sure, every jurisdiction is struggling with this. anything that we can keep out of the system is that much better for us as there are no guarantees on the back end. supervisor mirkarimi: appreciate that. if there are no more questions for puc, i will call up the executive director of the california poison control system. please. executive director, by the way. >> thank you, good afternoon. i am the executive director of the california for and control, part of the california school of pharmacy. we spend a great deal of effort in poison prevention and poison- proving household education. we very much support any effort that we can to minimize or

remove unwanted, and needed medications from the home. about 50% of the poisoning relates to children under the age of 6. we are very concerned about that, as well as elderly folks. many folks have tried to return medications. our issue is that we want them removed in an effective and timely manner with a program that we brought the support. in the past recommendations as stated were primarily to flush them down the drain. we have backed away from that, although for some people that is the only thing they can do. other programs, drop-off programs, whatever. i urge that whatever the final program is, if there is one, the practical, simple, something that everyone can support and results in moving these not

needed and not wanted products out of a household. >> -- supervisor mirkarimi: appreciate those comments. what percentage of calls does the poison control center get about unwanted, and used drugs? >> not a lot. we manage over 320,000 exposures statewide. there is certainly something that we engaged in, it is very organized throughout the state. another broad program that we can all engaged in there are landfall solutions michael

walgreen's program that is simple and easy for consumers to follow. there are increasing numbers, but not a lot of calls about disposal. supervisor mirkarimi: when you mention those programs, you are not mentioning the costs of the subsidies of the programs, i have noticed. we would encourage a broad approach to that so that all of those involved in production, distribution, and receipts are engaging in an effective and economical way to accomplish this. supervisor mirkarimi: do you know how public safety would actually be improved by their potentially being a program of private disposal and the nexus according to that?

>> the exposures that happened in households where most of the products were, there were recent studies showing that the exposure frequently related most often to the products currently in use in the household. out on a counter because people were using them. some of the unwanted, and use medications stored in cabinets were less of an issue. nonetheless, i believe that those should be removed. children get into things that are easy to get their hands on if they are left out. elderly people are easily confused by multiple medications in the cabinet. we would certainly like to see a reduction in these accidental ingestion that occur from unnecessary medication in the household. supervisor mirkarimi: thank you. appreciate that. supervisor chiu: as a statewide

agency you talk about how different localities have different programs that lead to confusion. are we not setting that up to continue? san francisco will potentially set up a plan to impose some sort of feed? if every city and county has their own plan and feet, where does it end? should the responsibility not live perhaps with legislature in sacramento to make uniformity in the state? or perhaps washington, d.c., where we can have uniformity across the country? it is said -- >> it is a cumulative response. north carolina launched a safe kids program where they looked at the models and how they could be introduced in the most consistent and across the board

met that. i think that this ordinance, which i do not take a specific position on, is certainly causing us to think about this issue in our community. what can we do to make it a consistent, mainstream practice? i would urge a commonality for these, but i do not think we have the best model sorted out yet. supervisor mirkarimi: curious, on that note, in the absence of the state government from being able to take a comment and effective action, should cities just sit back and wait? >> no, as we do in our work every day we should try to educate the public about the hazards of medication. we all do what we can to educate and inform people when they should be doing something about these medications in their home, taking advantage of what now exists, which is not ideal in

terms of flushing. various education programs that teach people how to prepare their medication, promulgating drug drop-off programs. but they are not uniformly available. we have to start from the ground up informing the public about this concern. supervisor mirkarimi: is just that we might be able to set the model from the ground up. right? thank you. if it is ok i will move into speaker cards that i have here. supervisor elsbernd: one more question, do not get up, the environmental commission, have they taken a stand on this? public utilities? have they said whether or not they support the legislation? or must you remain quiet until the commission has acted? >> the part of the environment,

we have no position at this time. >> -- supervisor elsbernd: simply puc? no position? have we heard from the department of health? we do not know or they have had no hearing? supervisor mirkarimi: supervisor elsbernd: know this is the first public hearing on this -- supervisor mirkarimi: no. supervisor elsbernd: this is the first hearing on this? supervisor chiu: if we could move on to public comment, each member of the public will have up to two minutes. supervisor mirkarimi: [reads names] 1 after the other, please. >> i represent the bay area clean water agency prevention group. our organization represents about 51 wastewater treatment plants to protect water quality.

we protect this ordinance. we know it is wiser and less expensive to keep the pollution out of the water in the first place. we also know that many complex chemicals like those in pharmaceuticals are so persistent that even the most sophisticated trains cannot remove them. even if we could, hypothetically, that technology and energy required would be so huge that the cost of the public would not be sustainable. which is why we strongly support product restriction registration to stop pollution where it starts. area waste-water treatment agencies have led the way in california to prevent pharmaceutical pollution. in one month we collected more than 30,000 pounds of pharmaceuticals. in september of this year, the usda collected 110,000 pounds of pharmaceuticals in one day. we know that the demand for

copper disposal is there. it is no longer acceptable to throw things down the toilet or in the trash. batteries, paint, carpet, pharmaceuticals. the cost of this is so high that it should not be borne by cash strapped local government. manufacturers have distribution mechanisms that can be safe and cost-effective for the public to take back, and we urge you to support this ordinance. supervisor mirkarimi: next speaker, please. >> i am with san francisco suicide prevention. san francisco has 120 suicides as opposed to the 80 homicides every year, 6000 suicide attempts each year. one every hour and half. most of these attempts take place with pharmaceuticals or

over-the-counter drugs. we would like to speak out in favor of this measure. according to an article in the journal of american medical association that appeared in 2006, one of the most salient preventative measures that could be taken against suicide was the removal of lethal means from the immediate surrounding by person in crisis. especially a young person. this implies -- applies to adolescence that make impulsive a thames, especially if they have access to means in their homes -- impulsive attempts, especially if access to means in their home. we can protect the children and the environment. i urge that we take that into account. supervisor mirkarimi: thank you. after this next speaker i will call more names. [reads names]

>> good afternoon. my name is bruce. i am the director of state government relations for a generic drug manufacturers. my company is the largest generic in the united states, facilities in multiple states. as well as more than 20 countries. one out of every 13 prescription drugs in the united states is accounted for by my company. while we share this goal in the ordinance to reduce the risk of drug abuse, accidental poisonings, and protecting the water supply, we respectfully opposed this proposal and the method in which it uses to address this issue. we believe that this approach could be difficult, if not

impossible, to implement on the scale of san francisco county and city. we also believe that it would increase health care costs and reduce access to lower care drugs. -- lower-cost drugs. currently they account for 70%, but we are only 22% of the cost. i would like to address a couple of things very quickly. first of all, we would beg to differ with the spokesperson from the department of the environment on what the cost of this would be. i worked on this effort in maine, which is similar in population to this city. proposing a cap of $1.5 million for the first year with an expectation that it would exceed $2 million each year to run such a program on a statewide basis. generics have razor-thin profit margins. generic manufacturers cannot afford to foot the costs of

these programs. if a program like this were implemented, it would potentially leave generic manufacturers with two options. first, raise the prices to cover the cost of the program, which would be difficult, or to decline to allow our products to be sold into the city. if that were the case, even if some manufacturers this -- declined to sell their drugs here, you could have products that were no longer available. supervisor mirkarimi: i have a question, through the chair. what is your profit in the united states? the profit margin for the sale of moderate -- sales of pharmaceutical -- sale of pharmaceuticals? >> i honestly cannot answer, and i can get it for you. supervisor mirkarimi: do you want me to answer for you? with regards to your company's lobbying efforts in the state of maine, we called their. i am curious, what follow-up

after your company's intervention in maine on this lot, what did you do point to follow up to say what level of state voluntary program would you like to establish? >> we did work with the legislature on an alternative at the time, which the senate was willing to pass. the sponsors in the house and environmental protection storage of institute, who were behind this effort, declined to accept a program that was anything but a manufacturer funded take back. we offered an alternative that we were willing to voluntarily participate in, but that was not acceptable to the department of environmental protection. they made it clear that they preferred no program rather than an alternative program. supervisor mirkarimi: so, status quo, then.

>> it is still an issue for conversation up there. supervisor mirkarimi: thank you. next speaker, please. >> good afternoon, supervisors. i am hazardous materials program manager for the county of santa clara. in may of 2007 the board of supervisors of santa clara county advanced a product stewardship responsibility resolution in full support of the efforts you are taking on today. i think it needs to be called out that local government has saddled this burden and the purpose of product stewardship is to simply shift the financial and physical was bonn's ability for end of life management back to those producers that profit for them. the manufacturers of pharmaceuticals in this country are content with privatizing those profits and socializing those costs. as long as we as local governments continue to accept

that responsibility, we will have absolutely no voluntary coordination or cooperation from the manufacturing community. whether it is pharmaceuticals, pesticides, the list goes on and on. many of these products are banned from landfills. local governments have no choice but to deal with them. as it relates to expecting the federal government, for that matter the state government, to take care of the public health of our local jurisdiction, i urge you to support this ordinance and applaud you in your efforts. thank you. supervisor mirkarimi: thank you. i will read the names of the cards i have left. [reads names] that is all the cards, if other people want to speak out. >> hello, my name is andrea and i am here on behalf of clean

water action. we have 60,000 members here in california, most of whom live in the san francisco bay area. we applaud san francisco for once again showing leadership by introducing this ordinance to promote product stewardship. this is the type of proactive action needed to stop pollution at the source and is essential to truly protect our water resources. i, this from a very specific perspective. i spend a great deal of my time working to be sure that remediation for our waterways are adequate to bring water back into compliance with clean water quality standards, water quality act standards. i want to say that these plans to take -- i have to do about 2000 right now on the books --

these can take over one decade, to develop these plans. one century to implement. it will cost californians millions of dollars. the thing is, it is a never- ending cycle. the emerging contaminants like pharmaceuticals in our water like we see today, they are the cleanup plans that we will have to do? line in the future. we believe that a program, like the one that san francisco needs to implement, must move forward. we think it must meet the specific needs of san francisco and take into consideration the specific experiences from other jurisdictions that have moved ahead on creating these drug products three program. i want to address two things that came up in previous comments. should this be done at the state or national level?

we actually hear this from the other side. the reality would be nice, but the truth of the matter is that oftentimes these initiatives have to start at this level. we applaud you for that. supervisor chiu: thank you very much. supervisor mirkarimi: thank you, next beaker, please. >> good afternoon. thank you, supervisors. i am the director of state government relations for the consumer health-care products association. we are a trade association representing major u.s. manufacturers of non- prescription drugs. we must respectfully oppose this legislation. our member companies participate in programs like the american medicine chest challenge, providing education for consumers about properly disposing of medicine and national drug take back days, such as the one being sponsored on november 13. if you look at the products in your home that you use every

day, if you look at those products for drug fact labeling, you might be surprised to find how many of the common products they use are regulated as non- prescription drugs, like to faced and lip balm. if this legislation is passed, the outcome for consumers could result in many of the products they rely on every day could no longer be available to them if the regulatory burden is so high that some companies have to make the choice between not selling the product or setting of a system for products that, in many cases, for the manufacturers i represent, are not likely to be returned to the city using this program. we encourage support of the existing programs like the american medicine chest challenge and to oppose this legislation. thank you. supervisor chiu: next speaker, please.

>> mr. chair, and i am here to represent the california healthcare institute, a statewide association of 250 entities of pharmaceutical companies, like science companies, medical of but manufacturers, and universities. there are 275,000 employees in those companies. chi has submitted a letter that i would encourage you all to read. i will lift a few comments and then the conclusion of a letter. product stewardship programs must be a shared responsibility. in your proposal you define extended producer responsibility as shared responsibility. this is not shared responsibility, it is sole responsibility placed on the manufacturers. the disposal of pharmaceuticals

in the sewer system is a minor cause of the amount in the water system. most of the pharmaceuticals that wind up in the water supply are the result of patients taking those drugs, not metabolized and extreme -- excreted. let me point out, in a letter there is a reference to a german study in 1998 from german sewage plants and rivers. in that experience they have mandatory take back programs. they discovered no discernible reduction in the concentration of pharmaceuticals in surface water as a result. no discernible production with mandatory take back programs. in conclusion, patient and environmental safety related to madison is a top priority of the biomedical industry. cha supports the necessity of a

clean environment and save water, opposing efforts to place the burden on the biomedical industry that will not achieve the goal of the ordinance. we are willing to be part of a comprehensive and reasonable solution that includes -- [tone] however this ordinance does not do that, and we are opposed to this legislation, we would encourage you to study the issue further. thank you. supervisor mirkarimi: thank you. next speaker. i was just handed two more cards. [reads names] >> good afternoon, supervisors. paul juicebee, we are the recycling company here in san francisco. we are also the disposal company. pharmaceuticals do not belong in a landfill. it is extremely onerous and not

efficient to take them to a household hazardous waste facility. we support legislation of this type that would have some sort of take back for pharmaceutical companies and drug stores for this. supervisor mirkarimi: the wall govern and administer the land waste, the waste that is processed through your company -- you all government and administer the land waste, the ways that is processed your company, but would you call the primary concerns of drugs disposed in the waste stream? >> they do go to the landfill. and it is not a landfill that is properly maintained. they can leach into the environment, get into groundwater, that kind of thing. hopefully within the next five years we will have a contract for the disposal.

it is still probably a good idea to not have them in a landfill. supervisor mirkarimi: you have been with the company for how long? >> 33 years. supervisor mirkarimi: has anyone from the pharmaceutical industry contacted you to say they wanted to help with the diversion? >> not to my knowledge. supervisor mirkarimi: thank you. next speaker, please. >> my name is gail [unintelligible] ,ceo of [unintelligible] bio, a nonprofit organization representing a live science companies in california. we support a clean environment and applaud the concern that is shown to keeping our waterways safe. but we oppose the sf board since on drug disposal. we believe that we need to address it at the national level. that needs to be a shared system

and a coordinated effort. as you may know, the federal government already has a program initiated in product stewardship. the smart disposal program is a joint effort of the u.s. fish and wildlife services, the american pharmacists' association, and the pharmaceutical manufacturers association. together, public and private enterprises are working to have a coordinated effort at keeping api's out of the system and we think that san francisco should support this effort. an uncoordinated effort could do more harm than good in undermining the federal efforts already underway. bye-bye to dissuade a couple of issues that my colleague has already mentioned. first, the waterways are shared. as a patchwork of ordinances'

amongst city governments, it will not effectively address the problem. multiple european studies have found that mandatory take back programs are not effective. studies have shown that over 90% of the drugs that get into landfill and waterways are because of excretion from patient use, not take back programs. we would urge the city of san francisco to reject the city program and, in its stead, support the smart disposal federal program already under way, and to also support the american medical chest challenge day coming next month. thank you. supervisor mirkarimi: next speaker, please. thank you. >> my name is [unintelligible] and i am a volunteer with the department of the environment. i support the safe drug disposal

ordinance. almost everyone has old medication that they do not know to -- what to do with. personally i have tried to take them back to my school clinic, what marines, they will not take them. many people still follow the old advice of flesh of -- flushing them down the toilet. this is at least in part because of synthetic estrogen winding up in the environment where does not belong. we need a way to make sure that this place and does not wind up in the environment. thank you supervisor mirkarimi: thank you. -- thank you. supervisor mirkarimi: thank you. mac's speaker, please. >> my name is susan, recent graduate of the san francisco bay presidio graduate school in sustainable management. i have been actively studying and working in this area