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1

Annual Report

on the

Ontario Medications Return Program

and the

Ontario Sharps Collection Program

for the period of

January 1, 2020 ʹ December 31, 2020

Submitted to:

Charles O'Hara

Resource Recovery Policy Branch

Environmental Policy Division

Ministry of the Environment Conservation and Parks

Prepared by:

Terri Drover

HPSA Director General

March 31, 2021

2

Contents

Definitions ..................................................................................................................................................... 3

Executive Summary ....................................................................................................................................... 5

I. 2020 HPSA Members ............................................................................................................................ 6

II. 2020 Collection Locations ..................................................................................................................... 6

III. Overview of the Collection and Disposal Process ............................................................................. 7

IV. 2020 Collections ................................................................................................................................ 8

A. Pharmaceuticals ................................................................................................................................ 8

Table 1 - Program Performance ʹ Report on Collection of Pharmaceuticals by Quarter ..................... 9

B. Medical Sharps .................................................................................................................................. 9

Table 2 - Program Performance ʹ Report on Collection of Medical Sharps by Quarter ..................... 10

V. Public Education Materials and Campaigns ........................................................................................ 11

A. Collection Locations ........................................................................................................................ 11

B. Website and Social Media ............................................................................................................... 11

C. Municipal Outreach in Ontario ....................................................................................................... 13

D. National Campaigns ........................................................................................................................ 14

1) Institute for Safe Medication Practices Canada .......................................................................... 14

2) Drug Free Kids Canada ................................................................................................................ 15

Appendix 1 - HPSA Members ʹ OMRP .................................................................................................... 17

Appendix 2 - HPSA Members ʹ OSCP ...................................................................................................... 19

Appendix 4 - Samples of HPSA Materials ................................................................................................ 23

Appendix 4 (continued)- Samples of HPSA Materials ........................................................................... 23

Appendix 5 - Producer Member Websites .............................................................................................. 25

Appendix 6 - List of Registered Pharmacies with OMRP & OSCP ........................................................... 30

3

Definitions

The following terminology is used throughout this document: Collection Sites Community pharmacies registered in the HPSA programs to collect unused and/or expired Pharmaceuticals and used Medical Sharps returned from the public. Pharmaceuticals Products sold directly to consumer and include:

Prescription drugs

Non-prescription drugs

Natural health products

Member Brand-owner/steward/producer who is a member of the Health

Products Stewardship Association (HPSA).

Medical Sharps Ont. Reg. 298/12 - "A needle, safety engineered needle, lancet or other similar instrument that is designed to puncture the skin of individuals or companion animals for medical purposes and that is sold to consumers in Ontario, whether it is sold by the producer of the sharp or by any another person, and includes anything affixed to the sharp, including a syringe" For the purpose of the Ontario Sharps Collection Program (OSCP) Plan, a medical sharp shall be generally defined as a. Infusion sets with needles attached. b. Lancets, including safety lancets. c. Needle tips. d. Needles, including safety needles. e. Pen only with needle attached. f. Pen needles. g. Prefilled cartridges only with needles attached. h. Pre-filled syringes only with needles attached. i. Safety pens only with needles attached. j. Syringes only with needles attached.

Natural Health

Products

Under the Natural Health Products Regulations, natural health products (NHPs) are defined as:

Vitamins and minerals

Herbal remedies

Homeopathic medicines

Traditional medicines such as traditional Chinese medicines

Probiotics

Other products like amino acids and essential fatty acids NHPs must be safe to use as over-the-counter products and do not need a prescription to be sold. 4 Non-prescription Drugs Non-prescription drugs do not require a prescription of a practitioner under Section C.01.040.03 of the Food and Drugs Regulations in order to be sold and are not listed in the Prescription Drug List established under Section 29.1 of the Food and Drugs Act.

Examples include:

1) A drug available from a pharmacist but does not require a

prescription. These are the drugs located in the area of the pharmacy "behind the counter", where there is no public access and no opportunity for patient self-selection or

2) A drug which does not require a prescription and is available

for self-selection from the area of the pharmacy under the direct supervision of the pharmacist or

3) A drug that may be purchased from any retail outlet (such as a

grocery store)

OMRP Ontario Medications Return Program

OSCP Ontario Sharps Collection Program

Prescription Drugs A drug requiring a prescription for sale in Canada Regulation Collection of Pharmaceuticals and Sharps ʹ Responsibilities of Producers ʹ 298/12 ʹ Environmental Protection Act Producer Means a brand owner or first importer under HPSA membership criteria 5

Executive Summary

Since 2013, the Health Products Stewardship Association (HPSA) has been administering the Ontario Medications Return Program (OMRP) for Pharmaceuticals (prescriptions drugs, non- prescription drugs and natural health products) as well as the Ontario Sharps Collection Program (OSCP) for Medical Sharps that are sold in the province of Ontario through the "consumer/residential" waste stream. These programs are operated under the principles defined by Ontario Regulation 298/12

Collection of Pharmaceuticals and Sharps ʹ Responsibilities of Producers, which is Ontario's first

and only Extended Producer Responsibility regulation created under the Environmental

Protection Act (EPA).

The OMRP and OSCP are designed to ensure that collection sites are available to all municipalities of the province so that any unused and/or expired Pharmaceuticals and used Medical Sharps returned by the public can be properly collected, packaged, handled, transported and disposed of in a safe, compliant and environmentally responsible manner.

2020 has been a difficult year due to the pandemic. Although collected weights have decreased

from 2019 (-7% for Pharmaceuticals and -10% for Medical Sharps), the collection network remained strong: In 2020, a total of 4,146 Ontario retail pharmacies or 91.2% of total accredited pharmacies in Ontario were registered as HPSA collection sites. HPSA would like to express its gratitude to the pharmacy community for supporting both of these collection return programs during these challenging times. 6

I. 2020 HPSA Members

Section 9 (2) 1 ʹ The name of each producer on whose behalf the report is prepared. The list of producers/members for Pharmaceuticals is attached in Appendix 1. The list of producers/members for Medical Sharps is attached in Appendix 2. Under Regulation 298/12, producers are required to have a link on their website that takes consumers to the HPSA website where information on the OSCP and OMRP can be found. A list of HPSA producer/member website links can be found in Appendix 5.

II. 2020 Collection Locations

Section 9 (2) 2 - The number of collection locations and the location of each of the collection locations at which collection of the designated material of the producers was provided for by all of the producers and a description of any changes that occurred with respect to the number and location of collection locations from the previous calendar year. The collection sites for both the OMRP and the OSCP are community pharmacies (listed in

Appendix 6).

Each HPSA collection site has signed a Collection Location Agreement or CLA detailing procedure for collection, handling and storage of Pharmaceutical and Medical Sharps received from the public. In accordance with Section 4 of the Regulation, HPSA ensured that the number of collection locations is at minimum equal to 90% of pharmacies in Ontario, as of October 1 in the preceding calendar year. The Ministry of the Environment Conservation and Parks website posted 4,543 as the number of registered pharmacies that were eligible to participate in the

OSCP and OMRP.

As of December 31, 2020, 4,146 active pharmacy collection locations in Ontario were registered with HPSA and had returned designated material in the last 12 months. In the previous calendar year, the number of registered and active retail pharmacies participating in HPSA's stewardship programs was 4,132. 2020 saw an increase of 14 retail pharmacies participating in the HPSA programs versus the previous year. The participation rate of total eligible collection locations in the combined programs in

Ontario was 91.2% at the end of 2020.

In accordance with Section 4 (2), there is at least one HPSA collection location in every municipality in Ontario. 7 Section 9 (1) 6 - A description of any actions taken by the producer during the previous calendar year that exceeded the actions required for the purposes of section 4, in order to provide for the collection of the designated material of the producer. HPSA contacted by mail and e-mail all non-registered, eligible retail pharmacies to introduce outreach is between 5 to 10 pharmacies a day.

4.3 A producer of a pharmaceutical or sharp shall ensure that at each collection location at which the

producer provides for collection of the designated material of the producer, the collection is (a) available free of charge to consumers

b) not subject to any limitations with respect to the quantity of the designated material of the producer

that a consumer may bring for collection; and

c) if the collection location is in a pharmacy in respect of which a certificate of accreditation is in effect

under section 139 of the Drug and Pharmacies Regulation Act, available during the business hours of the

pharmacy. HPSA delivery and pickup services are provided to all registered collection locations and the public at no cost. HPSA take back programs generate extra retail traffic at participating pharmacies. Guidelines are reviewed by pharmacy staff upon registration and HPSA develops specific brochures for pharmacy staff. III. Overview of the Collection and Disposal Process Section 9 (1) 4 - A description of how the designated material of the producer collected at collection locations was handled and how it was disposed of during the previous calendar year. 8 Unused and/or expired Pharmaceuticals collected through the OMRP are packaged in lined, reusable, 60L pharmaceutical HPSA branded waste containers (MRP containers) at the collection locations. When ready for shipment, collection locations tie off the container liner, secure the lid to the base and arrange for shipment. The service provider contracted by HPSA (Stericycle, ULC or ECS Cares) transports the waste to an HPSA approved disposal site where the Pharmaceuticals and any associated packaging are incinerated. Once emptied, the MRP containers are cleaned and inspected for reuse; every year an average of 11% are deemed unsuitable for further use. The approved disposal facility is managed by Stericycle ULC. Used biomedical sharps collected through the OSCP are received from consumers in sharps containers labelled with a Biohazard symbol. At the collection location, these sharps containers are packaged in a secondary containment packaging in the form of a corrugated cardboard box with the universal Biohazard symbol on the outside and lined with a 2 mm plastic bag. When ready for shipment, collection locations tie off the box liner, seal the box and arrange for shipment. The service provider contracted by HPSA (Stericycle, ULC or ECS Cares) transport the boxes of biomedical sharps to an HPSA approved disposal site where the boxes of biomedical sharps/sharps containers are autoclaved. The approved disposal facility is managed by Daniels Healthcare. Used cytotoxic sharps collected through the OSCP are received from consumers in sharps containers labelled with a cytotoxic symbol. At the collection location, these sharps containers are packaged in lined, corrugated cardboard boxes with cytotoxic labelling on the outside. When ready for shipment, collection locations tie off the box liner, seal the box and arrange for shipment. The service providers contracted by HPSA (Stericycle, ULC. or ECS Cares) transport the boxes of cytotoxic sharps to an HPSA approved disposal site where the boxes of cytotoxic sharps and sharps containers are incinerated. The approved disposal facility is managed by Daniels Healthcare.

IV. 2020 Collections

A. Pharmaceuticals

Section 9 (2) 3 - The total weight of all of the following that was collected at the collection locations during the previous calendar year: i. Pharmaceuticals. ii. Containers described in paragraph 3 of section 2, excluding any containers that were recycled. In 2020, a total of 19,040 MRP containers were supplied to the HPSA collection network and

287,360.8 kilograms of Pharmaceuticals were collected.

In 2020, 272,654.8 kilograms of Pharmaceuticals were safety disposed by Stericycle ULC in Ontario (note: the delta between tonnage collected and tonnage disposed is the total weight of the reusable MRP containers). 9 Table 1 provides a summary by region of the total weight of Pharmaceuticals collected through the 4,146 collection locations in 2020. Table 1 - Program Performance ʹ Report on Collection of Pharmaceuticals by Quarter

B. Medical Sharps

Section 9 (1) 3 - The total weight of all of the following that was collected at the collection locations during the previous calendar year: i. Sharps. ii. Containers described in paragraph 3 of subsection 3 (1). In 2020, 351,072 HPSA branded medical sharp containers were supplied to HPSA collection network for distribution to the public at no cost, and a total of 308,376.9 kilograms of Medical Sharps waste was collected by Stericycle ULC and ECS Cares and disposed of by Daniels Healthcare.

Greater Toronto1,238 16,100.2 10,514.6 13912.6 20,109.7 60,637.1

Haliburton76 2,029.1 1,576.8 1963.3 1,584.2 7,153.4

Huron Perth #14 Waterloo Wellington

Bruce Grey Simcoe481 12,061.8 7,990.3 9083 9,504.6 38,639.7

Northern Region272 8,358.6 4,711.5 6858.2 6,767.8 26,696.1

Oakville, Burlington, Hamilton, Niagara576 10,838.0 5,736.1 10068.1 14,187.2 40,829.3

Ottawa and Countryside275 5,011.1 3,569.8 5307.8 5,384.3 19,273.0

South Eastern Ontario175 4,538.8 2,441.3 3293.4 4,418.4 14,691.9

South Western Ontario424 10,407.2 8,225.1 8249.1 8,223.2 35,104.6

York Durham HH HW Northumberland

Kawartha629 11,140.3 7,353.2 11181.4 14,660.8 44,335.8

MRP Collection Total4,14680,485.1 52,118.6 69,916.9 84,840.2 287,360.8

Q1, 2020Q2, 2020Q3, 2020Q4, 20202020 Total

10 Table 2 provides a summary by region of the total weight of Medical Sharps collected through the 4,146 collection sites in 2020. Table 2 - Program Performance ʹ Report on Collection of Medical Sharps by Quarter

SCP Kit - Biomedical PU

Greater Toronto1,238 15,529.3 10,252.7 17447.3 18,677.4 61,906.7

Haliburton76 1,889.8 1,493.1 2047 1,782.3 7,212.2

Huron Perth #14 Waterloo Wellington Bruce

Grey Simcoe481 8,321.8 6,278.1 8215.2 8,632.4 31,447.5

Northern Region272 6,063.2 3,008.3 6072.4 5,772.1 20,916.0

Oakville, Burlington, Hamilton, Niagara576 10,838.0 6,899.0 11447 12,711.4 41,895.4

Ottawa and Countryside275 6,066.5 4,894.0 7359 8,869.7 27,189.1

South Eastern Ontario175 3,841.9 2,187.1 3750.6 4,595.6 14,375.3

South Western Ontario424 7,450.7 5,903.8 7567.8 7,320.0 28,242.3

York Durham HH HW Northumberland

Kawartha629 10,423.6 7,126.3 12456.1 13,768.8 43,774.8

s/total SCP Biomedical4,146 70,424.7 48,042.4 76,362.4 82,129.7 276,959.2

SCP Kit - Cytotoxic PU

Greater Toronto1,238 105.5 54.9 - 53.6 214.0

Haliburton76 359.3 267.2 277.7 311.1 1,215.3

Huron Perth #14 Waterloo Wellington Bruce

Grey Simcoe481 2,740.3 1,593.8 3025 2,656.1 10,015.2

Northern Region272 1,569.6 883.3 1374.5 1,128.6 4,956.0

Oakville, Burlington, Hamilton, Niagara576 58.3 76.7 21.7 87.6 244.3

Ottawa and Countryside275 14.7 - - 14.7

South Eastern Ontario175 681.2 189.3 502.7 558.5 1,931.7

South Western Ontario424 3,116.4 2,311.8 3154.4 3,076.6 11,659.2

York Durham HH HW Northumberland

Kawartha629 280.5 116.0 376.7 394.0 1,167.3

s/total SCP Cytotoxic4,146 8,925.8 5,493.0 8,732.7 8,266.1 31,417.7

SCP collection total 79,350.6 53,535.4 85,095.1 90,395.8 308,376.9

Q1, 2020Q2, 2020Q3, 2020Q4, 20202020 Total

Q1, 2020Q2, 2020Q3, 2020Q4, 20202020 Total

11

V. Public Education Materials and Campaigns

A. Collection Locations

Upon registration, all HPSA collection sites received a package that contains the following consumer related educational materials: information on how the public should safely store and handle unused and expired

Pharmaceuticals in the home (see here).

information on how the public should safely store and handle used Medical Sharps in the home, the use of sharps containers and how sharps are disposed of (see here).

In addition, every year, each collection site receives a physical copy of the most up to date list of

all HPSA registered collection locations in Ontario. This mass mailout usually occurs in the spring. Promotional material order forms are available online here, enabling participating pharmacies materials to be made available to the public. In 2020, HPSA sent over 86,600 brochures and distribution.

B. Website and Social Media

prospective and existing collection sites. HPSA added a news banner to the website's front page to make information more accessible for consumers and pharmacies. The news banner is updated regularly with the latest news for the public and other stakeholders. HPSA is also tracking the ranking and search engine optimization of the webpage. Currently, the webpage has organic keywords that take consumers directly to HPSA webpage: sharps container, approved sharps container, ͞can I return medication to pharmacy͟, returning medication. tool for consumers, which allows visitors to enter their postal code to access a drop-down menu that provides the address and contact information of the nearest collection site. The searchable Collection Site Finder is at www.healthsteward.ca. HPSA continues to post and keep its Facebook account current, using this social media platform to share best practices, HPSA videos, events (National Drug Drop Off Month), article and events 12 from other health partners (such as the Community Pharmacist Network, ISMP or Drug Free Kids

Canada).

As HPSA sees the value of growing organization through social media, it is now present on additional social media platforms such as LinkedIn and Twitter. HPSA places efforts in growingquotesdbs_dbs23.pdfusesText_29

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