Pharmaceuticals

by Hanz Atia, Associate, Policy & Programs

The COVID-19 pandemic expedited the growth of at-home care for all types of patients and that number is expected to continue to grow. While at-home care has several challenges, one that is least talked about is how to properly dispose of medical and pharmaceutical waste outside of a healthcare facility.

Stericycle, a PSI partner, recently released its second annual Healthcare Workplace Safety Trend Report, revealing key perspectives and insights for improving patient and provider safety, including the challenges of managing medical and pharmaceutical waste in at-home care settings. 

The report found that most healthcare providers (90%) and administrators (83%) expect the rate of at-home care to increase over the next five years. Only half (53%) of providers surveyed said they know how to dispose of medical waste in a safe manner in at-home care settings. That concern is increasing; in 2021, 65% of providers agreed their knowledge of disposal in at-home settings was sufficient. Providers are also concerned about the resources available, with less than half (41%) believing they have the adequate tools and resources available to properly dispose of regulated medical and pharmaceutical waste in at-home care settings.

On the heels of immense change brought on by modernization, new technology, changing expectations – and of course, the COVID-19 pandemic – the report delivers actionable steps for healthcare organizations to help create a healthier and safer environment for their patients and staff. Stericycle’s recent blog also shares critical information.

Medical “sharps” – disposable needles, syringes, and lancets – also allow people to self-inject medications at home and in public spaces. Americans discard more than three billion of these materials each year, often dumping them down drains or in the trash, but medical sharps can pollute the environment and injure sanitation workers. For more on solutions for medical sharps management, visit our product page. 

by Hanz Atia, Associate, Policy & Programs

When dumped in the trash or flushed down the drain, pharmaceuticals can contaminate our environment – and, when left in medicine cabinets, drugs can cause accidental overdoses. But Oregon just passed an amendment to its 2019 EPR law, which expands the type of facilities at which covered drugs under drug takeback programs may be disposed. SB 411 will now go to Governor Tina Kotek for signature. 

In 2010, PSI led a national coalition to pass the Secure and Responsible Drug Disposal Act and change related regulations that made it possible for retail pharmacies to host drug take-back programs for unwanted medicines, including controlled substances. That year, we developed model pharmaceuticals EPR legislation with our national coalition; by 2012, PSI Member Alameda County had used our model to establish the first pharmaceuticals EPR ordinance in the country, which was upheld by the courts despite industry appeals. Learn more on our pharmaceuticals product page. 

We testified in support of SB 411, which added federally regulated medical waste incineration facilities to Oregon’s drug disposal program. These facilities provide incineration service options in other state drug take-back programs, providing additional competition that can potentially lower drug disposal costs.  

Editor’s note: This legislation was signed into law on May 23, 2023.

by Rachel Lincoln Sarnoff, Marketing and Communications Director

2023 legislative sessions are now underway and many extended producer responsibility (EPR) bills were first out of the gate! There is an unprecedented momentum for these bills. Both Connecticut Governor Ned Lamont and New York Governor Kathy Hochul have indicated their backing, representing an unprecedented level of support for the passage of packaging EPR legislation in these states.  

During legislative session, we monitor activity on bills requiring new EPR programs or amending existing EPR laws in the United States; this information is shared with our Members and Partners through emailed Legislative Updates and is also available to them in our Legislation Library. At press time, these are the bills that had been introduced: 

• Battery EPR in New York and Washington; on January 17th, the District of Columbia enacted their Batteries and Electronics amendment. Our model EPR legislation informed the first EPR law for all single-use household batteries, enacted in Vermont, as well as battery bills introduced in states across the country from 2015 to 2020, and, in 2021, the first battery EPR law for single-use and rechargeable batteries, as well as battery-containing products, which was enacted in Washington, D.C. Learn more about our perspective on battery EPR by clicking here. 
• Household hazardous waste (HHW) EPR in Vermont. Although no HHW EPR program currently exists in the United States, they have operated successfully in Canada since the 1990s: In Manitoba, collection volumes increased four-fold in the first five years of program implementation. PSI’s research fueled the introduction of HHW EPR bills in both Oregon and Vermont. Learn more about our perspective on HHW EPR by clicking here.
• Packaging EPR in Maryland, New York, Washington, and New Jersey (originally introduced in 2022 and still active). In 2016, we developed our model packaging EPR legislation, then updated it in 2019 with input from industry and government. Maine and Oregon used our model to enact packaging EPR laws in 2021, Colorado followed suit in 2022 and, that same year, California also enacted legislation that was informed by our model. Learn more about our perspective on packaging EPR by clicking here.
• Paint EPR in Missouri, which, if passed, would be the state’s first EPR law. Beginning in 2003, PSI convened and facilitated a multi-stakeholder dialogue that included participation and support from the paint industry, state and local governments, the U.S. Environmental Protection Agency (EPA), and recycled paint manufacturers to develop a consensus model for paint EPR legislation. In 2009, Oregon used our model to enact the country’s first paint EPR law; since then, we have helped pass paint EPR legislation built on the same model. Today, there are paint EPR laws in 10 states and the District of Columbia. Learn more about our perspective on paint EPR by clicking here.
• Mercury-containing lighting EPR in Washington. In 2007, PSI initiated a dialogue on fluorescent lighting that resulted in a national action plan on lamp recycling and contributed to the enactment of EPR laws in five states; we also partnered with rural governments in 13 other states to boost collection of lamps and other mercury-containing products. Learn more about our perspective on lighting EPR by clicking here. 
• Pharmaceuticals law EPR amendment in Oregon. In 2010, PSI led a national coalition to pass the Secure and Responsible Drug Disposal Act and change related regulations that made it possible for retail pharmacies to host drug take-back programs for unwanted medicines, including controlled substances. That year, we developed model pharmaceuticals EPR legislation with our national coalition; by 2012, PSI Member Alameda County had used our model to establish the first pharmaceuticals EPR ordinance in the country, which was upheld by the courts despite industry appeals. Since then, our work has helped pass pharmaceuticals EPR laws in eight states and 23 local jurisdictions. Learn more about our perspective on pharmaceuticals EPR by clicking here. 
• Refrigerant-containing appliances EPR in Washington. In 2014, PSI provided research and policy analysis to New York City, which passed the first-ever law to safely manage refrigerant-containing appliances; since its passage, manufacturers collected more than 90,000 products and saved the city more than $1.3 million. PSI also helped defend New York City’s law against a legal challenge from the Association of Home Appliance Manufacturers, and we contributed to the hydrofluorocarbons emissions reduction law enacted by Washington State in 2021. Learn more about our perspective on refrigerant-containing appliance EPR by clicking here. 
• Solar panel EPR in Minnesota. Washington state passed the first state solar panels EPR law in 2017. In 2021, PSI helped develop the solar panels EPR law enacted by Niagara County, New York – the first such local law in the country. Learn more about our perspective on solar panel EPR by clicking here. 

We also expect to see introductions of additional battery, carpet, electronics, mattress, packaging, paint, and pharmaceuticals EPR bills and amendments in additional states. We appreciate the leadership of legislators and stakeholders who are leading the charge, and look forward to celebrating with our community when these bills become law. 

By Senator John F. Keenan, Massachusetts Senate

On March 16, 2016, Governor Charlie Baker signed into law a comprehensive drug abuse prevention bill that made Massachusetts the first state in the nation to require drug companies to fund and manage a safe disposal program for unwanted medications. Massachusetts Senator John F. Keenan was the first to introduce the drug take-back portion of this bill to the MA legislature, and acted as an influential proponent of its inclusion in the final law. Below, Senator Keenan cautions us to stay vigilant to PhRMA’s attempts to skirt the law’s intended purpose.

You would think that a group that helped create the opioid epidemic, which certainly has profited from it, and which is acknowledging that its products continue to fuel the epidemic, would offer more to help solve the epidemic than a catchy phrase, a website and a complete abrogation of playing any role in cleaning up the mess.

Yet, that’s what a newly formed group called “My Old Meds” has done. The sponsor of this group is the Pharmaceutical Research and Manufacturers of America (PhRMA), made up of representatives of the pharmaceutical industry. Some of these people and the firms they represent are making a lot of money from the sale of prescription painkillers, firms like Purdue Pharma, the people who brought us OxyContin and, more recently, OxyContin for kids.

“My Old Meds” recently brought their message to Massachusetts, advising that unused drugs are often diverted and become fuel for the opioid epidemic, and that old meds should therefore be disposed of at home in the trash or at government sponsored drug disposal sites.

In so advising, the sponsors of “My Old Meds” attempted to wash their hands of any responsibility for the disposal of unused medications, and place it instead on the patient and the taxpayer. Their theory: sell more pills than people need, reap the profits, then make others pay for the cleanup.

Their message was strategically timed, just as Massachusetts was considering legislation to require that pharmaceutical companies themselves become responsible for funding and operating a take-back and disposal program for unused pills. The industry was very comfortable with the arrangement of the past, watching their balance sheets grow in step with the excessive number of pills sold while communities scrambled to address the resulting opioid epidemic. That’s why they introduced their catchy phrase and website. They wanted to appear to be helpful, to convince us that no real change was necessary.

The Massachusetts Legislature was not fooled. We can be proud now of becoming the first state in the nation to require a pharmaceutical product stewardship program.

But now we must expect PhRMA’s campaign for in-home, patient and community funded disposal to continue. They will “educate” the public that they can spend their own money to buy cat litter or other carbon products that make pills “safe” for disposal, or that pills can simply be flushed into our water systems.

We must be vigilant. The new law allows the Massachusetts Department of Public Health to design an alternative stewardship plan, in which manufacturers will be allowed to participate rather than fund and operate their own programs. We must work to prevent the industry from influencing the regulatory process. We cannot let them seek regulations that set a low bar for industry responsibility, and that maximize the share of responsibility falling back onto public systems. We must work to ensure that the Department’s program is robust and effective, not a back door that lets manufacturers again step away from responsibility for safe stewardship of unused medications.

We have taken an important first step, but we must continue to fend off the message that manufacturer responsibility can be satisfied with a slogan and website.

Senator Keenan wrote a follow-up piece related to National Take-Back Day on MassLive. Learn more about Senator Keenan by visiting his website. Please feel free to contact Vivian Futran Fuhrman, PSI’s pharmaceuticals lead, with comments and questions (617-236-4771), or visit the PSI pharmaceuticals webpage for more information. 

By Scott Cassel, Chief Executive Officer and Founder, Product Stewardship Institute

This week an announcement rocked the pharmaceutical take-back community. Walgreens will set up collection kiosks at 500 stores in 39 states to accept controlled and non-controlled prescription drugs.

In one instant, a decade of advocacy work was rewarded as a principal player stepped forward to help alleviate drug abuse and accidental poisonings in America. In this one move, Walgreens validated those of us who have long promoted take-back as the safest way to manage leftover drugs and remove a health risk from our homes.

It was a long road to this point. It all started for a reason we should not forget – concern over how pharmaceuticals impact water quality and aquatic organisms. The U.S. Geological Survey brought our attention to this issue in 2002 by reporting the prevalence of pharmaceutical compounds in waterways. Studies and photos of aquatic impacts – male fish with female characteristics, infertility in aquatic species, and related environmental concerns – incited our interest in finding a solution.

But it quickly became clear that the nation’s drug abuse issue would drive a solution. When King Pharmaceuticals, an opioid manufacturer, funded PSI’s pharmaceuticals take-back website, along with one of our 2008 national dialogue meetings, we knew we were on the right track. At that meeting, we reached stakeholder consensus: the federal Controlled Substances Act needed to be changed. This law limited the collection of controlled substances to locations where law enforcement staff were present – a costly, impractical, and inconvenient constraint.

In order to change the law, we needed to reach a strong agreement among government agencies, reverse distributors, and other stakeholders on two specific points: how we defined the problem and what specific language we recommended to change the law. We met with the Office of National Drug Control Policy (ONDCP), the Drug Enforcement Administration (DEA), the Department of Transportation, the U.S. Environmental Protection Agency, and the Food and Drug Administration to solidify a unified message, and wrote testimony that synthesized concerns and recommendations. In 2010, the Secure and Responsible Drug Disposal Act was enacted.

But that was only the first step. From there, PSI held multiple stakeholder calls and meetings to provide input into implementing the DEA regulations that would eventually put the new law into action. When DEA finally released its final rule in late 2014, some stakeholders remained skeptical. They questioned whether the rule went far enough, if it created unintended loopholes, and why pharmacies didn’t jump in to start collecting soon after the rule was announced. PSI, therefore, set out to find pioneering pharmacists who were collecting controlled substances under the new rule, like Monty Scheele of Four Star Drug in Nebraska, who enthusiastically explained on one of our national webinars how easy it is to collect old drugs and how beneficial it is for business.

Obviously, Walgreens was listening to pharmacists like Monty Scheele. They responded to the drum beat of requests from an ever-expanding group of take-back advocates, as well as ONDCP and DEA, who made it clear that pharmacy collection was a main goal all along when they changed the regulations.

A decade ago, King County, Washington started an epic pilot program for non-controlled substances at Bartell Drugs, a pharmacy in Seattle. Dave Galvin, one of the County’s pilot program leaders, always said: “Most people don’t go to their police station voluntarily, but they do go to the neighborhood pharmacy.”

It’s been a long journey, one that took perseverance and hope. But simple truths are hard to keep submerged. Customers are neighbors, and they will stay loyal to your pharmacy if you help alleviate a pressing community problem.

It was only a matter of time until a major initiative like this one was bound to occur. A decade isn’t so long, after all.

By Scott Cassel, Chief Executive Officer and Founder, Product Stewardship Institute

It was one of those quiet moments of victory for environmentalists and public health advocates: In 2012, California’s Alameda County Board of Supervisors unanimously adopted the nation’s first ordinance requiring pharmaceutical manufacturers to fund and manage a drug take-back program.

Millions of overprescribed, unused, and expired medications contribute to drug abuse, accidental poisonings, aquatic impacts, and water quality issues. The trash or drain is not a safe method for disposing drugs – which is why King County, Washington; San Mateo County, California; and San Francisco, California followed suit with similar ordinances.

Big Pharma, however, has spent the last three years fighting back in the courts, arguing that the Alameda law interferes with interstate commerce. After two lower court decisions cited no interstate commerce violation, Big Pharma took the case to the U.S. Supreme Court. The high court recently declined to hear the pharmaceutical industry’s case against the Alameda County Safe Drug Disposal Ordinance. Whether Big Pharma will continue to pursue its costly litigation strategy remains to be seen, but one thing is clear: if the industry instead chose to collaborate, it could help shape a long-term, cost-effective solution that protects all interests – economic, health, and environmental.

Drug take-back laws may be new, but laws requiring manufacturers to take responsibility for the safe disposal of their products are not. What’s more is that not all industries continuously push back and fight against such laws. Currently, there are 8 states (and the District of Columbia) that require the paint industry to fund and manage the recycling and safe disposal of leftover paint; all of these laws were developed in collaboration with the American Coatings Association (ACA), which represents over 95 percent of U.S. paint manufacturers.
First some background: Back in 2002, the Product Stewardship Institute (PSI) asked the paint industry to take responsibility for managing leftover household paint because, when poured down the drain or sent to landfills, leftover paint threatens aquatic ecosystems and wastes valuable resources. Managing paint wastes is typically the most costly part of municipal household hazardous waste programs as well. PSI estimated that it would cost paint manufacturers about $650 million each year to safely recycle or dispose of the estimated 75 million gallons of leftover paint generated yearly in the United States.

After initial reluctance, the paint industry agreed to meet with PSI and some of PSI’s state and local government members. After nearly a dozen meetings and multiple calls over four years, PSI and ACA reached an agreement in 2007 on a model state program that would be implemented nationwide. Since then, the nine aforementioned jurisdictions have used that model to adopt laws holding the paint industry responsible for collecting and properly managing all leftover paint in their area; similar bills are pending in another dozen states. As a result, 8 million gallons of paint have been diverted from disposal so far in the first five states in which the paint stewardship program has been implemented, saving local governments over $50 million in transportation and processing costs, according to paint industry estimates.

What can the pharmaceutical industry learn from this?

1. Producer responsibility doesn’t hurt the bottom line. Since ACA’s PaintCare program was first adopted in Oregon in 2010, paint sales are still strong, retailers have the opportunity to offer a new service to their consumers, and paint recycling is on the rise. Through its PaintCare program, the paint industry has gotten out in front of the regulations, working with government to shape laws that fit with their business model. ACA representatives are regularly called upon to speak at state recycling conferences in sessions that highlight the industry’s successful demonstration of corporate sustainability and public-private collaboration. The lesson: an industry can take responsibility for its post-consumer products, and not only does it not hurt the bottom line – it often ends up benefitting them overall.

2. Producer responsibility programs show immediate results. In just five years, the paint industry has made convenient paint take-backs available to at least 95% of residents in three states, and local governments have saved millions of dollars of taxpayer money. Unlike other recycling programs that funnel collected fees into a government fund and require significant government hours to manage (e.g., scrap tire laws), the paint stewardship program is largely run by the paint industry, alleviating the need for a large bureaucracy to handle day-to-day operations.

3. Dialogue doesn’t mean a loss of control. It enables industry to shape policy that is effective and cost efficient. When PSI approached ACA with its request, the industry agreed to begin talks. What resulted was a national multi-stakeholder dialogue that led to joint research to answer key questions, such as “what will this program actually cost?” and “how will paint be collected and recycled?” From the beginning, ACA helped shape the program’s development; when the first bills were drafted, ACA was in the driver’s seat. The solution developed was an innovative funding model that worked for both industry and other stakeholders.

With the number of prescription drug overdoses rising annually, the risk posed by leftover medications raises the stakes, as well as the opportunity, for the pharmaceutical industry to take the lead and create convenient medicine take-back programs for U.S. residents. Such a program is within reach, and would cost the pharmaceutical industry roughly $3.51 per capita annually for the safe collection and disposal of pharmaceuticals, according to estimates from King County, WA. Similar programs have operated for years in Canada and at least a dozen European countries, taking the financial burden off of taxpayers.

This is clear: the pressure on the pharmaceutical industry isn’t going away. The path for industry-funded producer responsibility has been paved; with 88 producer responsibility laws operating in 33 states across the US for 12 different product categories, there is ample proof that take-back legislation can be implemented successfully. The pharmaceutical industry could be poised to become the next big success story – if it is willing.

Pharmaceuticals are an essential component of our healthcare system. They save lives and improve quality of life for many of us. Yet, as the number of prescriptions written increases, so too do the problems related to unwanted pharmaceuticals in the home.

Allowing unwanted pharmaceuticals to accumulate in homes increases the likelihood of accidental overdose, illegal diversion, and environmental contamination. It’s time to commit to a solution that works.

The Take Back Solution
Take-back programs provide a safe way for people to remove unwanted medications from their homes.

Existing take-back programs vary widely as to how they are organized and funded. Many happen only a couple days each year. Some local law enforcement agencies have installed permanent drop boxes in their buildings. With the recent withdrawal of federal DEA support, many programs are struggling to find funding to continue this important public service.

A new federal rule for the disposal of unwanted controlled substances allows pharmacies to run their own take-back programs, a convenient option for consumers. However, the new DEA rule does not provide any funding to make participation easier.

Both law enforcement and pharmacy-based take-back programs are severely limited by a lack of consistent funding. While voluntary take-backs are a step in the right direction, these programs simply aren’t enough.

Extended Producer Responsibility (EPR), also known as product stewardship, describes a system where the life cycle costs of a product become part of the cost of manufacturing. EPR is a proven method to sustainably fund the recycling or disposal of fluorescent lights, mercury thermostats, paint, mattresses, household batteries, and other products.

Why, then, is EPR the best solution for pharmaceuticals?

1. Proven
EPR is already being successfully implemented for pharmaceuticals in many European countries as well as some Canadian Provinces. In British Columbia (BC), for instance, 97.5% of pharmacies participate in a drug take-back program due to a solid EPR foundation. These locations collected a total of 112,888 pounds of pharmaceuticals in one year alone, equaling out to 0.02 pounds of meds collected per person. For comparison, Oregon, a state with a similar population but without an EPR program, collected only 0.004 pounds of meds per person in one year, a rate five times lower than British Columbia’s.

2. Economical
A coordinated EPR approach lowers collection and disposal costs per pound. The pharmaceutical EPR program in France, for example, collects an average of 16,237 tons per year, at a cost of just $0.0022 per box. Funded entirely by pharmaceutical manufacturers and run by the non-profit group Cyclamed, this French program is highly effective in collecting unwanted pharmaceuticals. In a recent survey, 77% of French residents claimed to have disposed of unwanted medication via these take-back sites, while 70% said they “always” dispose of pharmaceuticals in this way.

3. Stable
Unlike the current patchwork of funding used by U.S. programs, an EPR program provides secure, long-term funding. The aforementioned program in British Columbia started their mandatory Medications Return Program in 1996 with a program revamp in 2004. The pharmaceutical industry, therefore, has been funding the entire cost of the program for over 19 years.

4. Ready to Go
Momentum is growing: Alameda County, CA; King County, WA; and San Francisco, CA have all adopted EPR laws. Despite having been willing EPR partners in other countries, pharmaceutical manufacturers have challenged the Alameda law in court. Considering the narrow grounds of the appeal and improvements made to subsequent iterations of the law, other communities will soon be passing pharmaceutical EPR laws.

Please consider promoting an EPR bill in your county or state. Each new EPR law brings us one step closer to a national program.

Ed Gottlieb is the Chair of the Coalition for Safe Medication Disposal in Tompkins County, NY. Ed can be contacted at egottlieb@cityofithaca.org. 

I stared at the faces – perhaps one hundred individual photos, side-by-side – of all ages, sizes, and colors – cut down by the ravages of prescription drug abuse.

For the most part they were ordinary people, like you and me. A few fit the stereotype drug addict depicted on TV – disheveled, worn beyond years, tired, and glazed. But most were the epitome of success, gleaming with promise and potential.

As I gazed into their eyes in the lobby of the Omni Orlando Resort at ChampionsGate, which hosted the 2013 National Rx Drug Abuse Summit, the importance of our work on leftover pharmaceuticals solidly hit home. I can help prevent a death. I can help save a life. In fact, we can all help prevent drug abuse, and the death and destruction that appear in its wake.

I understand the over-simplicity in my statements. Every person carries historical baggage, and for some people, it may seem just too complicated, too heavy, too difficult, and too much to bear. All the support in the world might not help at times. But we can remove barriers to the chance for a healthy life, and provide needed support. One of those barriers is that too many drugs are lying around the home when they should be cleaned out and safely destroyed. I do not want to overlook the environmental and aquatic impacts of leftover medications in our waterways. But make no mistake: drug abuse drives the issue of pharmaceutical take-back.

Prescription drug abuse is the fastest growing drug problem in America and has been classified as an epidemic by the U.S. Centers for Disease Control and Prevention. Nationwide, unintentional prescription opioid overdoses kill more Americans than cocaine and heroin combined. A host of federal agencies, including the Drug Enforcement Administration, Environmental Protection Agency, and the Office of National Drug Control Policy, recommend that leftover medicine be brought to take-back programs for safe collection and disposal. So do 43 states.

We know the problem, and we know at least part of the solution. But we also need a way to pay for the means to educate people about the problem of drug abuse, make them aware of the need for safe disposal, and increase the availability of take-back programs. To date, the pharmaceutical companies that make the drugs, particularly addictive opioids like OxyContin and Percocet, have refused to take any degree of responsibility for safely disposing of leftover medications from the home. Not only is there a lack of convenient options to safely dispose of leftover medicine, there is an epidemic of over-prescription.

Two counties have stepped forward to lead a national effort to reverse this trend – Alameda County, California, and King County, Washington. PSI is supporting both of these agencies in their efforts to hold pharmaceutical companies responsible for financing and managing programs to safely collect and destroy leftover home medicines. Thousands of U.S. government agencies support this approach. Provinces in Canada and countries in Europe already successfully and cost-effectively run take-back programs financed and managed by pharmaceutical companies.

PSI is fortunate to have sensed the rise of this issue seven years ago. With the help of many of you, we began the slow, deliberate process of building national support for leftover drug take-backs, changing the federal Controlled Substances Act and associated Drug Enforcement Administration regulations (still in draft form). We are helping to implement the King County law and are setting up voluntary collection sites and raising awareness in rural counties in Washington and Oregon as pilots for national replication. We also finished a three-year project in the Great Lakes, where our coalition developed a model producer responsibility program, created a comprehensive online resource for anyone looking for more information about what to do with their leftover medications, compiled a series of “Lessons Learned” to assist communities nationwide, and created a consumer-friendly info sheet to educate people on what to do with leftover medicine. For these efforts, PSI was honored with a “A Million Thanks”  award from Covanta Energy. Personally, I find it rewarding to take part in such worthy efforts, and feel fortunate to have the opportunity.

Please help PSI do more by joining our effort. I have never solicited funds on this blog post before. But the devastating effects of drug abuse are happening right now, right before our very eyes, insidiously belying normalcy. Please consider becoming a PSI partner, making a donation*, or offering a sponsorship* to help us reverse this growing trend. Neil Young sang about every junkie being “like a setting sun.” Together, we have the power to let them see the sunrise.

*To make a donation to PSI or offer a sponsorship, contact Amanda Nicholson at 617.236.4833 or by email at amanda(at)productstewardship(dot)us.