BILL ANALYSIS                                                                                                                                                                                                    �



                                                                            



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                                    THIRD READING


          Bill No:  SB 1014
          Author:   Jackson (D), et al.
          Amended:  5/27/14
          Vote:     21

           
           SENATE ENVIRONMENTAL QUALITY COMMITTEE  :  5-1, 3/26/14
          AYES:  Hill, Hancock, Jackson, Leno, Pavley
          NOES:  Gaines
          NO VOTE RECORDED:  Fuller

           SENATE BUSINESS, PROF. & ECON. DEVELOP. COMMITTEE  :  6-0, 4/21/14
          AYES:  Lieu, Block, Corbett, Hernandez, Hill, Padilla
          NO VOTE RECORDED:  Wyland, Berryhill, Galgiani

           SENATE APPROPRIATIONS COMMITTEE  :  5-1, 5/23/14
          AYES:  De Le�n, Hill, Lara, Padilla, Steinberg
          NOES:  Gaines
          NO VOTE RECORDED:  Walters


           SUBJECT  :    Pharmaceutical waste:  home-generated

           SOURCE  :     Alameda County Board of Supervisors
                      California Alliance for Retired Americans
                      California Product Stewardship Council
                      Clean Water Action 


           DIGEST  :    This bill establishes the Home-Generated  
          Pharmaceutical Waste Collection and Disposal Act to be  
          administered by the Department of Recycling and Recovery  
          (CalRecycle) according to certain guidelines.  This bill  
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          authorizes a pharmacy to accept the return of home-generated  
          pharmaceutical waste (HGPW) from a consumer.  This bill provides  
          that HGPW under a collection and disposal program is not medical  
          waste.  

           ANALYSIS  :    Existing federal law:

          1.Under the Food, Drug, and Cosmetic Act, the Food and Drug  
            Administration (FDA) is authorized to oversee the safety of  
            food, drugs, and cosmetics.

          2.Under the Resource Conservation and Recovery Act (RCRA) of  
            1976, the management of solid and hazardous wastes is  
            regulated.  In the context of pharmaceuticals, RCRA imposes  
            strict protocols for the collection of controlled substances.

          Existing state law:

          1.Under the California Hazardous Substances Act, the Department  
            of Toxic Substances Control (DTSC) is authorized to regulate  
            hazardous materials and wastes in accordance with RCRA.

          2.The California Integrated Waste Management Act:

             A.   Requires CalRecycle to implement a statewide household  
               hazardous waste substance information and collection  
               program.

             B.   Authorizes local jurisdictions to include in their  
               Household Hazardous Waste Elements a program for the safe  
               management of sharps waste.

             C.   Requires pharmaceutical manufacturers that sell or  
               distribute a medication in California that is self-injected  
               at home through the use of a hypodermic needle, pen needle,  
               intravenous needle, or any other similar device to submit  
               to CalRecycle a plan that describes what actions, if any,  
               the manufacturer supports for the safe management of sharps  
               waste.

          1.The Medical Waste Management Act (MWMA):

             A.   Requires the California Department of Public Health  
               (DPH) to regulate the management and handling of medical  

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               waste.

             B.   Defines "pharmaceuticals" as a prescription or  
               over-the-counter human or veterinary drug.   
               "Pharmaceutical" does not include any pharmaceutical that  
               is regulated pursuant to either RCRA or the Radiation  
               Control Law and certain items, such as household waste, are  
               specifically excluded from the definition of medical waste.

             C.   Defines "pharmaceutical waste" as any pharmaceutical  
               that for any reason may no longer be sold or dispensed for  
               use as a drug and excludes from this definition those  
               pharmaceuticals that still have potential value to the  
               generator because they are being returned to a reverse  
               distributor for possible manufacturer credit.

             D.   Specifies that waste comprised only of pharmaceuticals  
               is biohazardous, and is considered "medical waste."

          This bill:

          1.Establishes the Home-Generated Pharmaceutical Waste Collection  
            and Disposal Act.

          2.Authorizes a pharmacy to accept the return of HGPW from a  
            consumer.

          3.Defines "HGPW" for the purposes of the MWMA as a prescription  
            or over-the-counter human or veterinary home-generated  
            pharmaceutical, including, but not limited to, a  
            home-generated pharmaceutical as defined under federal law  
            that is waste derived from a household, including, but not  
            limited to, a multifamily residence or household.

          4.Provides that medical waste does not include HGPW, including  
            but not limited to, consolidated HGPW, that is handled by a  
            collection and disposal program operating in accordance with  
            regulations adopted by CalRecycle.

          5.Makes the following definitions in the Public Resources Code  
            related to HGPW collection and disposal:

             A.   "Consumer" is an individual purchaser or owner of a  
               pharmaceutical and does not include a business,  

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               corporation, limited partnership or entity involved in a  
               wholesale transaction between a distributor and a retailer.

             B.   "Entity" is a state or local public agency, pharmacy  
               veterinarian clinic or other office or facility.

             C.   "HGPW" means the same as above and includes all of the  
               following:

                     Articles recognized in the official United States  
                 Pharmacopoeia, the official National Formulary, the  
                 official Homeopathic Pharmacopeia of the United States or  
                 any supplement of the formulary or those pharmacopoeias.

                     Articles intended for use in the diagnosis, cure,  
                 mitigation, treatment or prevention of disease in humans  
                 or other animals.

                     Articles, excluding food, intended to affect the  
                 structure or function of the body of humans or other  
                 animals.

                     Articles intended for use as a component of an  
                 article specified above.

             A.   "Participant" is an entity that CalRecycle deems  
               appropriate for implementing and evaluating a program in  
               accordance with regulations and that chooses to  
               participate.

             B.   "Sale" is, but is not limited to, transactions conducted  
               through sales outlets, catalogs or the Internet, or any  
               other similar electronic means, but does not include a sale  
               that is a wholesale transaction with a distributor or  
               retailer.

          1.Requires CalRecycle to adopt regulations authorizing a  
            participant to establish a program to collect and properly  
            dispose of HGPW.  Specifies that the regulations be based upon  
            the model guidelines already developed by CalRecycle and  
            require a participant to do all of the following:

             A.   Provide, at no additional cost to the consumer, for the  
               safe take-back and proper disposal of the type or brand of  

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               pharmaceuticals that the participant sells or previously  
               sold.

             B.   Ensure the protection of the public health and safety,  
               the environment and the health and safety of consumers and  
               employees.

             C.   Report to CalRecycle, for the purposes of evaluation,  
               the safety, efficiency, effectiveness of the implemented  
               program on an annual basis.

             D.   Protect against the potential for the diversion of  
               pharmaceutical waste for unlawful use or sale.

             E.   Provide notices and materials to consumers that provide  
               information about the potential impacts of improper  
               disposal of HGPW and return opportunities for the proper  
               disposal of HGPW that include Internet Web site links,  
               telephone numbers on an invoice, information about  
               opportunities and locations for no-cost HGPW disposal,  
               prominently displayed and easily visible signage, written  
               material provided to consumers at the time of purchase or  
               delivery, reference to the HPW take-back.

          1.Requires the regulations to also do the following and  
            authorizes CalRecycle to revise the regulations if changes  
            will ensure public health and safety:

             A.   Specify the types of participants authorized to maintain  
               permanent collection locations.

             B.   Specify requirements for obtaining state permits or  
               approvals.

             C.   Require participants to enter into arrangements with  
               medical or hazardous waste haulers to ensure that all HGPW  
               is appropriately picked up and transported by registered  
               waste haulers.

             D.   Specify which HGPW may be included in a program,  
               including the requirements for the collection of a  
               controlled substance.

             E.   Specify methods for handling wastes commingled in  

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               containers with other household or hazardous waste.

             F.   Provide methods for collecting and storing HGPW,  
               including the use of secured containers and ensure that  
               collected HGPW is not resold, reused, sold, donated or  
               provided to anyone other than a registered medical or  
               hazardous waste hauler.

             G.   Provide that a facility that collects HGPW is  
               responsible for ensuring that the storage, removal and  
               transportation of containers and the waste are in  
               compliance with state laws and regulations.

             H.   Require the collection and retention of detailed  
               information and invoices for each collection site.

             I.   Impose requirements for one-time or periodic collection  
               events.

             J.   Impose requirements for mail-back collection and  
               disposal programs.

             AA.  Include provisions for the appropriate management of  
               HGPW to ensure public health and safety.

           Background
           
           California's Model Guidelines for Take-Back.   In 2007, the  
          Legislature passed SB 966 (Simitian, Chapter 542) which required  
          CalRecycle's predecessor, the California Integrated Waste  
          Management Board (CIWMB), to develop, in consultation with  
          appropriate state, local, and federal agencies, model programs  
          for the collection and proper disposal of pharmaceutical drug  
          waste.  Those guidelines were developed in consultation with a  
          pharmaceutical working group which included CIWMB staff, Board  
          staff and representatives from the Department of Public Health,  
          Department of Toxic Substances Control and State Water Resources  
          Board.  The model programs include parameters for both permanent  
          and occasional take-back event collection sites and also include  
          a mail back component as an alternative to onsite collection.   
          The guidelines, "Criteria and Procedures for Model  
          Home-Generated Pharmaceutical Waste Collection and Disposal  
          Programs" were adopted by CIWMB in 2009 to provide consumers the  
          ability to dispose of unwanted prescription and over-the-counter  

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          drugs without flushing them down the toilet or throwing them in  
          the garbage (the guidelines did not include controlled  
          substances which must be returned only to law enforcement).   
          These guidelines are only guidelines and not currently  
          enforceable as standards.  

           Take-Back in California.   Absent a statewide program, many  
          consumers utilize dedicated, one-day take-back opportunities to  
          safely dispose of medications. These one-time events allow  
          individuals to dispose of prescription or non-prescription  
          medications which are taken to a safe disposal site after  
          collection.  The DEA's seventh National Take-Back Day in October  
          2013 collected 324 tons of expired and unwanted medications  
          across all 50 states.  Since the inception of the National  
          Take-Back Day in 2010, the DEA has collected over 3.4 million  
          pounds of medicine from circulation.  

          Between 2009 and 2010, CalRecycle identified 177 continuous  
          collection programs at pharmacies and law enforcement offices in  
          California.  In that time, these programs collected more than  
          200,000 pounds of pharmaceuticals.  San Francisco established a  
          Safe Medicine Disposal Pilot Program in 2012, allowing residents  
          to return pharmaceuticals (not including controlled substances)  
          to 13 pharmacies via secured collection bins or any  
          pharmaceuticals to San Francisco police stations during business  
          hours.  As of October 2013, over 25,800 pounds of  
          pharmaceuticals had been collected, 93% of which was at the  
          pharmacy locations.  The Los Angeles County Sheriff's Department  
          launched their Safe Drug Drop-Off program in September 2009  
          where drug disposal boxes are available 24 hours a day, 365 days  
          a year outside of sheriff's stations.  A total of 21 drop-off  
          locations have collected over 53,000 pounds of prescription  
          medication as of September 2013.  Santa Clara County currently  
          has two county agencies that collect and safely dispose of  
          pharmaceuticals - the county Household Hazardous Waste Program,  
          which spends roughly $21,600 annually on the collection and  
          disposal of 7.2 tons of medication a year (1,200 pounds a month)  
          and a program run by the county sheriff's office at 10  
          locations.  Annually, the program costs the county $41,600 for  
          10.8 tons of collected and disposed medication.  Alameda County  
          passed a Safe Drug Disposal Ordinance in 2012 that requires  
          producers of covered drugs (including both brand name and  
          generic drugs) to operate take-back programs after submitting a  
          plan to the county's Department of Environmental Health.   

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          Programs include the creation, administration, promotion, and  
          payment of the program (including the payment of Alameda  
          County's costs to administer and enforce the Ordinance).   
          CalRecycle reports that the average cost of current take-back  
          programs in California vary from $3-$7 a pound.

           Barriers to Broader Implementation of Take-Back.   In  
          implementing take-back programs on a more broad scale throughout  
          the state, concerns still remain and there are only a small  
          number of pharmacies currently accepting drugs back from  
          consumers.  Drugs are very heavily regulated throughout each  
          step of the supply chain and there are even a limited number of  
          options (all of which are also tightly regulated) for pharmacies  
          to remove drugs that have not been dispensed.  For example, a  
          pharmacy can return unwanted drugs to the wholesaler the  
          pharmacy bought the drugs from provided the drug has not expired  
          or been recalled; wholesalers are Board licensees.  Pharmacies  
          can also return outdated, nonsalable drugs that have not been  
          dispensed to a reverse distributor, also a Board licensee, for  
          possible manufacturer credit and destruction.  Pharmacies can  
          provide outdated, nonsalable drugs to licensed hazardous waste  
          haulers.  With regards to mandatory take-back collection sites  
          within pharmacies, issues have been raised about the potential  
          for pharmacies to become recycling centers when they are a  
          location where health care is being provided.  Pharmacies have  
          also expressed concerns over the past number of years that there  
          may not be the appropriate space needed for proper collection  
          and cite the costs associated with the appropriate handling of  
          drug waste.  

          The 2010 CalRecycle Report found that only about one-third of  
          existing programs in California meet the model guidelines and  
          highlighted a number of barriers.  According to CalRecycle, law  
          enforcement programs can readily meet requirements for  
          collecting controlled substances, but the public may not be  
          willing to bring pharmaceutical wastes to police stations.   
          Further, law enforcement agencies themselves have higher  
          resource allocation priorities.  Pharmacies are widespread and  
          accessible, but they typically do not meet all of the safety  
          protocols (e.g., regarding collection bins and security)  
          delineated in guidelines.  Household Hazardous Waste facilities  
          also face similar issues as pharmacies, particularly relative to  
          safety, and are dependent on local government funding support.   
          Periodic collection events are somewhat easier to implement for  

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          local governments and can accommodate large amounts of materials  
          in a short time, but are not as cost-effective as continuous  
          collection programs, often do not have safety protocols, and are  
          subject to local government budgetary constraints.  Mail-back  
          programs can be convenient and safety is not a major concern,  
          but there are only three such programs in the state and a high  
          return rate is necessary for the method to be cost-effective. 

           Related Legislation  

          AB 333 (Wieckowski, 2013) makes various changes to the Medical  
          Waste Management Act.  The bill is currently in the Senate  
          Environmental Quality Committee.

          AB 467 (Stone, 2013) creates a licensure category for a surplus  
          medication collection and distribution intermediary.  The bill  
          is currently in the Assembly for concurrence of Senate  
          amendments.

          AB 1727 (Rodriguez, 2014) restricts certain pharmaceuticals from  
          county operated prescription drug collection and redistribution  
          programs.  The bill is currently in the Assembly Health  
          Committee.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

          According to the Senate Appropriations Committee:

              One-time costs between $250,000 and $300,000 from the  
              Integrated Waste Management Fund (special) to CalRecycle to  
              develop the required regulations.

              Ongoing costs between $50,000 and $150,000 from the  
              Integrated Waste Management Fund (special) to CalRecycle to  
              receive and analyze reports from HGPW collection program.


           SUPPORT  :   (Verified  5/28/14)

          Alameda County Board of Supervisors (co-source) 
          California Alliance for Retired Americans (co-source) 
          California Product Stewardship Council (co-source) 
          Clean Water Action (co-source)

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          Bay Area Physicians for Social Responsibility
          California State Board of Pharmacy 
          Californians for a Healthy and Green Economy
          Center for Environmental Health
          City of Camarillo
          East Bay Municipal Utility District
          El Dorado Irrigation District
          Health Officers Association of California
          League of Women Voters of California
          Worksafe

           ARGUMENTS IN SUPPORT  :    According to the author's office, this  
          bill will help ensure that local entities  that decide to  
          conduct voluntary take-back programs have minimum standards to  
          follow that will help protect public health and safety and the  
          environment, and protect against the potential for diversion of  
          pharmaceutical waste for unlawful use or sale.  In addition,  
          this bill provides clarity to existing law, by specifically  
          authorizing pharmacies to accept the return of home-generated  
          pharmaceutical waste, should they decide to do so.



          RM:AL:nl  5/28/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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