Coalition for Safe Community Needle Disposal

1. Coalition for Safe Community Needle Disposal Product Stewardship Institute SAFE COMMUNITY NEEDLE DISPOSAL Stakeholders Conference

2. History of Coalition Bloodborne Pathogens Standard- In 1990, OSHA issued a standard designed to prevent health care (and other) workers from being exposed to bloodborne pathogens such as Hepatitis B, Hep C and HIV Multiple OSHA enforcement actions and threshold question of whether waste workers were reasonably anticipated to be exposed WM wanted to move towards primary prevention eg segregate sharps from municipal solid waste(MSW=household trash) similar to HHW CDC engaged WM in dialogue in 2000 Coalition for Safe Community Needle DisposalCoalition for Safe Community Needle Disposal

3. Sharps Statistics 9 million Americans self-inject prescription drugs. 1 in 12 homes in the U.S. houses a self-injector. 3 billion needle injections occur yearly outside of medical facilities (at home, work, while traveling). 2 billion injections are self-administered by patients using prescription drugs to treat chronic illnesses. 1 billion injections are attributed to individual injection drug users (IDUs) using illicit drugs.

4. Why Billions of Needles? • Increasing U.S. population, average life span. • Increase in incidence of chronic illnesses • Incidence of obesity and diabetes growing rapidly-21 million have DM currently and # growing • Patient care pushed out of medical facilities. • Pharmaceutical industry pipeline of injectable drugs developed and marketed to treat chronic illnesses.

5. And The Problem Will Only Get Worse… Unchecked, a number of factors will conspire to exponentially increase needle use/waste/sticks and their personal/social/economic consequences. 4x 3x Needle Users  Needles  Waste  Sticks 2x • Demographics • Diseases • Self-Injectable Treatments 1x Today 10-20 Years …Unless We Work Together on Solutions

6. Coalition – First 2 Years January 2001: Safe Community Syringe Disposal: Understanding the Barriers and Creating Solutions was held in Washington, D.C. Hosted by Dr. Steve Jones, CDC January 2002: Similar Meeting. BD and WM agreed to provide start-up funding for Coalition. SCI was third Board member April 2002: Coalition Officially Launched (founding members Included: ADA, AMA, APhA, NASTAD, AADE, NASTHO, BD, WM, SCI February 2003:New Members Join the Coalition (US Conf. Of Mayor, NACDS, NSWMA, NAHC, NACCHO, NRC)

7. Coalition Agenda Call to Action letter Advocate to EPA to re-write Federal guidelines for at-home needle disposal (completed 12/04) http://www.epa.gov/epaoswer/other/medical/sharps.htm Advocate to individual States to create legislation re-writing non-regulated medical waste regulations to ban sharps from MSW Advocate to pharmaceutical and medical device industries to develop sharps disposal solutions for all self-injecting drugs Assist communities to develop needle disposal programs Advocate for development of reimbursement strategies

8. Coalition – Past 4 Years February 2004: CA Introduces Bill Encouraging HHHW Facilities to Accept Sharps (Passed – Implemented 2005) September 2004: NJ Introduces Syringe Access Bill with Needle Disposal Component (Did not Pass – Reintroduced next session) December 2004: EPA Issues New Recommendations on Safe Needle Disposal June 2005: HR 2841 (Medicare Bill) Introduced in House by Ferguson/Strickland (Did not pass) February 2006 – CA Introduced Bill Making it Unlawful to Throw Needles in Household Trash (July 2006 Passed – Have until Sept. 2008 to Comply)

9. Coalition – Past 6 Years June 2006: S 3604 (Medicare Bill) Introduced in Senate by Isakson (did not pass) July 2006: MA Passed Syringe Access Bill that Includes New Needle Disposal Component December 2006: NJ Passes Syringe Exchange Bill with Needle Disposal Component February 2007: CA Introduces AB 501- a Bill that Requires All Pre-filled Syringes Provide Needle Disposal Solution by Pharma 2007: on-going discussions with retailers

10. Coalition – Past 6 Years Summer 2007: Louisiana passes legislation S 224 making it unlawful to throw syringes/needles in household waste July 2007: Senator Isakson and Representative Ferguson re-introduce Medicare Bill for needle disposal reimbursement September 2007: Began working with PSI January 2008: NH Introduces legislation to remove needles from the household garbage and January 2008: Novo Nordisk (Pat Quinn) joins the Coalition Board of Directors February 2008: MS introduces legislation to remove needles from household garbage (currently waiting for Governor’s signature)

11. Problem: Improper Disposal of Needles U. S. Survey on People With Diabetes indicates: 93% of responding self-injectors dispose of their used syringes in the trash 4% placed syringes in puncture-resistant containers 3% flushed syringes down the toilet Most sharps end up in municipal solid waste!

12. Problem Impact: Accidental Needle Sticks Household residents (family members, guests, pets) General population in public venues (airports, casinos, hotels, parks, restaurants, stadiums, stores) Workers in various service industries Environmental Services (janitorial, recycling, waste disposal, water treatment) Hospitality (hotels, theme parks, stadiums, casinos, airports) Retail (stores, restaurants)

13. Improper Disposal In Many Forms/Locations Improper Disposal: Many Forms/Locations

14. “Cost” Impact of Accidental Needle Sticks • Physical/emotional trauma to individual • Cost of diagnostic testing and preventive treatment regimens ($500-$10,000 per incident) • Transmission of pathogenic diseases (HIV, HEP B & C, etc.) leading to preventable morbidity and mortality • Life-long utilization of medical care and need for income replacement • Lawsuits, litigation and settlements

15. Types of Needle Disposal Programs Community-Centric Needle Disposal Programs - Drop Box Collection Sites - Residential Special Waste Pick-Up - Household Hazardous Waste Programs - Syringe Exchange Programs Patient-Centric Needle Disposal Programs - Disposal by Mail Programs - In-Home Individual Disposal Products (needle destruction devices)