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 is a no brainier. well fair groups and recovery addictions and others have chime -- have chimed in to support this. vote yes and approve and send this with full recommendation to the board. thank you. speaker: thank you. and now i'm going to call speaker cards starting

with maria muni. if you can line up to my left. i'm going to call a couple of other names. jenny, and michael lion, david grant. i don't know if this is michael or michelle. the last names is lion from the great panthers. starting with mara. speaker: i want to thank breed for your leadership and for considering this policy. i do urge you to support the drug take back legislation. excessive waste has been proven to impact our environment and we're seeing pharmaceuticals reaching alarming levels in the bay including antibodies and anti-depressants and

anxiety reducers. these are major food source for bay area species. and we can expect to see these chemicals, bio accumulating and top consumers here such as sea lions and sharks and harbor -- our local species are sensitive to synthetic hormones. this release of these products may cause reproductive failure in the population. because of their nature, pharmaceuticals can have adverse effects on wild life even at low concentrations and we know the effects of this pharmaceutical pollution and we need to take preventive action from happening in our bay. there's an environmental need, but there's a public need as well. the number one -- the top visited page at save the bay website is

information regarding pharmaceutical disposal. this is something the public is seeking out to protect the environment and do the right thing. and obvious leap the pilot program has had a lot of success and has kept about 50,000 pounds of chemicals out of our bay. we do urge that the committee accepts this proposal. speaker: thank you. next speaker, please. speaker: hi, my name is jenny and i'm here from safe the bay. i want to thank you for considering this policy to protect public health and the environment. we're here to support this proposed take back drug legislation. save the bay has been concerned with pollution in the bay for over 50 years and we've addressed pollution already that's there such as plastic bags and styrofoam and san francisco has taken leadership in the past. we believe today,

pharmaceutical disposal is a threat to bay water equality. it's not appropriate -- to fall only on the city. the industry needs to take responsibility as well. an extended model has been implemented in other systems. this isn't a new concept such as car tires and motor oil. this has been tried before. the problem arising from improper pharmaceutical products should not be -- san francisco has been leading in the past such as the plastic bag ban and it's important for san francisco to lead in this area. we urge this supervisors to accept this proposed and i just wanted to reiterate that to save

the bay -- it's highly visited so we see interest in participating in this sort of program. thank you. speaker: thank you, very much. next speaker please. speaker: good morning, supervisors. my name is david grant. thank you for the opportunity to come today. i'm here on behalf of the california alliance and the cochair along with michael lion of the san francisco chapter. a number of our members are here in the room because we were the organizational sponsor for this bill when it was in sacramento and we fought for two years through hearings and stakeholder meetings and delayed before the drug industry killed the measure. we're urging those in san francisco to take it up. in san francisco, this morning, there's 117,000 people over 65 who on average take up to 10 prescriptions a piece. that means that right now, there's over

100-0000 of these -- there's 1 million bottles sitting on people's kitchen sink. you don't know when it expires. looking at this -- when you grab it off the shelf in the middle of the night because you have a pain or problem, that's a real formula for disaster. i do know that too many seniors are in the same boat not knowing what's in the bottles and what's the problem. this is a serious issue. my mother, a former nurse put herself in the emergency room three times because of what medication she had forgotten. as we heard earlier, often times this might be good for you. or maybe not. children in the home especially they're young and teenagers can