behalf. the department of the environment will review that plan and ask for a four year cycle. as was said before, the important part is an attempt to double the sites available for consumers to a minimum of 55. as you heard and you can see in this slide, district 6 and 7 have no retail pharmacy drop off sites, district 6 only has a police station drop off site, and district 7 has no drop off site at all. under the ordinance, we would double the number in each location for a total of 55 sites. just to give you a sense of, are there enough potential locations for this mandate to increase convenience? there are 137 retail pharmacies in san francisco. in addition, the ordinance requires san francisco to city run pharmacies, the one in san francisco general and the

one at community behavioral health services in sylma serve as sites. we're halfway there and then you add the -- our public police stations. we're over halfway there. we think we have an opportunity to make this convenience a reality. next i really want to stress that the ordinance really was designed with a lot of flexibility. to allow producers to be very creative, and their approach to bringing convenience forward. as was said earlier, producers knows their industry best. they can leverage their knowledge in creating a take back site. they don't have to provide collection sites. they can use pre-paid mailed envelopes where for seniors and others who are maybe home bound or disabled and can't get to a location, you can use that. they can do collection events and many other things.

if they can't reach the five pharmacies or five drop off locations in a soup -- it allows flexibility. they can come to the department and said we tried and we couldn't find every facility available, but here's what we're going to do to make sure consumer in that district have ability and access and convenience. there's flexibility built into the system. next, we really heard a lot and we experienced a lot in working with our pilot program. both working with pharmacies and working with consumers. that's teaching consumers how to use the system. and so there's a significant component in the ordinance. it talks about education and outreach. the big thing we think is exciting is we require producers to follow the city's example by adhering to our action ordinance and making sure that term materials are available to the public in

languages they can under and comfortable with. the department isn't going to let the producers loan on this issue. we plan to work with them on an education and outreach component. we have a lot of experience -- the city has great experience at this. we plan to provide assistance and help with the department, and designing a single system of promotion. and then, what's also important to mention is that the board of supervisors in 2011, passed the safe drug disposal information ordinance which requires all pharmacies who are not participating in a take back program to make available to their customers, locations of where their customers can go take their unuse and unwanted medicine and that will continue. and another discussion has been in the ordinance, how do we measure success? how do we know we're doing the right thing and doing it well? the first is awareness. producers in the ordinance, producers must conduct a survey of

resident and pharmacy and other health care professionals every two years. the survey will test awareness of the plan, and the survey will evaluate whether medicine collection are convenient and easy to use. two, is convenience. producers must provide an annual report to the department detailing the number of location and events and utilization to the event. and how much has been collected. they must update their plan every four years, again, to allow new opportunities and ways of making the program successful. and finally the department shall report by annually to the board of supervisors on the effectiveness on the program. let me talk about the implementation and oversight. the ordinance designates the department of the environment as the lead agency for implementation and oversight. what does that mean. for department, it really means

one providing technical assistance and that is working hand and hand with producers to develop and design effective programs. we're not just going to assume that they know all the answers. weaver -- we're going to be there to help make connections and connect the dots and introduce them to the programs and make it successful and then it's the review plan and finally enforcement. it gives the department rules necessary to make sure requirements are being met. supervisors, let me give you a sense of what the timeline is. the ordinance spells out lots of dates and i want to give you a sense that we're not rushing into trying to produce a program overnight that the ordinance really does allow for 18 months to develop an effective program. first, within two months of the effective date, wholesalers must notice the

department of producers selling into san francisco. basically who all is selling covered drugs in san francisco. second, within six months of the effective date, these producers must acknowledge to the department that they are subject to the ordinance. and as debbie mentioned in her comments, we really believe that producers will participate in san francisco. if you look at alameda county, 229 producers are participating there. and in king county, 271 producers are participating there. we believe producers will be responsive and follow the law in san francisco. next is within 9 months of the effective day, producers must invite all pharmacy and law offices in san francisco to participate. again, in drafting the ordinance, we took this and found it as a mile stone. there's discussions as to what if we can't find enough pharmacies to participate. let's look at king county as an

example. up there, the producers received commitments from 93 pharmacies and are in discussion with 174. as i mentioned earlier, we have 130 retailers in san francisco. we believe the retailers won't have problems finding willing partners in san francisco. fourth, within 12 months of the effective date, producers will submit a stewardship plan. next, the department will have three months to review the plan, ask then finally we will approve a plan and then within 18 months, we should have a program up and running. should the board and the mayor approve this ordinance, we have between 18 and 24 months to work and develop a world class model program. we're not rushing into this. we have a lot of good evidence, we have a lot of good data. we plan to do this right. we plan to be engaged with producers on this. we want this to work for

san franciscans. this is the outline of the ordinance. thank you for your time. speaker: thank you, very much. there are a few questions before we move onto the next presentation. supervisor yee. excuse me. so the next presentation will be from dr. judith martin who is with the department of public health. followed by the public utilities commission, and the police department, finally. so there's three other presenters. if you want to ask questions of any of the departments as they come up, supervisor christensen, would you like to ask the department of environmental a few questions. speaker: i would. if i might ask, mr. raphael just a few -- first my congratulations. it's delightful to see city employees excited in

knowing they can make a difference. i appreciate that. a few technical questions about the implementation. so does the department have an estimate of how many producers are likely impacted by this ordinance? speaker: supervisor, no, we don't have that information. we built into the ordinance, the requirement that wholesalers and distributors and retail pharmacies, their requirements in the ordinance is to inform the department of the environment, who their producers are, so the way we will collect and understanding of all manufacturers that sell covered drugs, and the program is by relying on -- according to the ordinance, our retail partners to provide information to us of who their providers are and wholesalers so we'll

collect that answer based on responses from the retailers and wholesalers or distrib ters. -- distributors. speaker: you don't know how many there are. there's some in nor way and switzerland. you're correct that we don't know that yet. we're looking that we're not the first, so we can look at what's going on in alameda county and king county. they had 250 drug producers, 320, 270. they join together in coalitions. so they had two stewardship plans, not 270 stewardship plans, so those producers then pitch in money to a non profit that creates the stewardship plan. we don't be dealing with hundreds of people. we're dealing, at the end of the day with stewardship organizations.

speaker: let me see if i understand that correctly. we have maybe two or three hundred, assuming alameda did a good job collecting -- speaker: we have two or three hundred companies head quartered all over the world and we're going to use walmart and rite aid and the retailer who's are purchasing from these companies to help identify them self. so some of those drug companies, probably the orders are being placed at their head quarters some where else and some are buying from wholesalers. if you run a small neighborhood pharmacy, you would have to get to your wholesaler who would then have to provide the context information for the drug companies. speaker: you're right. this is not trivial, but it's not impossible. speaker: nothing is impossible. so then you talked a little bit about the idea that they'll be an entity

that would represent these companies. if i'm a swift drug manufacturer and i'm selling in san francisco, so through the pharmacies you're going to find out that i exists and i'm going to get a note if -- i'm going to get a notification from the city of san francisco. speaker: that's correct. speaker: i receive this ordinance that tells me my company must comply, so then -- has the department been able to identify any pharmaceutical representative entity or any organization in the city that might be a -- speaker: good morning. there's two, one -- i'm sorry. speaker: who are you? speaker: i'm maggie johnson

with the department of environment. i'm the project manager for the pilot program. there are two existing organizations that we know of. one is called the pharmaceutical product stewardship working group. i always get it wrong, sorry and then the other is a group that's called, i believe, return meds. and it's actually organized by another product stewardship organization for -- that has focused in the past on rechargeable batteries and it's call to recycle. you might have seen them. both of those organizations have done plans and submitted them to king county. speaker: king county? speaker: king county, washington. speaker: so these groups have a presence in the bay area already? speaker: yes. speaker: so then the city having collected the contact information and

notified the pharmaceutical companies all over the world, is the city in a position then to suggest to the pharmaceutical companies who are located miles away, how they might take a step toward implementing this or do these potential coalition organizations reach out to those companies? speaker: it could be either. i know both king county and alameda county posted the names and contact information on their websites and they receive many calls as a result of the letters. speaker: so legally it's okay for the city -- if you send a notice to zip a flap drug company in ziric and we say we have an ordinance and you're responsible for helping getting rid of your drugs that people don't take, we suggest you contact return meds. speaker: we wouldn't say

suggest, but we know these organizations are providing this type of service. speaker: so then it's up to these pharmaceutical companies which may not have relationships with one another, to then somehow come together and agree on a funding mechanism for this coalition organization. if this was never done before, i would say this is a lot to ask from people. but this is being done all over the world and they know how to come together and they have stewardship programs so it's a question of saying, you've done it now -- you've done it in mexico and british columbia which is not that far away, we want you to do the same thing. speaker: we're accustomed to it. speaker: my last question is, so as you acknowledge being an early adopter of this process, there's a

certain amount of challenge in getting an organization together. i'm familiar with other models so for example, if any of us, you know, have a car accident and we go to the body shop and have our car fix or you get a tune up, there's a waste disposal fee and my understanding is that goes to the bureaucracy. there's a bureaucratic solution where you pay a few cent and that forms a bureaucracy that manages the system. there's people who might profit from -- we have electronic facilities. or there are models where the manufacturer's responsible. if you're a volkswagen in germany, you have to take back the volkswagen.

those are three models that i'm aware. this is new to me because it's the creation of an entity that has to be funded by people. the thing that's interesting to me, we're asking this entity to do outreach, the way we would like or the way you would like to see it done. we're asking them to brand the program, we're asking them to do reporting. and we're asking them to manage a fairly complicated system, so we have a great deal of faith that this tough little ordinance is then going to result in a robust enough organization that they can do this the way we want it. so are there punitive measures that will urge them to be good at what you want them to do? speaker: i will -- yes. there are punitive measures and the models you said -- you're right, there's different models of dealing with things at the end of life. the big challenge comes when you have a commodity with

no value. cell phones, you just take them back to whatever cell phone store you bought them because there's value to them. the problem comes to things like florescent light bulb. the battery industry is doing this on their own. they have the rechargeable battery that does the outreach. so companies are very familiar with this model of producer responsibility. so i don't think that's a problem and you are correct that there are different ones. the issue of enforcement. how do we know they're doing a good job? we have various points along the way of these mild stones where we can check in. the way these ordinances are put together in alameda county and king county and other products like paint and thermostats is the company, the organization that non profit puts a plan that have to get approval from us. is the outreach done to our standards? is the messages correct? is

it confusing? are the convenience -- so we have incersion points. speaker: i'm going to let gilmore talk about our ordinance. it's fairly detail. speaker: basically, can we make it happen? speaker: yes, we have enforcement capacity. we have fine capacity with the civil code to take penalties. i'm sorry, that was a long winded answer. speaker: that's okay. i said that was my last question. i lied. i have one more. the end of life -- the end of product life questions are pretty challenging in many cases. so i think it's also fair to be clear about where all this goes. 15 or 16,000 pounds of material out of our land field is a great accomplishment. but i think it's fair to say, where is all this

going? speaker: absolutely. speaker: i'm glad you brought that up. speaker: because it's not -- there is no way. i mean, that's just the law of -- you cannot create or destroy matter. it gets converted to something else. that's the law of physics and the same with these pharmaceuticals and where do they go? the best available technology is where all drugs go when they're expired drugs, all recalled drugs go to the same place. they go to medical innocent raters for their admissions. speaker: i would love to not have that be the case and we have put in the ordinance, if a better answer comes, we're for it and we want to hear about it. speaker: not only are they incenerated a cross the country. speaker: there's trucks going there with medications everyday because there's tons of medication that

needs to go to that. that's a much attractive solution than going into the environment in some other way. speaker: okay. thank you, supervisor. supervisor yee. speaker: thank you. thank you supervisor christensen for asking the questions. you asked a lot of what i wanted to ask. i'm going to be supportive of this program. i love to share responsible piece of it. as pointed out, day 7 is the only one that has no day or go. when you talk about identifying, as we go forth, the 55 sites, and we were unsuccessful in identifying anything in d 7, how are you going to rectify that?

speaker: it's pretty clear to us that we're going to need a concerted effort to make sure that the producer responsibility organizations are successful in district 7. i don't know why there was such a challenge there, but it will have to be rectified. the nice thing about the ordinance, as gilmore alluded to, there's ways of achieving that help. i may ask for your help. if there are some sites that have some fears or some con ster nation, maybe all of us can go together and see if we can convince them to participate and see what is the issue holding them back. we have the ability to offer residents mail back options, events. there's a lot of flexibility in there that the pharmaceutical companies can work on. speaker: since i didn't know what the other sites are outside of law enforcement, they were probably

walgreens and so forth. it seems ludicrous that certain walgreens are taking certain ones. have i plenty in cd 7. it's all the chains. drug companies are there, so, yeah. i'm hoping it's not an issue. the enforcement piece of this, i know the question has been asked, and i see that kings county, they charge $2,000 a day as a penalty for not complying. i'm just wondering if that's the thought at this point of how we do enforcement? speaker: supervisor gilmore. part of the question is how do you know they're not complying. speaker: certainly, with respect to producers not complying, again, the department will have the names of all of the producers who do sell in

to san francisco. we will also know, which producers are participating in one of the plans that have been submitted. again, the requirement of whole sellers in san francisco or through the state needs to be registered so we know who all the wholesalers are and we can work with them since they have to be registered with the state, so we'll find out who the producers are and who is participate and who is not. the ordinance provides for both civil penalties of up to 1,000 per day. it has been the department's practice that we really believe that producers are going to participate. they want to participate. again, we think that some of the other options that we have and we've discussed them is to be very public about which producer was participating and which producers are not participating and letting the public know that information.

those are the mechanisms, we think are going to be engaged. we look to examples in alameda and in king county that are ahead of san francisco in implementation and in those two counties, we're seeing producers step up to their responsibility and have filed plans and in those two counties, we suspect that producers will want to follow the law in san francisco and i'm sure there's -- there are industry represents for those in the room, and it will be a great question to ask them. if their members are planning to follow the law in san francisco? speaker: thank you, supervisor. speaker: in regards to the two examples of king's county and alameda and maybe -- i'm just curious in terms of when the drug companies actually are participating, what's the cost

to them? speaker: supervisor, we don't have that cost information for alameda or king county. what we have is a sense of what our cost are as a department to run our program. you heard supervisor breed in her opening statement give a range based on kind of our program and what potential cost could be, but we don't have a specific budget. speaker: it didn't sound like it would be a lot per company if there's 250 companies and i think i heard a figure of 200,000 as the cost which means they're only paying 5,000 a company. speaker: potentially that small. speaker: the amount they make by selling ten pills. speaker: potentially, yes.

speaker: this one, i don't know who to ask, but it's one thing to say that we're collecting tons of pills, and i guess in my mind, there are probably some pills that are worse than others for the environment. i'm curious if there's, as you collect them, do they actually tell you what kind of pills are being collected? speaker: we did -- legally we're not allowed to do that. so system is once it's in there, you're not allowed to touch it because if you touch it, then you could have that diversion that they're worried about of pills going in. we did do a study looking at pills and it's a wide variety in san francisco. do you know the percentage of controls? about 10% of what we collected -- what we did was got permission to actually work with recology once we collected them

to sort them. it was very time consuming and about 10% are controlled substances by weight. speaker: yeah, the question wasn't asked to look at individuals, but -- speaker: as a whole we think it's 10% controlled substance and the other is -- if it's not a controlled substance it can have the ability to disrupt -- this is the problem drugs are by definition bio active. that's what they're designed to do, so when they get into the environment, they are bio active there as well. speaker: thank you very much. speaker: thank you very much, supervisor yee. next i'd like to invite up dr. judith martin, the deputy of health services and medical director of substance use services as the department of public health. speaker: thank you, president breed and chairman yee and supervisor

christensen. i was asked to talk about the effects in the interface between this pioneering ordinance and my field which is addiction. and i'm trying to close this slide so i can open mine. thank you. there was a survey done that was published in the medical literature last year about unused prescription medications and the reason i included it here is because it's specific to california which is hard to find. and the -- there were approximately 2 of 3

prescription medications reported to be unused. and the reasons for that were the disease or the condition improved and they were no longer necessary which suggest that maybe some of our prescribing -- it was the reason they weren't using their medications. thrown in the trash was the most common method of disposal which was government's advice not too long ago to mix it with kitty litter and make it not identifiable. people are dying from analgesics or pain overdose. if