PSI National Dialogue on
Medical Sharps
Boston, MA
May 21-22, 2008
© Product Stewardship Institute, Inc.
May 2008
What is the
Product Stewardship Institute?
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Non-profit, based in Boston, founded in 2000
Membership
 44 State members
 51 Local agency members
 20 Adjunct Council members
Board of Directors: 7 states, 4 local agencies
Multi-stakeholder product stewardship network
Adjunct Council: business, environmental/organizational
© Product Stewardship Institute, Inc.
May 2008
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PSI Full and Affiliate State Members
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Why was the Product Stewardship
Institute Created?
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Unified voice: State and Local Governments
Fiscal relief for government on waste issues
Objective data for decision-making
Forum for collaboration with industry
Nationally coordinated systems/harmonized
regulations
© Product Stewardship Institute, Inc.
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PSI Projects
 Medical Sharps
 Telephone books
 Pharmaceuticals
 Gas Cylinders
 Fluorescent lamps
 Tires
 Mercury Thermostats
 Beverage containers
 Paint
 Packaging
 Electronics
 Batteries
 Radioactive Devices
 Motor oil
© Product Stewardship Institute, Inc.
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What is Product Stewardship?
“Product Stewardship" is a principle that
directs all those involved in the life cycle of a
product to take shared responsibility for
reducing the health and environmental
impacts that result from the production, use,
and end-of-life management of the product.
© Product Stewardship Institute, Inc.
May 2008
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PSI Role in Dialogue
 Research
 Facilitate/mediate dialogue meetings
 Implement projects & initiatives
 Evaluate projects
© Product Stewardship Institute, Inc.
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PSI’s “Agenda”
• Promote product stewardship solutions
• Reduce product impacts
• Forge partnerships that share responsibility
– Product management
– Sustainable financing
• Get results – not just discussion
© Product Stewardship Institute, Inc.
May 2008
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Meeting Objectives
• General agreement on:
– Stakeholder roles/process
– Issue statement
– Dialogue goals
• Confirm road map
© Product Stewardship Institute, Inc.
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Meeting Objectives
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Learn from presentations and research
Explore priority issues and strategies
Establish work groups on 2 priority strategies
Determine next steps
– Meeting date/location
– Stakeholder assessment
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Priority Issues and Strategies
#1 – Source reduction
#2 – Collection, transportation, and disposal
infrastructure
#3 – Regulation and enforcement
#4 – Sustainable financing
#5 – Education, outreach, and risk
communication
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Stakeholder Roles
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Authorized to represent company, agency, or organization.
Attend 4 meetings (or via phone).
Active participation between meetings.
Jointly develop agreement.
Ensure your interests/others’ interests are met.
Participation in dialogue does not preclude legislative
activity.
• Negotiate in good faith.
© Product Stewardship Institute, Inc.
May 2008
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Consensus
• All participants can live with decision and no
one will actively block or undermine decision.
• The greater the stakeholder agreement, the
greater the likelihood that the agreement will
be sustainable.
© Product Stewardship Institute, Inc.
May 2008
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Consensus
• Consensus is preferable for broad initiatives:
– Technical standards
– Policies
– Legislation
• Consensus is NOT needed for pilot projects or
individual initiatives.
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Road Map
MEETING 4
AGREEMENTS
• Finalize agreements
•2 Workgroups
•Develop
findings
•Draft work plans
MEETING 1
START
• Develop
Implementation Plan
•Refine draft
agreements
MEETING 3
• Present Workgroup findings/plans
• Discuss additional strategies
• Start to develop draft agreements
MEETING 2
•Refine Workgroups
•Develop Findings
•Draft work plans
•Present Workgroup
findings/plans
• Full financing discussion
•Discuss additional strategies
May 2008
© Product Stewardship Institute, Inc.
May 2008
August 2008
November 2008
PSI Medical Sharps Dialogue Meeting
Workgroup
Activity
Dialogue
Meeting
February 2009
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Possible Dialogue Outcomes
• Pilot projects with measurable results
• Demonstration project to test comprehensive
program
• Model state policies (e.g., procurement)
• National standards/requirements
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Possible Dialogue Outcomes
• Business innovations/profitability studies
(e.g., reverse logistics potential)
• Model state or federal legislation
• Model state or national education campaign
• National sustainable financing system for the
management of medical sharps
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Possible Mechanisms
for Agreements
• Letter of agreement between those
involved in pilot project
• Memorandum of agreement between
stakeholders stating intent to perform
certain activities
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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What do we want to avoid?
• Multiple state solutions
• Unilateral state or federal regulation
© Product Stewardship Institute, Inc.
May 2008
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Potential Stakeholder Contributions
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Manufacturers (sharps and pharmaceuticals)
Pharmacy benefit managers/third party payers
Insurers
Retail pharmacies
Government agencies
Public health/other associations
Waste management companies
© Product Stewardship Institute, Inc.
May 2008
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Potential Contributions:
Sharps Manufacturers
 Develop/promote sale of products with safety
features
 Increase public awareness about importance
of safe disposal and collection locations
 Produce/sell approved sharps disposal
containers for sale with sharps products
 Manage and finance safe collection of
medical sharps
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Potential Contributions:
Pharmaceutical Manufacturers
 Develop/promote sale of products with safety
features
 Increase public awareness about importance
of safe disposal and collection locations
 Require self-injected products to be
accompanied by approved sharps disposal
container
 Manage and finance safe collection of
medical sharps PSI Medical Sharps Dialogue Meeting
© Product Stewardship Institute, Inc.
May 2008
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Potential Contributions: Pharmacy
Benefits Managers/Third Party Payers
 Require self-injected products to be
accompanied by approved sharps disposal
container
 Increase awareness of importance of safe
sharps disposal and collection opportunities
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Potential Contributions: Insurers
 Reimburse costs of sharps disposal
containers and collection/disposal of sharps.
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Potential Contributions:
Retail/Mail Order Pharmacies
 Increase public awareness about importance
of safe disposal and collection locations
 Collect used sharps on site or via mail-back
 Provide coupon as incentive to return used
medical sharps for disposal
 Promote sale of products with safety features
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Potential Contributions: Government
 Oversee manufacturer collection programs
 Increase public awareness about importance
of safe disposal and collection locations
 Regulation/enforcement to level playing field
and maintain fairness
© Product Stewardship Institute, Inc.
May 2008
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Potential Contributions:
Government, cont.
 Require that sale of self-injected products
includes safe sharps disposal
 Provide existing facilities for safe consumer
collection convenience
 Explore tax credits or other opportunities to
encourage private sector participation in sharps
disposal programs
 Explore public financing options
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Potential Contributions:
Waste Management Companies
 Increase awareness of importance of safe
sharps disposal and collection opportunities
 Provide safe transport and treatment for
sharps disposal
© Product Stewardship Institute, Inc.
May 2008
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Process for Developing Action Plan
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Draft Problem Statement and Goals
Issues/Strategies
Interviews/input from over 35 stakeholders
Input incorporated into Action Plan
Draft Action Plan/comments
Input on 2nd Draft Action Plan – due 2 weeks
NOT PSI’s Issue Statement and Goals
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Issue Statement
• Sharps are used for self-injection and blood
glucose testing by people with diabetes,
patients administering their own medications,
and injection drug users.
• Sharps used in the “community” typically end
up in MSW, recycling, or wastewater
• If not properly disposed of, sharps can pose a
hazard to sanitation workers, others
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Issue Statement
• Sharps may also be left in public places
• Sharps may damage or disable equipment
• Problem is expected to increase as number of
people with diabetes rises and “biologic”
drugs expand markets
© Product Stewardship Institute, Inc.
May 2008
PSI Medical Sharps Dialogue Meeting
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Dialogue Goal
The primary goal of the project is to
maximize the safe and environmentally
sound collection and disposal of waste
sharps by developing a nationally
coordinated system that is financially
sustainable.
© Product Stewardship Institute, Inc.
May 2008
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Dialogue Focus
This project will focus on sharps generated
outside the traditional health care setting,
including households, hotels, casinos,
restaurants, airports, and other public
venues.
© Product Stewardship Institute, Inc.
May 2008
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Purpose of Presentations
 Educate attendees on basics
 Outline current boundaries of knowledge
 Illustrate product stewardship
 Show potential for collaboration
 Portray possibilities
© Product Stewardship Institute, Inc.
May 2008
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Issue/Strategy Discussions
 Background technical information
 Clarify issues and strategies
 Additional strategies
 Prioritize strategies
 Workgroups at end of 2nd day - top 2 strategies
© Product Stewardship Institute, Inc.
May 2008
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