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 you use them repeatedly, you become depend on them and addiction have followed these curves as they're shown here. we have a little bit of san francisco statistics about the deaths and supervisor breed mentioned this earlier. 127 prescription poisoning deaths and out of those, most were op -- they're sedatives used in mental health. there was one study done on prescription opioids cost. it showed a 55 billion cost to the united states in 2007. some was work place and some were health care and

some was criminal justice. the national institution of drug abuse asked what was their first a -- young people use pills as well. this is from the modern of future studies that looks at high school. kids, basically. and they're using various prescriptions, vicodin, sedatives, oxy cotton and ritalin. it's not just people on the street addicted, but it's young people taking some of these pills. and when they're asked about where they got the pills, many of them are taking their

own leftover medication. so again, you are prescribing practices. we have to look at that and we are looking at that. and some of them received them from a dentist or an emergency room doctor, and other kinds of physicians. and then other diversion sources, here's that word again, when somebody who is taking it not as prescribed, and not the right person, internet, friend or relative is very high. so people share drugs. sometimes for free and sometimes bought. and then another 20% or so from drug dealers. this is from the adolescent health literature. these are the things we try to make opioids safer and the take back program fits into this. so we're supportive of this ordinance. and this is my

effort to show all the things that it has done in san francisco over the years on opioids safety. we certainly worked hard on predicting the disease and the exposure to opioids starting in the 90s with needle safety and heroin use, and then including -- including in mental health clinic and specialized clinic like methadone clinics and then in 2009, we started looking in the city, and even though these are arrow points, system changes are more like clouds because somebody has a good idea, then we talk about it, then eventually it happens, but this is my estimate of when things started and there's a pain management work group that talks about safe prescribing. the physicians are

stepping up and taking responsibility for changing our prescribing practices and educating the patients we see about that. and florida was the first state to show an actual drop in overdose deaths and this was, even though we don't have proof of what caused it, we think that it was the massive efforts in the state to reduce the availability of opioids. so even though it's hard to prove that an ordinance like this stops deaths, we suspect that it -- it doesn't mean we shouldn't do it just because we can't prove it. so this survey was done at a community take back in 2003 and notice there were almost 800,000 pills that were worth over $1 million that were collected and they surveyed 818 people and

common reasons for disposal is there were discontinued medications. and they noted that dozing in month units and maybe we should shorten that and also if you mail order, you get three months at a time. blood pressure, stomach and pain relievers were the most therapeutic categories. a family medicine pharmacy had an initiative of handing people envelopes and seeing if they would pay a small fee for an unwanted, unused or expired medication and most of them, again, said that they put it into the garbage or stored it or stock piled it at home and even though some of these envelopes were sold to participants, only out of the ten who bought them, only four of them used them. so there was -- there probably

will need to include some education of the public on how to do this. i also many including poison control statistics that i received from patty hyatt. these are her numbers. and some of these were already quoted by supervisor breed. exposers is defined as contact of a substance regardless of how it showed up and information calls don't say whether someone was exposed or not, but they received roughly 6,000 contacts from the -- in san francisco, in 2014. and then they ask what happened. what the medical outcome of those exposures were in 2014. and some of them resulted in deaths, most of them had a minor effect or a minor effect was expected from the

exposure. and the pharmaceutical categories that resulted in these calls, it's right up there. this over lapse the marketplace where my clients sometimes get their drug of abuse. thank you. speaker: thank you very much. any questions, from colleagues. not at this time. okay. so we have just two more presentations. i know we have a lot of anxious people who are here to provide public comment so we'll move on and i would like to invite kerry, the resource recovery manager at the public utilities commission to come forward. speaker: hi, i'm actually laura pagona and i'm the regulatory program manager for the public utility commission. carry would be a delightful person to be here, but she was called away. so i'm delivering remarks on

behalf of the sffpuc. because there's no permanent reliable drug disposal option, san francisco residents are left with a choice to throw them in the trash or flush them into the sewer system. this is harm to the pacific ocean and the bay. our system is -- it's not designed to process these drugs. in the past the sffcc has programs including mail programs and temporary collection events. these efforts are costly. one collection event can cost $2,000 and the mail back envelopes cost approximately $3.75 each. we fill the pharmaceutical industry some take responsibility for managing their product, not local

jurisdiction. they keep old and expired medications out of our waste streams. i'm happy to take further questions that you might have. speaker: nope. we're good. thank you for coming. last we're joined by lieutenant jim. the head of the san francisco's police department narcotics union -- unit. speaker: good morning, supervisors. it's hern, but that's okay. it's only a last night. i'm not here to give a presentation, but i'm here to represent the san francisco police department and express our support for this ordinance. prescription drug abuse diversion drug overdoses are increasing in the united states. this ordinance is an important step to address this

complex problem. safe, convenient and proper destruction of unused or expired medications is a key step to prevent diversion or drug abuse. this ordinance will help prevent prescription medication from falling into our children's hands or polluting the environment. and the san francisco police department is happy to continue collecting prescription medications at the ten district stations and we'll continue to participate in the program and the stewardship ordinance. so we're looking forward to the participation. speaker: great, thank you. i appreciate you being here today. and so i would like at this time to open it up to public comment. i know we have a lot of distinguished guest here today. i would like to call of dr.

roger with the medical society followed by heidi with the california produce stewardship council and then followed by bruce wolf with the alcohol justice and then i'll start calling additional names. speaker: thank you, madam president and supervisors. i just want to -- i'm dr. roger and i'm friends the medical study and chief radiology -- i want to stand up here on behalf of the medical students who support the concept of a take back drug program that's financed by the pharmaceutical company. i won't be labor the points that have been stated previously. we do concur this is a public health epidemic that as we increase different effective drugs to treat patients that

correspondingly they'll be increased waste that goes with that. they're lacking programs currently as to how to dispose of them that does eventually reach our land field, reach the water system and then goes back and becomes a public health program. one suggestion that has come up regarding the issue of effectively, if you do you have a program and you expand the pilot program, we would love to help out with is perhaps expanding beyond the pharmaceuticals to expand to major health care facilities and some of them will be willing to participate in taking back those drugs since we are involved in delivering those drugs. it's a roundtrip circuit of the whole product. and the society would be very much interested and willing to help facilitate that as appropriate.

we wanted to rise here and express our support. we believe it's an allotable goal and the time now is to affect change and both help our environment and our patients including our youngest most vulnerable children, our children. thank you. speaker: thank you very much. good morning supervisors. i'm heidi, we're formed in 2007 and we're dedicated to building partnerships and recyclable problems sustainable. we tried 2010 when i presented to develop partnerships and offer voluntary approaches and pilot projects and we've never been taken up on that project. san francisco is one of many founding members of the product stewardship council and we have made great process. resulting in new programs,

state wide for carpet, paint, thermostats and mattress and had industry support. californians has paint and other products returned to the stores to where they bought it, which is where they would like to go. i've traveled to british and ontario canada, where they fund the programs effectively and even for sharps in ontario. they're experts at managing their products and -- to design and operate these programs. reversal is an area of the expertise and i received an e-mail that the reversal district association developed qr codes and they're testing them now to make it easier for any producer to show them how to return their products for proper

disposal. i'll jump to outcomes. in british columbia, they operated their program for 15 years successfully. annual cost are less than $1,000 per pharmacy. in 2011, it cost just over $5,000. between 2009 and 2013, they've seen 81% in medicines collects. i can go on. speaker: thank you for being here. mr. wolf. speaker: good afternoon. my name is bruce wolf with alcohol justice. i have letters of support here from our organization and from others concerned about this issue. let me take off my glasses. national capital poison center reported in 2013, unintentional

poisoning from prescription drugs accounted for 77% all over injuries and of that, 44% were to children. this was just in the washington dc metro area. alcohol justice, our mission is to reduce harmful effects of family. we want producers to take shared responsible for the harm our products have caused to our friends and families. we were awarded with a federal program and have added prescription drugs as the next harmful substance to our list effecting kids and their families and the environment, not to forget to mention seniors and those with disabilities and family pets. in san francisco, we had a huge victory in san francisco banning all alcohol bans. with these prevention legislation, this prescription disposal