medicine Disposal Ordinance.
The overall assessment offers the following of the key insights and recommendations:
Establishing one centralized agency to oversee a countywide program would minimize operational overlap•
and thus improve collection efficiency.
With roughly 51% of the county citizens within close proximity to a take-back site, new sites are necessary•
for residents that lack easy access to take-back sites.
Establishing new sites in larger medical institutions, such as hospitals, would likely provide the most efficient•
and effective results.
Educating pharmacists would likely improve collection rates in pharmacies and educating health executives,•
health professionals in primary care and end-of-life caregivers will likely improve program outcomes.
Centralizing management would simplify the waste collection system and drive cost of disposal down. •
In keeping with on-going transition in national regulatory agencies, including the United States Drug Enforcement
Agency and the United States Environmental Protection Agency, there will likely be modifications to the current design
and implementation of the Alameda County Safe Medicine Disposal Program. Whether the Alameda County Safe
Medicine Disposal Ordinance is upheld or overturned, it is likely that the results of total medicine collected and safely
disposed will continue to climb. While great progress now shows in the fact that roughly 50% of citizens of the county
live in close proximity to a take-back location, continued development of new take-back locations is necessary, to con-
tinue this welcome trend toward increased collection quantities of unused and unwanted household pharmaceutical
waste. Costs of disposal too will likely continue to trend downward.
In summary, overall, the Alameda County Safe Medication Disposal Initiative and the Safe MEDS Workgroup together
have successfully brought about an innovative public health service that continues to remove unwanted medicine
waste from households with the benefit of reducing accumulations of unused medicines in homes throughout the
county. This initiative, program, and ordinance serves as a model for grass-root efforts to further develop public health
policy in other municipalities.
INTRODUCTION
The Alameda County Safe Medication Disposal Initiative involves a diverse group of individuals committed to reducing
prescription drug misuse in seniors and youth by assuring that all citizens have access to a safe disposal system for
unused medicines. Over a period of seven years, the Alameda County Safe Medicine Disposal Workgroup (Safe MEDS
Workgroup) focused on providing a sustainable solution to the challenges of creating safe medication disposal systems
for unused household medicine.
Previously the Bay Area Pollution Prevention Group, a consortium of environmental professionals devoted to keeping
the water of the San Francisco Bay Area free from contamination, had been working to reduce household pharmaceu-
tical waste from entering surface and ground water. As the Safe MEDS Workgroup emerged, it became clear that
public health professionals and policy professionals would need to work together with environmental professionals to
develop a program for educating the public on the need for and the value of creating a functional waste disposal
system for managing household pharmaceutical waste. These different stakeholders came together in this workgroup.
While often considered a single identifiable program in conventional terms, the Alameda County Safe Medication
Disposal Initiative is in reality a loosely knit collection of public, civic and private stakeholders who worked towards
providing a comprehensive service or program. The Safe MEDS Workgroup provided space for agencies and organ-
izations to meet, discuss and coordinate collection efforts. Under the leadership of Supervisor Nat Miley, the Safe
MEDS Workgroup also coordinated the ground activities and advocacy for legislative and public policy that forwarded
the goal of safe medicine disposal. The team has seen over fifty participants, representing over thirty organizations,
come and go over roughly six years of strategic planning, mapping and growing the initiative into a program.
As of May 1st 2014, the Alameda County Safe Drug Disposal Ordinance and the associated Alameda County Environ-
mental Health Department’s regulations have officially come into effect. What this means for the Alameda County
Program is uncertain, but in terms of the initiative, the workgroup’s goals are in place to be continued.
The assumption is that the current program will evolve into a 2nd iteration, in which an independent product stew-
ardship organization working with the Alameda County Environmental Health Department, will manage a more com-
prehensive program throughout the county. This new, non-governmental organization will provide fiscal leadership
and the oversight to operate the program effectively. This should translate into refined program goals, improved growth
rates and target outcomes, as well as the fiscal commitment that supports growing and maintaining the infrastructure
necessary for operations well into the future. Educational outreach will likely also be clarified and updated for greater
effectiveness.
It is within this backdrop that this report is presented. To date there has been little if any assessment of the initiative’s
effectiveness or effect. This was unfortunately not a priority for the Safe MEDS Workgroup and there has not been a
single identifiable person or organization to perform this task. Given the transition, the new organization taking over
this initiative will find this report poignant and helpful in defining how to proceed. Yet there are many other stakehold-
ers who might also find this assessment useful. Alameda County will be the first county in the United States to have
a safe medicine disposal program using a product stewardship model. As a model program, others are paying attention
7ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
to this initiative. Policy advocates in other counties and states throughout the United States will find this report of
value as a measure of change, an assessment of scale (how small the numbers really are compared to how big the
situation really is), and as an evaluation of what could be improved.
Another consideration taken by this report is the reality that without an assessment, there will be little if any way of
knowing how the initiative evolved into policy. To citizens of Alameda, new guidelines for safe medicine disposal simply
turn up as a notice in a utility bill, a link on a website that says “bring back your meds” to the local hospital or
pharmacy nearby, or a sign on a green mailbox that appears in a pharmacy letting one know how to place pills inside.
Should it matter how we got here? Given the continuous challenges in our ability to care for one another and our
environment, this story is just a small episode for the larger changes in public and environmental health policy, but
one that is the beginning of what may turn out to be a change in how we do business in the future. A look at the
history of soda and beer bottle returns, smokefree restaurants and airplanes, and most recently plastic bag bans come
to mind. These changes in human social behavior started in a very small way. This report captures some of this evo-
lution for future use.
What follows in the initiative outline of this report is a brief history of the initiative, a survey of which agencies in fact
operate the programs, an assessment and discussion of the take-back locations, the systems used for collecting
wastes, and finally a discussion of waste disposal services, the regulated system that takes care of the collected waste
once picked up from the take-back bin.
The next section is the research section, which reviews the overall results of waste collection over the five years this
data has been collected, including pounds collected and costs of disposal. A brief review of educational outreach is
followed by the results of a survey of users of the program completed this past February through April of 2014 at nine
take-back sites.
The report continues with an assessment of program results with recommendations about lessons learned. A section
on next steps offers a very current update on what is emerging. While this document is in no way comprehensive, it
is the author’s intention to provide relevant data for a variety of stakeholders that have worked tirelessly to support
and see the project through its entirety.
This report does not contain the evidence for the need and reason for drug disposal systems pertaining to unwanted
household drugs. Over the seven years of the Safe Medication Disposal Initiative, countless hours have been devoted
to revealing the evidence for the public health and environmental challenges of unwanted medicine. Briefly, the
evidence suggests that a) the elderly and the very young are at risk for accidental poisoning due to significant
accumulations of medications in home and improper or careless disposal of prescription drugs; b) groundwater and
drinking water are currently contaminated with very low concentrations of pharmaceuticals; c) teenagers are at
increased risk of prescription drug abuse. With these in mind, providing a safe, reliable, cost-effective means for re-
ducing the accumulation of unused and unwanted medications became the focus of the work reviewed in this report.
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE8
9ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
INITIATIVE OUTLINE
History
Beginning in 2007 with funding from the Alameda County Behavioral Health Care, the Community Prevention of
Alcohol & Drug Related Program (COMMPRE) operated by Horizon Services, Inc. initiated focus groups in an effort to
identify essential substance abuse issues for older adults. These focus groups identified alcohol and prescription
drugs as the most pressing issue, and the challenges of mixing the two were surprisingly significant for seniors.
Emerging from these focus groups was the initiation of a workgroup devoted to appraising and implementing policy
in response to the growing need for public health programs addressing prescription drug issues for seniors. Under
the direction of Linda Pratt of COMMPRE, workgroup meetings began with the goal of bringing together a diverse
group of stakeholders to tackle this problem.
BRINGING DIVERSE STAKEHOLDERS TOGETHER
Linda Pratt
Alameda County Safe Medicine Disposal Workgroup Facilitator
“I’ve been really heavily involved in coalition work over the last 10 years and established two drug-
free community coalitions, the only ones in Alameda County. Both of them are based on the method-
ology of having a minimum of 12 diverse sectors in the coalition. So that’s what is so exciting about
this coalition, because, as a preventionist, I’ve never worked next to waste collection, water people,
and waste management. They have really different perspectives — and they’re not used to partnering
with us. So I think it’s a really effective way of moving community change efforts.
“You just never know what is going to resonate or be important to emphasize when you’re working
with legislators. I think for a while we got away from drug prevention and got more into the environ-
mental effects. But now we’ve come back more to the science around the drug and alcohol connec-
tion. That’s why it’s so important to support each other. We’re much more powerful together than
on our own. When we started doing the Safe Medication Disposal Initiative, we had to bring in
Alameda County Household Hazardous Waste, Teleosis Institute, the sanitary districts, and all these
other new partners, in order to fulfill that implementation strategy. I see this as an implementation
strategy leading to policy.”
Over the course of five years, at least 30 different organizations and agencies participated in the Safe Meds Workgroup.
They include: Castro Valley Community Action Network, United Seniors of Alameda County & Oakland, Alameda
County Hazardous Waste, Cherryland Community Association, Davis Street Family Resources Center, County Counsel,
Senior Injury Prevention Partnership, Lifelong Medical Care, Teleosis Institute, Alameda County Public Health, County
Hepatitis B Free Campaign, Union Sanitary District, Eden Hospital, East Bay Municipal Utility District, California Prod-
uct Stewardship Council, Alameda County Environmental Health, Supervisor Nat Miley’s office, and Supervisor Alice
Bitker’s Office. This group, which eventually took the title Alameda County Safe Medication Disposal Workgroup, con-
tinues to meet monthly, hosted by Supervisor Nat Miley. He first became aware of the problem by participating in one
of the initial focus groups in 2007.
With health promotion and policy as the emphasis of the group, assembling interested parties around prescription
drug removal became center stage. Professionals working with seniors in the public health sector felt that the misuse
and abuse of prescription drugs was a significant problem and that seniors were becoming ‘accidental addicts.’ The
workgroup found that drug disposal, or rather the lack of the ability to dispose of medicine, posed a significant barrier
to the reduction of the accumulation for these potentially harmful substances. Seniors in the United States are typically
taking over seven different medications daily. The average 75-year-old will receive 15 prescriptions annually, assuring
that it is common for seniors to have prescription and over-the-counter (OTC) drugs piling up in their homes. The
workgroup felt that securing a method for safe and accessible disposal was a necessary and achievable first step
towards mitigating the problem.
Safe medication disposal was not new to the San Francisco Bay Area. The Bay Area Pollution Prevention Group had
identified the issue as early as 2003, hosting take-back events successfully in 20061. These initial programs were
event-based, a cadre of staff, including a pharmacist, a police officer, and other staffers would set up a booth for a day
to make collections. From these events it became clearer that ongoing take-back sites would be more efficient and
more effective. Such permanent take-back sites were already in operation throughout the San Francisco Bay Area in
Palo Alto and San Mateo County. On-going take-back programs are far more cost-effective to operate. Household Haz-
ardous Waste facilities typically have been taking back unused or unwanted medications for years at a very low cost.
In 2007, the Teleosis Institute initiated the Green Pharmacy Program2, which set up 12 ongoing take-back sites in
pharmacies in San Francisco, Berkeley and other locations in the Bay Area. The Green Pharmacy Program collected
over 4,500 pounds of unwanted medicines over a period of 18 months. In 2009, the Alameda County Safe Medicine
Disposal Workgroup contracted Teleosis Institute to identify and initiate five new permanent take-back sites in un-
incorporated Alameda County. As part of this work agreement, Teleosis was to develop a plan for sustained funding
for such endeavors. Throughout the region, all take-back programs were essentially funded by local municipal
agencies, with the exception of sites operated in hospital pharmacies and the occasional independent sites funded
by non-profit philanthropic donations.
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE1 0
1 Report on the San Francisco Bay Area’s Safe Medicine Disposal Days, Bay Area Pollution Prevention Group, (2006)
http://c.ymcdn.com/sites/www.productstewardship.us/resource/resmgr/imported/SFBAYSafeMeds_Report_August2006.pdf
2 Green Pharmacy Preliminary Data Report,Teleosis Institute (2009) www.Teleosis.org
1 1ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
TAKE-BACK EVENTS OR TAKE-BACK SITES
Bill Pollock
Program Manager of the Alameda County Household Hazardous Waste Program,
a program run by Alameda County Environmental Health.
“One of the emerging developments in household hazardous waste is classes of wastes like batteries
and fluorescents which everybody has. But having three or four household hazardous waste facilities
isn’t a very convenient way of getting rid of it; having to get in your car and travel a couple of miles
to drop this stuff off isn’t very convenient. So for all those types of waste streams that are universal
in nature, and distributed at places like drugstores or hardware stores, we’re looking for ways of dis-
tributing the collection mechanism. We have a number of sites for batteries and lamps around
Alameda County in hardware stores, and we are looking at the same idea in some ways for pharma-
ceuticals.
“I first got involved in setting up sites when Supervisor Alice Lai-Bitker in 2008 asked us for help in
doing a pharmaceutical take-back at a local community clean-up in San Lorenzo. It was a one-day
event. And after that, word got around. I was invited to start attending the medication disposal ini-
tiative meetings about that time. So we did a couple of events for Supervisor Lai-Bitker, and we did
about 12 or 13 more for others, often with Supervisor Miley on the Medication Disposal Initiative.
We tried different kinds of events. Some occurred on DEA co-sponsored national medication collec-
tion days. Linda Pratt and I did an experiment of a rolling take-back, where we went to several senior
citizen developments, not nursing homes but just residences that were overwhelming inhabited by
senior citizens. We scheduled an hour at each facility. We pulled up with a policemen in tow. We’d
collect some drugs. We’d sort them out. The cops would recover the controlled substances, and we
would gather the other stuff.
“We were experimenting with those events. The one-day events were pretty labor-intensive, and for
some we didn’t get many drugs or people coming by. Supervisor Miley actually staffed some of
these too and suggested that this was silly. The best way was permanent sites. So that’s when we
at the Medication Disposal Initiative started identifying sources of funding, recruiting potential sites,
and potential long-term financial sponsors, for those sites in the Central County area.”
As of 2009, when the workgroup began to collect data on take-back sites, there were 10 take-back sites operating in
the county. Due to the diversity of program sponsors as well as take-back locations, data on the number of sites in
the county at that time was inconsistent. It is more accurate to say that in 2009, when the Safe MEDS Workgroup
began collecting data on the 10 sites, remaining independent sites were not reported. Figure 1 shows the number of
sites operating in the county by year since 2009.
TABLE 1
Take-Back Sites In Operation Total
2009 10*
2010 18
2011 27
2012 29 (30)**
2013 31 (32)**
* Other sites in operation at that time were not part of this program.
By 2010, all sites within the county were reporting to the Safe Meds Workgroup.
** One site operated by East Bay Municipal Utility district is in Contra Costa County.
The Alameda County Safe Medicine Disposal Ordinance and Regulations
As the number of sites increased rapidly between 2009 and 2011, the workgroup began the necessary steps to initiate
public policy that would provide improved program outcomes and for a sustainable funding mechanism.
One method for funding programs for non-hazardous or emerging contaminants is product stewardship or extended
producer responsibility (EPR). EPR considers the manufacturer of a product responsible for the entire life-cycle of
the product, including take-back and final disposal. EPR is used in many programs worldwide. In particular, it is the
method used for safe medication disposal programs operating in much of Canada.
With the help of Heidi Sanborn of the California Product Stewardship Council, Joel Kreisberg (author) of Teleosis
Institute, Bill Pollock of Alameda County Household Hazardous Waste, Ariu Levi of Alameda County Environmental
Health and Robert Reiter, Deputy County Council for Alameda County, a proposed ordinance was drafted which became
titled the Alameda County Safe Medicine Disposal Ordinance. The model used to develop this legislation was intro-
duced in San Francisco in 2010 by Supervisor Ross Mirkarimi. This model, The Safe Drug Disposal Ordinance, was
not approved by the San Francisco Board of Supervisors. Instead, a pilot program was funded by pharmaceutical
manufacturers with a contribution of $110,000. The initial results of this program were published in 2013.3
The Alameda County ordinance was first introduced for approval to the Alameda County Board of Supervisors in
February 2012. The Board of Supervisors, while supportive of the bill, was concerned that the ordinance appeared to
have been developed without enough participation of the pharmaceutical producers and several other related stake-
holders. They requested a series of four stakeholder meetings. These meeting would serve as a means of informing
and engaging all stakeholders as to the nature of the legislation and provide a forum for gathering feedback in an
effort to reach a broad consensus among interested parties. These meetings were successfully held in April through
June of 2012, at which time a revised ordinance was brought back to the Board of Supervisors.
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE1 2
3 Kreisberg, J, San Francisco Medicine Waste Characterization Study,(2013), Teleosis Institute.
www.teleosis.org/wp-content/uploads/2012/02/San-Francisco-Medicine-Waste-Charaterization-Study.pdf
The Alameda County Safe Drug Disposal Ordinance was passed unanimously in July 2012. This landmark legislation
was the first legislation passed in the United States that regulates household pharmaceutical wastes, and the first
extended-producer-responsibility modeled ordinance passed into law by a county in the United States for any product.
In June 2013, the King County Board of Health passed a similarly modeled ordinance for household pharmaceuticals.
The Alameda County Safe Drug Disposal Ordinance, passed on July 24th, by the Alameda County Board of Supervisors,
amends the Alameda County Ordinance Code by adding Chapter 6.53, sections 6.53.010 through 6.53.120 which:
“require any person who produces a drug offered for sale in Alameda County to participate in an approved drug stew-
ardship program for the collection and disposal of unwanted drugs from residential sources, provide for implementa-
tion, enforcement, fees and penalties; and make environmental findings.” (The complete ordinance can be found in
Appendix VI.)
In December 2012, a group of three trade organizations, the Pharmaceutical Research and Manufacturers of America
(“PhRMA”), the Biotechnology Industry Organization (“BIO”), and the Generic Pharmaceutical Association (“GPhA”),
challenged the ordinance in U.S. District Court for the Northern District of California, seeking to block the implemen-
tation of the ordinance. The trade groups declared that the ordinance violated the Commerce Clause of the U.S. Con-
stitution and violates 42 U.S.C. § 1983, for three distinct reasons. They asserted that it directly regulates and burdens
interstate commerce and its primary purpose by shifting the costs of a local regulatory program onto interstate com-
merce and out-of-state consumers; that it discriminates against interstate commerce by targeting interstate commerce
and products delivered from outside the county; and that it favors local interests by deliberately shifting costs away
from local consumers and taxpayers and onto drug manufacturers and pharmaceutical consumers nationwide.
The court did not find in favor of the trade organizations; an appeal has been filed in the United States Court of
Appeals, Ninth Circuit, Northern District of California.
On February 26th 2013, the Alameda County Board of Supervisors approved the necessary regulations developed by
the Alameda County Environmental Health Department. The Alameda County Safe Drug Disposal Regulations are
available at www.acgov.org/aceh/safedisposal/index.htm (Appendix VII.) The regulations provide all the necessary
rules for parties subject to the ordinance to meet the requirements of the ordinance. This includes the definition of
producers, the process for petitioning for an exemption, the submission of a product stewardship plan, the plan eval-
uation, the ability to petition for an alternative method of disposal, the review and approval of plan, the appeal process,
the creation of annual reports, and the plan renewal and fee schedule (Appendix VIII). In May of 2014, the initial date
of compliance with the ordinance went into effect.
Currently, a third party stewardship plan is in development in consultation with the Alameda County Environmental
Health Department. The Pharmaceutical Product Stewardship Work Group (PPSWG) is working with producers to
meet the requirements of the regulations. As of June 1st, 2014, approximately 180 producers have filed a notice with
the Environmental Health Department in an effort to comply with the regulations. The Environmental Health
Department is currently working with PPSWG in a effort to support the development of a plan that meets the require-
ments of the ordinance and regulations.
1 3ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
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WE WILL CONTINUE WORKING TO MAKE THIS SUCCESSFUL
Supervisor Nat Miley
Alameda County District Four
“It was one of the more challenging processes I’ve had to undertake. With alcohol it was mainly re-
tailers, locally or statewide; with tobacco, people had a visceral reaction wanting to see reforms.
The restaurant industry had to recognize that regulation wasn’t going to hurt business. But with
pharmaceuticals, it seemed like a national issue. I was surprised by the pharmaceutical industry
sticking to their position. They said they were not prepared to absorb the cost, and they didn’t see
making it an act of goodwill. It was surprising that they didn’t want to come up with a reasonable
accommodation. We will continue to work with a product stewardship organization to try to showcase
them as a model. We want to make this successful. If we have an ordinance and a model program,
then it can be duplicated anywhere.”
Agency Oversight
Contrary to the image of a unified program, the disposal services of the current Alameda County Safe Medication
Disposal Initiative is really a collection of 11 different fiscal organizations operating 31* take-back sites throughout the
county. Reviewing the list in Table 2 reveals the diversity of stakeholders operating take-back sites, including local
governments, water and wastewater utilities, hospitals, law enforcement and a non-profit. There is as of yet little
correlation between the great number of sites operating and the size and scope of the agencies.
TABLE 2
Types Of Agencies With Fiscal Oversight
Agencies Operating Programs Organizations # of Sites
Local Government 4 9 sites
Hospital 2 3 sites
Public Wastewater Utility 2 8 sites
Public Water Utility 1 10* sites
Law Enforcement 1 1 site
Non Profit NGO 1 1 site
Total 11 31 (32)* Sites
*EBMUD operates one site in Contra Costa included in this report.
1 5ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
The eleven organizations fiscally operating the 31 take-back sites are:
• Alameda County Sheriff’s Department
• Alameda County Waste Management Authority
• City of Fremont
• City of Hayward
• City of San Leandro
• East Bay Municipal Utility District (EBMUD)
• Oro Loma Sanitary District
• Sutter Health/Eden Hospital (Funded by Castro Valley Sanitary District)
• Sutter Health/Alta Bates Summit Medical Center
• Teleosis Foundation
• Union Sanitary District
Location of Take-Back Sites
With a county population of just over 1.5 million people, 31 take-back sites in the program might seem to provide
ample opportunities for citizens to have access to this public health service.
Using zip codes for planning distribution, accessibility of take-back site locations was evaluated. Alameda County has
49 distinct zip codes, with representative populations per zip code ranging from 715 persons for the smallest postal
zone, all the way up to 94,606 persons. The 31 sites in the county, when mapped by zip code covers 40% of the county
(20 zip codes). In terms of population, these 20 zip codes cover slightly more then half of the population of the county
(798,000).
Simply put, half the population of Alameda does not live in close proximity to a take-back site. The most obvious
example of this is the Tri-Valley region in the eastern part of the county, consisting of the towns of Dublin, Livermore
and Pleasanton. For this region of 170,000 persons, the closest take-back site is Eden Medical Center in Castro Valley.
Eden Medical Center is 10 miles from Dublin and 20 miles from Livermore.
Another approach is to consider take-back sites by types of host establishment. The county program offers take-back
bins in 11 different types of businesses ranging from pharmacies, the most likely location for a take-back location, to
household hazardous waste centers, medical clinics and hospitals. All of these host locations are either point of sales
locations for medicines, healthcare establishments or committed waste disposal locations. There are also take-back
bins inside the atriums of office buildings, senior centers, firehouses and police stations. Certainly these sites can
serve as locations for take-back bins. Alameda County Sheriff’s Station in San Leandro is the only site in the Alameda
County that accepts controlled substances. This site is quite successful. These other locations are less common places
for medications to be returned to. The data presented further in this report suggests that hospitals, pharmacies and
law enforcement are the most effective location given the passive nature of current program promotion (Table 7 and
8). Figure 3 provides the summary of existent take–back locations in the program.
TABLE 3
Take-Back Site Location By Type Number of Sites
Pharmacy 8
• Alta Bates Milvia Outpatient Pharmacy
• Alta Bates Peralta Outpatient Pharmacy
• Haller’s Pharmacy and Medical Supply
• Haller’s Pharmacy Newark
• Medical Arts Pharmacy
• Sal’s Pharmacy
• Ted’s Drugs
• United Pharmacy
Household Hazardous Waste (HHW) Center 4
• Alameda County HHW Drop-off Site - Freemont
• Alameda County HHW Drop-off Site - Hayward
• Alameda County HHW Drop-Off Site - Livermore
• Alameda County HHW Drop-Off Site - Oakland
Medical Clinic 4
• Davis Street Clinic
• Washington Township Medical Group
• Washington Township Medical Group at Nakamura Clinic
• Washington Township Medical Group at Warm Springs
Hospital 3
• Eden Medical Center
• Washington Hospital Community Health Resource Library
• Washington Hospital Main Lobby
Senior Center 3
• Albany Senior Center
• City of San Leandro Senior Center
• Emeryville Senior Center
Recycling Center 2 (3)*
• Berkeley Transfer Station #3
• Fremont Recycling and Transfer Station
• El Cerrito Recycling Center (in Contra Costa) *
Fire Station 2
• Oakland Fire Station #3
• Oakland Fire Station #20
Law Enforcement 2
• Alameda County Sheriff’s Office
• City of Alameda Police Department
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE1 6
TABLE 3
Take-Back Site Location By Type Number of Sites
Government Office 1
• California State Building
Public Utilities Administration Building 1
• East Bay Municipal Utilities District
Public Works Center 1
• City of San Leandro Public Works
Total Number Of Take-Back Sites 31 (32)*
Take-Back Collection Systems And Waste Collection
In December 2010, CalRecycle, the state agency responsible for managing environmental waste, published guidelines
for model take-back programs. These guidelines can be found at http://www.calrecycle.ca.gov/publications/
Documents/1370%5C20110080.pdf
Since many of the sites opened up after 2010, very few take-back sites are not following these state guidelines. The
lock-boxes are likely the two-key security systems, which maintain one key in possession at the take-back site and the
second key with the medical waste hauler. Other sites still operate with a single key security system kept at the location
by a program manager, which allows for more flexibility if bins overfill, but does not provide the security of the two
key system.
1 7ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Typical Take-back Bins
Waste Disposal Services
The collection bins are serviced by licensed medical waste disposal contractors. These waste disposal companies
range in size and scale from regional medical waste disposal companies such as Barnett Medical Services and Sharps
Solutions, to large national companies such as Clean Harbors, which offer services beyond medical and sharps
disposal. The list of companies contracting in Alameda County includes:
• Barnett Medical Services
• Clean Harbors
• Covanta
• Guarantee Returns
• North State Environmental
• Sharps Solutions
***The complete listing of waste disposal companies is available in Appendix III.
WHAT HAPPENS TO MEDICINES THAT ARE RETURNED
Larry McCarty
Owner of Sharps Solutions in Hayward California
“In the kiosk themselves, we use a reusable container. When the driver arrives, he pulls the reusable
out. He ties off the bag and seals it. We put a tight-fitting lid on it. That material is taken to a transfer
station the same evening, when the driver comes back in. Two or three o’clock the next morning,
it’s then taken on to a main consolidation point, which happens to be in our case, Fresno. All of the
pharmaceutical waste, because it is incinerable, is now taken by rail to Curtis Bay, Maryland for high
heat energy efficient waste-to-energy incineration mill. So it’s high heat, cold chamber, all the stages
up to 2,200 degrees, and it’s basically reduced to 1 percent carbonized ash. Once that ash is done,
it’s then put into a permitted medical waste landfill.
“We used to go almost always directly to Anahuac, Texas, to the waste management incineration
facility there. We have found that the cost was less expensive for us to ship by rail; we had railroad
ties and capabilities directly outside our facility in Fresno. Waste-to-energy incinerator is also
extremely efficient. So we’re much happier with the impact that it has on the environment.”
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE1 8
RESULTS
Total Collected Waste
When considering the effectiveness of the program, there are many data points of value. To date, given the lack of a
single fiscal agency responsible for the program, it has been difficult to keep track of results. For example, for total
weight of medicines returned and destroyed, not all the sites keep track of this data. This may seem like an oversight,
however for the Alameda Household Hazardous Waste sites, household medications are such a small waste stream
that in their facilities these wastes are commingled with other hazardous waste for disposal. Table 4 provides a sum-
mary of the total weight of collected and incinerated pharmaceutical waste disposed of by the sites reporting.
TABLE 4
Total Medication Collected and Disposed 2009-2013 (lbs) # sites reporting Total Sites
2009 473 lbs 1*10**
2010 2,915 lbs 9*18
2011 5,317 lbs 18 27
2012 9,702 lbs 27 29 (30)
2013 12,564 lbs 27 31 (32)
* mostly event based collection
** other sites were in operation at that time but were not part of this program and all have since
ceased operations.
More complete data is available for the most recent year 2013. Table 5 presents current results. Given the economy
of scale as well as on-going improvements in program operations and oversight, 2013’s results provide data enough
to calculate the average weight annually of returned per site. This is an average of 449 pounds per take-back location.
Using this figure to extrapolate the total drugs collected for all 31 sites in the program, the total waste collected for
2013 is estimated as 13,919 lbs.
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TABLE 5
Total Medication Collected and Disposed of in 2013
Total Sites Reporting Weights 27
Percentage of Sites Reporting 84%
Total Pounds of Medicines Disposed in 2013 12,564 lbs
Average Pounds Per Site 449 lbs
Calculated Total Medication Disposed (449 bs * 31 sites)13,919 lbs
The results provided by site supervisors allow for some assessment of the effectiveness of individual take-back sites.
Table 6 provides results for locations with the largest collections this past year. The sites with the largest collection of
medication waste include the sheriff’s station, two hospitals and a pharmacy. The smallest take back site in the county
are the City of San Leandro Public Works and Medical Arts Pharmacy (Table 7). The results for the smallest sites are
limited due to the fact that not all the agencies report waste collected by site.
TABLE 6
Sites with Largest Collection By Weight
Alameda County Sheriff’s Station 1,100 lbs
Eden Medical Center 1,036 lbs
Washington Hospital 960 lbs
Ted’s Pharmacy 936 lbs
TABLE 7
Sites with Smallest Collection By Weight
City of San Leandro Public Works 56 lbs
Medical Arts Pharmacy 169 lbs
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I THOUGHT IT WAS A GOOD FIT FOR OUR HOSPITAL
Christine Graham
Injury Prevention Specialist at Eden Medical Center for Trauma Services
“I was the one who brought the idea to the hospital. I went right to our CEO because I thought it
was an important service to provide the community and important for the environment. And I also
thought it tied well with my injury prevention efforts, especially with teenagers. Looking at some of
our trauma data, it was kind of surprising how the statistics showed that we had a high percentage
of motor vehicle crashes and people coming in under the influence of drugs and alcohol. So I thought
it was a good fit for our hospital.
“I think the key piece was going to the right person and getting the permission from the top, and
having buy-in from administration. Then there were smaller pieces. You had to work with engineering
to fit into the hospital and to make sure it was at a site that was secure through observation by
security without asking too much of staff. It was a really good fit for our emergency department.
I’ve never had any negative comments about our bin. No one’s ever complained. And that bin is full
every two weeks.
“I think it’s a perfect fit because we have security there. We’re open 24/7, and so you don’t run any
security risks that you might have if you’re not open 24/7. It was a challenge to get the bin in the
new hospital, but we got it done, and it’s there up and running and busy. So it’s worked out well in
our emergency waiting room.”
The following is a list of the sites that were not included in the overall weights collected in the program. All of these
sites offer services far beyond the return of unused medicine. As mentioned previously, at these locations, pharma-
ceutical waste is regarded as a small percentage for the overall waste returned.
• Alameda County HHW Drop-off Site - Fremont
• Alameda County HHW Drop-off Site - Hayward
• Alameda County HHW Drop-off Site - Livermore
• Alameda County HHW Drop-off Site - Oakland
• Fremont Recycling & Transfer Station
Costs of Disposal
Collecting the results for assessing costs of disposal has been inconsistent. Initially, costs were not well reported.
Sites with little waste might have the contents of their bins combined with other sites during pick-up. For the purposes
of this report, the data is more reliable as of 2011, due to the small data sample for previously reported costs (see
Table 8). In 2012, costs were considerably lower than in 2013. There is no obvious explanation for this. The trend
downward in general is consistent with the tendency for the economy of scale to bring the cost of disposal down as
larger quantities are collected and managed. This data does not take into consideration variations in the fees charged
by the medical waste disposal companies. Rather, it reflects the total cost of disposal averaged across all sites. Given
the fact that six companies are contracted for this services, costs of disposal can vary considerably. Using the average
cost per pound based on actual disposal in 2013, the extrapolated cost of the full 13,939 pounds for Alameda County
is $27,838.
TABLE 8
Costs of Disposal: (sites reporting) Costs Average
2009 (1) *$1,186 $2.51
2010 (1) *$4,650 $2.64
2011 (15)$8,487 $2.40
2012 (22)$13,752 $1.70
2013 (24)$21,956 $2.00
Extrapolated Total Costs of Disposal (13,919 X $2.00) $27,838
EDUCATIONAL OUTREACH
Currently little if any direct active consumer education is
occurring among the various agencies operating program.
For the 11 agencies polled, most are providing information
to consumers primarily on their websites. These websites
have a brief description of the purpose for proper medica-
tion disposal, plus information as to the location and hours
of operation for local take back sites.
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE2 2
Alameda County Household Hazardous Waste offers a direct call hotline providing consumers with information about
disposal of various hazardous wastes ((877) STOPWASTE). According to Bill Pollock, program manager for Alameda
HHW program, pharmaceutical waste disposal is a frequent inquiry by callers.
The Safe MEDS Workgroup keeps its website current plus a Facebook page and Twitter feed. Links are found in
Appendix IV. The website has a total daily reach of 29 persons per day. The Facebook page is loaded with new content
about once a week. Currently there are 192 likes, and the twitter feed has 106 followers, which reflects a limited
engagement.
During the initial phase of take-back site development, all of the agencies developed press release material, and pro-
vided detailed information in newsletters or direct mailings to inform community members. East Bay Municipal Utility
District has been the most active. It has been participating in take-back events since before the Safe Meds Workgroup
began. Event-based take-back programs rely heavily on consumer information and promotion. EBMUD uses a bi-
monthly newsletter that is enclosed and mailed with paper bills. The September-October 2013 featured a full page
summary of the program for the 8 sites operated by EBMUD.
2 3ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
This type of promotion has been utilized by many of the agencies operating the program.
GETTING IT OUT THERE TO MORE PEOPLE IS THE NEXT STEP
Mike Auer
Environmental Outreach Coordinator, Union Sanitary District
“I think that getting it out there to more people is the next step. There are always people who don’t
know about the program at our events. We have these locations and this is the practice that we
want people to take, using these disposal sites, rather than throwing drugs down the drain. We just
want to get more people using the disposal sites, because we feel that’s the best method to keep it
out of the waste stream.
“In terms of the running the programs, once we got them set up and got everything dialed in, it’s
been very little maintenance to keep them running.”
Currently no take-back program in the county effectively collects data on how many people are using the program.
Measuring effectiveness of the educational outreach beyond the annual assessment of weight of medications returned
provides the only means of assessment, a rather vague measure. Costs of current efforts are minimal in terms of
expense of staff time, given that so little active educational promotion is occurring. Most, if not all of these costs, are
subsumed in more general programmatic staff budgets.
WHO USES THE PROGRAM
The Safe MEDS Workgroup has focused primarily on improving access to take-back sites and creating a sustainable
funding system for this service. Less attention has been placed on the understanding program users and the motiva-
tions for participation. This information is not easy to obtain, as it has much to do with sociological behaviors and
ethical beliefs. The sociological attributes of program users—such as age, gender, household annual income, and place
of residence—appeal to a certain type of research. This contrasts the research methodology required to better under-
stand motivations and ethics, which may include concern for safety, concern for the environment or a personal expe-
rience with trauma through a loved one misusing pills. Given limitations in time and funding, the focus of the research
is on the sociological perspectives—who uses the program.
Little research has been published on the demographics of individuals returning medicine using currently available
take-back systems in the United States. The only study to date is a report by Owens and Anand4, in which 445 residents
were contacted by phone in an effort to identify their age, race, household income distribution and attitudes about
drug disposal. In the case of the current initiative in Alameda County, short of stationing a person at several sites to
collect data directly, which was prohibitively costly, data was collected using a written survey on location set in a
visibly convenient place on the take-back bin at nine of the 31 sites. Site representatives were instructed to encourage
participation in the survey, but responses from users were voluntary.
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE2 4
4 Owens, L & Anand, S (2009) Medication Disposal Survey, University of Illinois at Chicago, Survey Research Lab.
The nine sites were selected in an effort to be most representative of the broad variation of populations the initiative
reaches, as well as to allow for variations due to type of take-back sites (police station versus pharmacy, for example).
Given the voluntary nature of the collection systems, the most significant responses were collected at two pharmacies,
Ted’s Pharmacy and Sal’s Pharmacy in Berkeley. The reason is that at each of these locations the pharmacists are
highly committed to take-back services. Monta Patel at Ted’s Pharmacy in Hayward and Sal Nasser at Sal’s Pharmacy
in Berkeley encouraged participation in the survey. The other seven sites, without much encouragement, only returned
a small number of samples. The total number of responses collected over a three month period was 62.
Considering the voluntary nature of the survey, the questions were deliberately designed to be simple and easy to
complete. The survey was limited to one page with mostly multiple choice answers. The complete survey can be found
in Appendix IX. Discussion and analysis of survey responses are found in the Assessment and Recommendations
section.
Characteristics of Users
In terms of age of users, an approximately equal portion of persons 41 to 65 and persons over 65 was identified as
using the program. These two age groups were represented twice as often as the number of users between 26 and 40
years old. There were no respondents under the age of 26. This data is presented in Table 9. The survey reveals that
three times as many women use the program over men. This is reported in Table 10.
In terms of the household annual income, reported in Table 11, the program is used by citizens across the spectrum
of income levels. Of note, persons living close to or below the poverty line are well represented in the survey results,
with 28% of the respondents, the same percentage of users in the income level $71,000 to $105,000. Most of the
respondents have health insurance, with only 2% being uninsured, which is far below the national average of uninsured.
This data is presented in Table 12.
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Emergency Department take-back bin at Eden Medical Center.
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TABLE 9
Age Of Respondent
Below 26 0
26-40 20%
41-65 40%
Over 65 40%
TABLE 10
Gender Of Respondents
Female 65%
Male 22%
Declined to state 13%
TABLE 11
Annual Household Income Of Respondents
Under $30,000 28%
$31,000-$50,000 21%
$51,000-70,000 4%
$71,000-105,000 28%
$105,000 and above 19%
Number of persons declining to disclose household income 8
TABLE 12
Health Insurance Status Of Respondents
Currently has health Insurance 98%
Currently does not have health insurance 2%
Number of Persons Represented by the Returned Medicines
A question that continues to puzzle administrators and researchers of take-back systems has to do with this simple
issue: when a person brings medicine back to a take-back site, the medicine they bring may be just their own, or it
may come from a group such as a family. Assuming that one person bringing drugs back is bringing medicine for
only one person might be easy but it is inaccurate. Table 13 offers the responses to the question “How many people
are you returning these medicines for?” Fifty-six percent of the respondents reported returning their own medications.
Forty-four percent of the respondents were returning medication for more than just themselves. Table 14 offers the
results of the follow-up question which asks how many persons are in respondents household. While Table 13 and
Table 14 are not directly correlated, half the respondents were returning medicine of their own, however, only 24% of
the respondents live alone. While no conclusions can be made from this data, it does confirm the challenge of calcu-
lating how much medicine an individual disposes.
For deceased persons, someone else brings medicine to the take-back site. Table 16 reveals these results. Twenty-
three percent of the respondents completing the survey were returning medications for a deceased person. This is a
significant greater than the number mortality rate in Alameda County. This result suggests significant value for service
providers working in end-of-life situations.
TABLE 13
Number Of Persons Represented By The Returned Medicines
1 56%
2 27%
3 15%
4 4%
More than 4 3%
TABLE 14
Number Of Persons in Household Of Respondents
1 24%
2 39%
3 8%
4 10%
5 5%
6 6%
8 2%
Declined to respond 2 persons
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TABLE 15
Percentage Returning Medications For A Deceased Person 23%
Characteristics Of The Collection Data
Over 70% of the data collected was from the two independent pharmacies, Ted’s Pharmacy in Hayward and Sal’s
Pharmacy in Berkeley. As previously discussed, this seemed to be a function of two committed pharmacists that pro-
moted the survey in a manner similar to the way they promote their program. Table 16 shows the number of surveys
collected from the nine sites. Table 17 presents the distribution of the surveys by zip code, which was the only geo-
graphic data collected. With data so overly weighted to these two locations however, one would assume that the data
results skew towards representing disproportionately more affluent populations.
TABLE 16
Respondents By Site
Sal’s Pharmacy 39%
Ted’s Pharmacy 32%
Davis Street Clinic 6%
Eden Hospital 4%
United Pharmacy 3%
Alameda County Sheriff 3%
Medical Arts Pharmacy 3%
San Leandro Senior Center 3%
Haller’s Pharmacy 2%
TABLE 17
Zip Codes Represented By The Respondents
Zip Code Number Of Respondents
94707 9
94545 6
94577 4
94579 4
94708 4
94544 3
94546 3
94578 3
94702 3
94706 3
94541 2
94542 2
94580 2
94805 2
94520 1
94530 1
94547 1
94549 1
94560 1
94583 1
94587 1
94602 1
94608 1
94618 1
94705 1
94804 1
Total number of zip codes represented 26
2 9ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
ASSESSMENT AND RECOMMENDATIONS
The Safe MEDS Workgroup is a collection of people representing public agencies and private organizations that provide
the guidance for developing a service to address an emerging public health threat by a potential contaminant. Given
the structure of the initiative and this workgroup, what outcomes are expected and what is the best measure of these
outcomes? Is “success” defined as reducing the ongoing growing stock of unused pharmaceuticals in households?
Yes, but how do we measure that? Is success providing improved access for more vulnerable populations? Yes. Does
success include a more cost-effective program? Yes.
An alternative method of measuring success would be to consider the five years reviewed here as the first of a sev-
eral-step developmental process in public health policy. This step involved birthing a methodology for collecting a po-
tential source of harm and initiating public policy for seeing it happen in an organized manner. This process included
a free market organization of services with the overall aim of providing an increasingly useful service at a cost that
could be absorbed by the larger system without unnecessary burden. The initiation and development of public policy
that facilitates the growth of the service as an effective method to improve program goals and outcomes followed. In
this regard, the Alameda County Safe Medicine Disposal Initiative is successful in meeting its intended goals.
We do, however, live in an age of information. Information that we collect and use to measure progress towards a good
and just society. In this regard, there is often a mix-up between outcomes and outputs. Outcomes in this instance
would be less teenage prescription drug abuse, less accidental poisonings of children under six and lower concentra-
tions of pharmaceuticals in the water to name a few. Outputs, far easier and cheaper to measure, include number of
sites available for take-back, number of pounds collected and safely incinerated, and cost efficiencies improving. We
can usually feel good about achieving our goals in terms of program outputs but we have to accept that program out-
comes are harder to measure and even harder to attain, with multi-factorial causes. Program outputs are what is most
often celebrated as success. Should we not strive for noble outcomes? The Safe Medication Disposal Initiative confronts
this limitation. The data presented in this report is primarily assessing outputs rather than outcomes.
Still another assessment is qualitative rather than quantitative, focusing on what can we learn from what we are meas-
uring. This is the difference between concluding that we need more sites to improve access to all zip codes, for exam-
ple, versus recognizing that the data suggests that installing take-back sites in hospitals, the lobby and the emergency
department, is likely the most efficient strategy and will produce the greatest output for the investment. Information
and results can be used in many ways. More is not always better in a contemporary world that has to manage resources
skillfully. With this as a backdrop, some of the key findings will be discussed from this assessment.
Agency Oversight
This initiative “grew up,” so to speak as a grassroots brick and mortar movement. For this stage of development,
whenever a door opened that provided a willingness to extend a hand, likely an ally was found, and a stakeholder
joined the workgroup or a take-back site opened. In its sixth year of growth it’s easy to see that so many agencies
overseeing eleven small regions is an inefficient way to manage this service. While these variances may have value,
in truth, so many micro managers at the regional level suggests considerable amounts of redundancy. None of these
agencies itemize internalized expenses and overhead (or they did not report this information). A locally distributed
system possibly keeps supervisory costs low. What this means is that each of these local organizations stays within
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE3 0
their current scope of services and rightfully so. However, the potential for improving overall impact, for measuring
success, and for refining programmatic goals remain low at this level of municipal management. From this perspective,
it is easy to see a further value of the Alameda County Safe Drug Disposal Ordinance, it at least suggests a unified,
county wide program. This certainly means the potential for improving program outcomes and providing the most ef-
fective service.
Involving so many agencies is costly in terms of management, though this may be indirect. This translates into waste
and redundancy throughout the system. When there is one overriding agency operating this program, not only will
the services be provided more effectively, (assuming competency by that agency), but it will likely drive the costs of
disposal down due to the economy of scale of the waste disposal industry. It will likely improve program outputs by
streamlining educational efforts to more effectively reach the citizens of the county.
Recommendation: Establish one centralized product stewardship organization to oversee a county-wide program with
the potential of growing to manage a regional or state program.
Location and Access
In some respects current locations for take-back sites are haphazardly set. The criteria used to establish a take-back
site was partly a willingness by the location operator to allow for the service to be provided in a location that is safe
to provide this service. Other criteria did play a role into attempts to maximize local access, however, sites required
voluntary acceptance. The diversity of location types does not reflect an executed plan as to how to meet the needs
of citizens of the county.
It’s likely easy to understand the thinking behind placing take-back bins in such diverse settings as firehouses, hospitals
and government buildings. Yet, similar to post office boxes on street corners, depending on what phase of development
of the program one examines, more is not always better. The logic of a point of sales take-back system is consistent
with the premise that a business distributing medicine will be a good place to bring back unused medicine to the
same location. The data collected here shows that a well-placed box in a pharmacy with a pharmacist who promotes
its use can certainly be successful. What is essential is the professional commitment to reducing healthcare’s footprint
and to promoting public health and safety. Educating pharmacists and possibly physicians and nurses is essential for
improving outputs and likely outcomes.
In stark contrast, take-back bins in medical settings—hospitals and medical clinics, certainly locations people naturally
associate with drugs—require less professional advocacy, at least to users. Both of these locations distribute medicine,
though sometimes as a prescription filled in a pharmacy outside the facility. Yet these are locations citizens are likely
to have to come to during their lives, possibly regularly. Staffing and supervision is already present. Emergency
Departments are open all the time. Unlike the pharmacy, a lobby of a hospital and an Emergency Department waiting
room requires little if any retail promotion. In fact, these locations seem to attract and collect unused medications
rather effectively, with just passive promotion. Without any other explanation, it is logical to take advantage of this
trend. In terms of physical distribution of access, the distance one has to travel to find a take-back bin—hospitals are
well positioned in general.
3 1ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Transfer stations and hazardous waste facilities seem like good places for take-back bins given the overall function of
these locations is waste reduction. Operational costs remain very low. Other sites, including senior centers, firehouses,
office buildings, while seemingly good locations, have not been proven to be as effective to date. Each type of site has
a unique niche. Senior centers, for example, provide an easy location for a population that has frequent contact with
medicine. Data at this point does not suggest these sites are any more effective. These other sites may prove to be
inefficient once a more unified program throughout the county is developed. More research is required. With 51% of
the citizens of the county living within reasonable proximity of a take-back sites, the development and opening of new
sites is necessary for those not currently close to current take-back sites. It is reasonable to expect that a well-
constructed plan to provide this service in accessible locations throughout the county will create larger collection
results and improved outcomes.
Recommendation: Medical centers are very successful locations for providing take-back services. Beginning with
larger medical institutions such as hospitals, then moving into smaller clinical facilities, providing take back services
in these settings is likely the most efficient initial choice to make. Given the concentration of medical professionals
and hospital administrators, this is also the most efficient manner to stir professional awareness of the issue and the
solution. Pharmacies also provide an effective means for providing take back services when coupled with educational
opportunities for pharmacists to better understand the value and reason for participation. Other take-back sites should
be considered more strategically with further research into overall efficiency. Overall, more take-back sites are neces-
sary to provide easy access to all citizens of the county.
Costs of Disposal
None of the sites participating in this survey reported the costs of administration, operation or setup for the sites.
This is not to say that this data is not available, rather, it is often blended into other staffing costs. Thus, the only
costs easily accessed were cost of disposal. Due to the diversity and the overlap of site supervision, it is likely that
the costs of operating the program would likely be reduced if program operations were consolidated. This is likely
true for cost of disposal as well. In the Alameda County program, with 11 agencies operating the 31 sites, the collection
for disposal by medical waste company contractors are not able to set up a regular service run. Instead, due to small
size, many sites have pick-up on demand. In contrast, the program operating in San Francisco, which is administrated
through one agency, the San Francisco Department of the Environment, is able to contract with one medical waste
company to service all pharmacies and another to collect from the police stations. The 13 pharmacies sites in San
Francisco, which collect most of the waste, have a regularly scheduled pick-up every two weeks.
Recommendation: Streamlining redundancy in terms of waste management would reduce disposal costs.
Educational Outreach
Aside from direct-to-consumer public education, there are several constituencies that, if proper educational programs
were developed, could significantly affect program results. Most notably are pharmacists, hospice nurses, physicians
and nurses practitioners. These four professional health providers are the most closely connected with individual con-
sumer medication usage.
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE3 2
Given that all four of these health professionals have ongoing required continuing education, a minimum of one-hour
educational program, designed to provide the necessary evidenced-based information to these constituents could
greatly improve take-back participation and advocacy. These programs would indicate the need for and the value of
minimizing pharmaceutical waste as well as provide information about local take-back sites. This would likely influence
the public, given the role of health professionals in general. Educating providers is perhaps the most cost-effective
method of reaching consumers, given that direct-to-consumer marketing is expensive.
Another constituency that must be educated is hospital and medical administrators. Based on experience, it is likely
that the healthcare administration will either lead the way or prove to be an obstacle to providing this valuable service.
Both Eden Hospital and Washington Hospital have successful programs because both Chief Executive Officers recog-
nized the value of the service.
Given the stream of ongoing marketing and promotional materials so many levels of healthcare, public health and en-
vironmental health systems, regularly informing the public as to the purpose, value and access to take-back disposal
services is necessary for improving program outputs, though it can be costly to compete with other public health
needs. The current system of educational promotion is inadequate to the task. Given the amount of waste collected
annually and the increased demand and consumption, the outputs will continue to climb.
Recommendation:Educational efforts directed at medical providers and medical administrators will improve citizen’s
knowledge, supporting increased utilization of take-back programs. On-going promotion of take-back services should
use conventional and social media channels.
Program Users: Socio-demographics
Program users were evenly split between people 41-65 years old and 65 and older. They were three-to-one likely to
be female, and only half were bringing in medications solely for themselves. In terms of annual household income,
there was a spread with 28% of the users earning under $30,000, 28% earning $71,000 to 105,000 and roughly 20%
earning $31,000-$50,000 or above $105,000. While the sample size was too small to draw conclusions from this
data, the service is clearly reaching a broad spectrum of citizens. Given the concern for access, 28% participation
from disadvantage community members in the program represents a positive result. With 23% of the respondents
returning medicines for a deceased person, take-back services will continue to be essential for end-of-life service
providers and families of the deceased.
Recommendations: Further studies into the characteristics of program users are warranted. As the program outputs
grow, opportunities for data collection will improve. Committing time and energy for a research assistant to canvas
several take-back sites for one week would provide improved results.
3 3ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
I CONSIDER IT A SUCCESSFUL PROGRAM
Liz Jimenez
Solid waste and Recycling Coordinator, City of San Leandro
“It’s been a very successful program. It’s welcomed by the community. And I can tell you that I don’t
get as many calls asking, “Where do I drop off my medication? I can’t go the HHW facility.” It seems
to be a program that residents talk about and that they’re communicating with one another. “You
can go here. You can go there.” So I consider it to be a successful program, definitely.”
NEXT STEPS
The Safe MEDS Workgroup meetings have been visited by people outside of the county. The issue of unused medica-
tion in homes and teenage prescription abuse is not limited to the borders of the county. In 2011, the Safe MEDS
Workgroup hosted its first conference, the Safe Medicine Disposal Conference at the Castro Valley Library. With over
100 attendees, the conference highlighted much of the regional progress in setting up take-back initiatives. Lieutenant
Shelly James discussed the Contra Costa Program. Bill Chiang, legislative Aide to Adrienne Tissier, presented the San
Mateo program, and Caitlin Sanders, San Francisco Department of the Environment, shared material from the launch-
ing of San Francisco’s pilot program. Also featured at this conference was Burke Lucy, of CalRecycle, reviewing the
assessment of take-back programs throughout California and the recommendations for a model take-back programs
for the state.
On May 30 2013, the Safe MEDS Workgroup hosted the 2nd Alameda County Safe Medication Disposal Conference,
with the goal of sharing the ordinance and regulations with the wider audience. This second conference, created in
partnership with the California Product Stewardship Council (CPSC) and Product Stewardship Institute (PSI) in Boston,
MA, represented locations far beyond Alameda County. Heidi Sanborn, Executive Director of the CPSC, discussed
current legislative efforts in California. Scott Cassel, Executive Director of PSI, reviewed more than a dozen states in
the United States with take-back initiatives. Ginette Vanasse, the Executive Director of The Post Consumer Pharma-
ceutical Stewardship Association in Ottawa, Canada, shared her work overseeing fully operational programs in sev-
eral provinces of Canada. Keynote speaker Stevan Gressitt, MD, of the International Institute of Pharmaceutical Safety,
shared his thoughts on the movement towards safe medication disposal internationally.
In the 2014 legislative session for the state of California, the Senate recently passed SB 1014 on May 27th. This bill
amends CalRecycle’s Model Guidelines for Take-back Programs. SB 1014 would require CalRecycle to adopt regulations
reauthorizing local entities to establish a voluntary program to collect and properly dispose of home-generated phar-
maceutical waste. The regulations would be based on the Model Guidelines issued by CalRecycle in 2009 that allow
local entities to operate voluntary drug take-back programs. The preexisting guidelines expired January 1st, 2013, but
by reauthorizing and updating them, SB 1014 will provide clear direction for local governments, pharmacies and police
departments that would like to operate safe and secure pharmaceutical take-back programs Several key elements in
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE3 4
this Senate Bill include: the definition of Home Generated Pharmaceutical Waste (HGPW); an amendment to the cur-
rent CalRecycle classification of HGPW as separate and distinct from Medial Waste; and authorization of pharmacies
to accept the return of HGPW. Previous to SB 1014, unused
medicine from consumers was still considered medical waste,
meaning it was highly regulated and quite costly to capture for
disposal. The bill still has not passed in the California State
Assembly.
SB 1014 was authored by Senator Hannah-Beth Jackson, 19th
district of the California Senate and it was co-sponsored in
part, by the Alameda County Board of Supervisors and the
California Product Stewardship Council, both organizations
with regular members serving on the Safe MEDS Disposal
Workgroup: Supervisor Nat Miley and Heidi Sanborn.
NOBODY WOULD HAVE TAKEN THIS ON AT THE STATE
Heidi Sanborn
Executive Director, California Product Stewardship Council
“Nobody would have taken this on at the state level had Alameda not done what it did. The reason
is the lobby Pharma exerts its most influence at the federal level, the next most influence at the
state level, and much less influence at the local level. So going from local to state is much harder,
and nobody would have done that except to defend a county that had stuck its neck out trying to
help prove that local governments could in fact pass resolutions and ordinances requiring that pro-
ducers be responsible for what is sold in their jurisdiction. This was the first such requirement in
the country not just for pharmaceuticals, but for anything. So, this entire movement to get producers
to share in responsibility is literally hanging on the court case that Alameda is defending.
“We’re one of five co-sponsors of SB 1014, and we’re very proud of the co-sponsorship—Clean Water
Action, Alameda County, City of San Francisco, California Association of Retired Americans along
with CPSC. Everybody is pulling their weight, and they all bring different, important pieces to the
bill. Everyone is working hard. I’m very proud of this coalition and the enormous amount and
breadth of support we have received for the bill. If you look at the list of supporters versus opposi-
tion on the bill, I’ve never in my time seen a more lopsided list. Just a few associations of pharma-
ceutical companies are in opposition. And everyone from the sheriff’s association to the veterinarian
association to retired Americans and water groups and environmental groups, all supporting. It’s
astounding. Everyone in the capitol building is aware of the safe medicine disposal issue.
3 5ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
CONCLUSION
Certainly the Alameda County Safe Medication Disposal Initiative has had an impact. In simple terms, close to 14
tons of household generated pharmaceutical waste has been collected in 2013 alone from 31 sites distributed in about
half of the county. As well, the initiative has led development and implementation of public policy that is currently in
operation, though, regulatory legitimacy is disputed through a legal challenge that has the potential impede. Without
knowing what the future brings, it is difficult to offer a firm conclusion. Yet, much has happened and will continue to
happen. The 31 take-back sites continue to be open for collection.
The Pharmaceutical Product Stewardship Work Group, based in Washington, DC, is currently in discussion with the
Alameda County Environmental Health Department in an effort to develop a stewardship plan that will provide a
roadmap for the future of the program. The work of the Safe MEDS Workgroup provided a useful jumpstart for any
new program run by the PPSWG. The gaps are easy to identify. Eden Hospital, Washington Hospital and the Alameda
Sheriff’s Station are the most productive take-back sites. Given the access to these sites as well as the ease of oper-
ations, locating and opening similar sites throughout the county would be cost-effective. With the success of these
models, educating health executives and professionals should be the next priority.
Several policy changes are close to resolution at the time of writing this report. First, the United States Drug Enforce-
ment Agency will update its regulations as to who can handle unused household controlled substances. This is
expected to improve the ability for programs to safely collect and disposed of controlled medicines, which make up
about 10% of this waste stream. The current regulation limits this to only law enforcement agents. Second, SB 1014
could become law in California. While not requiring take-back programs throughout the state, it would certainly con-
tinue the momentum towards improving the regulatory conditions for programs such as the Alameda County initiative
to thrive. And finally, there is the legal challenge of the Alameda County Safe Drug Disposal Ordinance. If it is
upheld, the regulations and the stewardship plan will continue to channel efforts towards improved program results.
If overturned, the process will be reassessed. The 31 take-back locations in Alameda will continue to operate.
Lessons learned from this report will inform next steps either way.
The Safe Medication Disposal Initiative continues to work its way through the channels of public policy, healthcare
agencies, environmental health organizations and through the actions of citizens and professionals alike. The need
for a method of stewarding home-generated pharmaceutical waste from our healthcare system will likely grow. The
broader vision, cradle-to-cradle approaches to product development and distribution, is just beginning to be considered
by the health care industry. The Safe MEDS Workgroup and Initiative has raised considerable awareness for those
working for the health of all citizens.
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE3 6
APPENDICES
Appendix 1:
Agencies Operating Take-Back Sites
3 7ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Alameda County Sheriff’s Office (1)
Sergeant Bret Scheuller
510-667-7721
bscheuller@acgov.org
• Alameda County Sheriff’s Office
Alta Bates Summit Medical Center (2)
Mary Reiter, Assistant Director of
Pharmacy-Outpatient Services ABSMC
510-869-8451
reiterm@sutterhealth.org
Hospital
• Milvia Outpatient Pharmacy
• Peralta Outpatient Pharmacy
City of Fremont (1)
Bruce Fritz, Household Hazardous Waste Manager
510-252-0500
bfrtiz@blt-enterprises.com
Government
• Fremont Recycling & Transfer Station
• Recycling Center
City of Hayward (1)
Erik Pearson, Environmental Services Manager
510-583-4770
erik.pearson@hayward-ca.gov
Government
• Ted’s Drugs
City of San Leandro (3)
Liz Jimenez, Solid waste and
Recycling Coordinator
510-577-6026
ljimenez@sanleandro.org
Government
• City of San Leandro Public Works
• City of San Leandro Senior Center
• Davis Street Clinic
Alameda County Department of Environmental
Health (4)
Bill Pollock, Program Manager
800-606-6606
bill.pollock@acgov.org
County Government
• Alameda County HHW Drop-off Site – Fremont
• Alameda County HHW Drop-off Site – Hayward
• Alameda County HHW Drop-off Site –
Livermore
• Alameda County HHW Drop-off Site – Oakland
East Bay Municipal Utility District (10)
Audrey Comeaux, Environmental Services
Representative
510-287-1199
acomeaux@ebmud.com
Water Utility Agency
• Alameda Police Department
• Albany Senior Center
• Berkeley Transfer Station #3
• California State Building
• East Bay Municipal Utility Administration Bldg.
• El Cerrito Recycling Center*
• Emeryville Senior Center
• Oakland Fire Station #20
• Oakland Fire Station #3
• United Pharmacy
Eden Medical Center (1)
Christine Graham, Injury Prevention Specialist
510-727-3176
GrahamCJ@sutterhealth.org
Sponsored by
Castro Valley Sanitary
Jordan Figueiredo
jordan@cvsan.org
• Eden Medical Center
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE3 8
Appendix 1:
Agencies Operating Take-Back Sites
Oro Loma Sanitary District (1)
Rodney Smith, Industrial Waste Inspector
510-481-6971
rsmith@oroloma.org
Wastewater Utility Agency
• Medical Arts Pharmacy
Teleosis Institute (1)
Joel Kreisberg, Executive Director
510-558-7285
drkreisberg@teleosis.org
Non-profit
• Sal's Pharmacy
Union Sanitary District (7)
Mike Auer, Environmental Outreach Coordinator
510-477-7621
mikeauer@unionsanitary.com
Public Wastewater Utility
• Haller's Pharmacy and Medical Supply
• Haller's Pharmacy Newark
• Washington Hospital Community Health
Resource Library
• Washington Hospital Main Lobby
• Washington Township Medical Group
• Washington Township Medical Group
(at Nakamura Clinic)
• Washington Township Medical Group
at Warm Springs
Haller's Pharmacy has been taking back medication for many years.
3 9ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Appendix 2:
Take-Back Sites with Contact Information
Alameda County Sheriff’s Office (1)
• Alameda County Sheriff’s Office
15001 Foothill Blvd.
San Leandro, CA 94578
Sergeant Bret Scheuller
510-667-7721
Law Enforcement
Alta Bates Summit Medical Center (2)
• Milvia Outpatient Pharmacy
2500 Milvia Street, Suite 130"
Berkeley, CA 94704
Cathy Beachamp, Pharmacist
510-204-6550
beauchc@sutterhealth.org
Pharmacy
• Peralta Outpatient Pharmacy
3300 Webster Street,
Oakland, CA 94609
Sharon Leaf, Pharmacist
510-869-8835
leafs@sutterhealth.org
Pharmacy
City of Fremont (1)
• Fremont Recycling & Transfer Station
41149 Boyce Road
Fremont, CA 94538
800-606-6606
Recycling Center
City of Hayward (1)
• Ted’s Drugs
27453 Hesperian Blvd.
Hayward, CA 94545
510-782-6494
Monta Patel, Pharmacist
tedsrx@yahoo.com
Pharmacy
City of San Leandro (3)
• City of San Leandro Public Works
14200 Chapman Rd.
San Leandro, CA 94578
510-577-3440
Liz Jimenez, Solid waste and
Recycling Coordinator
ljimenez@sanleandro.org
• City of San Leandro Senior Center
13909 E. 14th St
San Leandro, CA 94578
510-577-7990
Heather Hafer, Recreation Supervisor
510-577-6079
hhafer@sanleandro.org
Senior Center
• Davis Street Clinic
3081 Teagarden Street
San Leandro, CA 94577
510-347-4620
Carol Alvarez, Behavioral Health Director
iscalvarez@davisstreet.org
Medical Clinic
Alameda County Department of Environmental
Health (4)
• Alameda County HHW Drop-off Site – Fremont
41149 Boyce Road
Fremont, CA 94538
Household Hazardous Waste Facility
• Alameda County HHW Drop-off Site - Hayward
2091 West Winton Avenue
Hayward, CA 94545
Household Hazardous Waste Facility
• Alameda County HHW Drop-off Site – Livermore
5584 La Ribera Street
Livermore, CA 94550
Household Hazardous Waste Facility
• Alameda County HHW Drop-off Site – Oakland
2100 E. 7th Street
Oakland, CA 94606
Household Hazardous Waste Facility
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE4 0
Appendix 2:
Take-Back Sites with Contact Information
East Bay Municipal Utility District (10)
• Alameda Police Department
1555 Oak Street
Alameda, CA 94501
510-337-8340
Barbara Leahy, Property Technician
510-337-8432
bleahy@ci.alameda.ca.us
Law Enforcement
• Albany Senior Center
846 Masonic Avenue
Albany, CA 94706
510-524-9122
Mary McKenna, Senior Services Coordinator
mmckenna@albanyca.org
Senior Center
• Berkeley Transfer Station #3
1201 2nd Street
Berkeley, CA 94710
510-981-7270
Wayne Anderson, Supervisor
510-812-5064
wanderson@CityofBerkeley.info
Recycling Center
• California State Building
1515 Clay Street
Oakland, CA 94612
510-287-1651
Bill Johnson, Water Resources Control Board
510-622-2354
bill.johnson@waterboards.ca.gov
Office Building
• East Bay Municipal Utility Administration Bldg.
375 Eleventh Street
Oakland, CA 94607
866-403-2683
Audrey Comeaux, Environmental Services
Representative
510-287-1199
acomeaux@ebmud.com
Office Building
• El Cerrito Recycling Center*
7501 Schmidt Lane
El Cerrito, CA 94530
510-215-4350
Garth Schultz, Operations and Environmental
Services Manater
510-559-7684
gschultz@ci.elcerrito.ca.us
Recycling Center
• Emeryville Senior Center
4321 Salem Street,
Emeryville, CA 94608
510-596-3730
Brad Helfenberger, Youth and Adult Services
Manager
510-596-3779
bhelfenberger@ci.emeryville.ca.us
Senior Center
• Oakland Fire Station #20
1401 98th Avenue at International Blvd.
Oakland, CA 94603
510-569-2568
Dan Girard, EMS Officer
415-317-0615
DGerard@oaklandnet.com
Fire Station
• Oakland Fire Station #3
1445 14th Street at Mandela Pkwy.
Oakland, CA 94607
510-238-4003
Dan Gerard, EMS Officer
415-317-0615
DGerard@oaklandnet.com
Fire Station
• United Pharmacy
2929 Telegraph Avenue
Berkeley, CA 94705
510-843-3201
Pamela Gumbs, Pharmacist
510-843-3201
Pharmacy
4 1ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Appendix 2:
Take-Back Sites with Contact Information
Eden Medical Center (1)
• Eden Medical Center
20103 Lake Chabot Road
Castro Valley, CA 94546
510-537-1234
Linda Scott Hickman
510-727-3211
hickmanl@sutterhealth.org
Hospital
Oro Loma Sanitary District (1)
• Medical Arts Pharmacy
13847 E. 14th Street
San Leandro, CA 94578
510-357-1881
Roland Cong, Pharmacist
510-357-1881
Pharmacy
Teleosis Institute (1)
• Sal's Pharmacy
1831 Solano Avenue
Berkeley, CA 94707
510-525-6500
Sal Nassar, Pharmacist
info@salspharmacy.com
Pharmacy
Union Sanitary District (7)
• Haller's Pharmacy and Medical Supply
37323 Fremont Blvd
Fremont, CA 94536
510-797-2772
Aarondeep Basrai, Pharmacist
510-366-8287
aarondeep@hallersrx.com
Pharmacy
• Haller's Pharmacy Newark
6170 Thorton Ave
Newark, CA 94560
510-797-4333
Russell Blowers, Pharmacist
russ@hallersrx.com
Pharmacy
• Washington Hospital Community Health
Resource Library
2500 Mowry Ave
Fremont, CA 94538
510-477-7621
Paul Kelley, Director of Biomedical Engineering,
Green Initiative and Asset Redeployment
510-791-3493
paul_kelley@whhs.com
Hospital
• Washington Hospital Main Lobby
2000 Mowry Ave
Fremont, CA 94538
510-797-1111
Paul Kelley
510-791-3493
paul_kelley@whhs.com
Hospital
• Washington Township Medical Group
6236 Thornton Ave
Newark, CA 94560
510-477-7621
Paul Kelley
510-791-3493
paul_kelley@whhs.com
Medical Clinic
• Washington Township Medical Group
(at Nakamura Clinic)
33077 Alvarado Niles Rd
Union City, CA 94587
510-477-7621
Paul Kelley
510-791-3493
paul_kelley@whhs.com
Medical Clinic
• Washington Township Medical Group
at Warm Springs
46690 Mohave Drive
Newark, CA 94560
510-477-7621
Paul Kelley
510-791-3493
paul_kelley@whhs.com
Medical Clinic
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE4 2
Appendix 3:
Waste Disposal Services Companies
Barnett Medical Services
barnettmedservices.com
Clean Harbors
www.cleanharbors.com
Covanta
www.covanta.com
Guarantee Returns
www.guaranteedreturns.com
North State Environmental
www.north-state.com
Sharps Solutions
www.sharps-solutions.com
Appendix 4:
Websites and Promotion
Alameda County Safe Medicine Disposal Initiative
www.acseniors-medisposal.net/index.html
Alameda County Safe MEDS Facebook page
www.facebook.com/AlamedaSafeMeds
Alameda County Safe Medicine Disposal Twitter Feed
@AlCoSafeMeds
California Product Stewardship Council/Pharmaceuticals
www.calpsc.org/products/pharmaceuticals
City of San Leandro: Safe Medication Disposal
www.sanleandro.org/depts/pw/es/safe_medicine_disposal.asp
East Bay Municipal Utility District: Dispose Medicine Safely
www.ebmud.com/water-and-wastewater/pollution-prevention/dispose-medicines-safely
Save The Bay Pharmaceutical Disposal Sites
www.savesfbay.org/pharmaceutical-disposal-sites
StopWaste: Proper Pharmaceutical Disposal
http://www.stopwaste.org/home/index.asp?page=1170
Teleosis Institute
www.teleosis.org/green-pharmacy
Union Sanitary District Permanent Medicine Drop-off Sites
www.unionsanitary.com/safeMedicineDisposal.htm
4 3ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
http://www.acgov.org/sustain/documents/ac_safe_drug_disposal_ordinance.pdf
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE4 4
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
4 5ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE4 6
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
4 7ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE4 8
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
4 9ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE5 0
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
5 1ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE5 2
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
5 3ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
ALAMEDA COUNTY SAFE MEDICATION DISPOSAL INITIATIVE ASSESSMENT • TELEOSIS INSTITUTE5 4
Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
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Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
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Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
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Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
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Appendix 5:
Alameda County Safe Medicine Disposal Ordinance
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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http://www.acgov.org/aceh/safedisposal/documents/SDD-Regulations.pdf
Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 6:
Alameda County Safe Drug Disposal Regulations
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Appendix 7:
Alameda County Safe Drug Disposal Fee Schedule and Cost Recovery
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Appendix 8:
Survey Questions
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1. Please enter your zip code: _____________
2. For how many people are you returning these medicines for?
(Are your bringing in medicine for more than one person?)
a. Only yourself
b. 2
c. 3
d. 4
e. More than 4
3. Are you returning medications for someone who is deceased?
a. Yes
b. No
4. Your Gender (circle one): Male Female
5. Your age:
a. Under 25
b. 26-40
c. 41-65
d. Over 65
6. Number in your household: ________
7. Your household Annual Income range:
a. Under $30,000
b. $30,000- $50,000
c. $51,000 – $70,000
d. $70,000-105,000
e. 105 and above
8. Do you have health insurance?
a. Yes
b. No
Appendix 9:
Safe Meds Workgroup Participants
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Angela Griffiths, Await & Find
Angelica Gums, Supervisor Miley’s Office
April Rovero, Contra Costa County Resident
Ariu Levi, Alameda County Environmental Health
Aubrey Schreck, Await & Find
Audrey Comeaux, East Bay Municipal Utility District
Avani Desai, CommPre
Barbara Woody, United Seniors of Oakland and Alameda County
Bill Pollock, Alameda County Hazardous Waste
Brian Washington, County Counsel
Charles Woody, United Seniors of Oakland and Alameda County, Alameda County Sheriff’s Department
Christine Graham, Eden Hospital, Supervisor Nate Miley’s Office, Senior Injury Prevention Partnership
Dan Arritola, San Lorenzo resident
David Silva, Castro Valley Community Action Network
Francesca Lomotan, CommPre
Heidi Sanborn, California Product Stewardship Council
Herb Lester, Fremont Unified School District Risk Manager
Janice Watkins, Cherryland resident
Jen Jackson, East Bay Municipal Water District
Jennifer Auletta, City of San Leandro
Jennifer Ong, Alameda County Hepatitis B Free Campaign
Jesse Garrett, CommPre
Joel Kreisberg, Teleosis Institute
Jorge Goitia, Alameda County LEA/Environmental Health Department
Garrett Wong, Irvington High School Seniors
Kamika Dunlap, Supervisor Miley’s Office
Kay Iwata, KIA, Inc
Karla Goodbody, Davis Street Family Resources Center
Kathleen Pacheco, County Counsel
Kathy Arritola, San Lorenzo resident
Linda Hambrick-Jones, United Seniors of Oakland & Alameda County
Linda H. Jones, United Seniors of Oakland & Alameda County
Linda Pratt, CommPre
Marie Haugen, San Leandro resident, Sandpiper Apartments
Mark Harvey, EXP Pharmaceutical Services Corp
Mark Hymel, Davis Street Resource Center
Mary Bradd, United Seniors of Oakland & Alameda County
Michael Auer, Union Sanitary District
Millie Gee-Poon, Supervisor Lai Bitker’s office
Miriam Rabinowitz, Alameda County Senior Injury Prevention Program
Morola Adjibodou, Teleosis Institute
Nate Harrison, United Seniors of Oakland & Alameda County
Paul Schafner, Supervisor Nate Miley’s Office
Pauline Von Stetten, Castro Valley resident
Peter Denyer, Irvington High School
Rachel Jeffers, Lifelong Medical Care
Robert Reiter, Alameda County County Counsel
Ronda Freyslaben, Senior Injury Prevention Partnership
Scott Seery; Alameda County Environmental Health Department
Steve Aguiar, City of Livermore
Sylvia Stadmire, United Seniors of Oakland and Alameda County
Teresa McGill, Davis St. Family Resource Center
Traci Cross, Castro Valley Community Action Network
T E L E O S I S I N S T I T U T E
863 Arlington Avenue
Berkeley, CA 94707
510.558.7285
www.teleosis.org