1. Dr. Theresa OKeefe PhD. Jim Mullowney Pharma-Cycle, Inc. Presentation at the CleanMed Conference Cleveland Ohio June 5, 2014

2. Origins of Chemotherapy 3. U.S. Department of Defense begins to study mustard gas as a cancer treatment during World War I 4. Therapeutic uses for liquid mustard gas are discovered in the 1930s and 1940s. 5. Use of chemotherapy begins in the 1950s. 6. In 1986, OSHA develops regulations to protect workers when handling chemo drugs. 7. In 2011 Hospitals Warned of Cancer Birth Defects Miscarriages Irreversible Effects Even After Low-Level Exposures. 8. Governments and Employers Zero Exposure for ALL WORKERS Drug Manufacturing 9. Governments and Employers Zero Exposure for ALL WORKERS Pharmaceutical Compounding 10. Governments and Employers Zero Exposure for ALL WORKERS Nursing Staff 11. Governments and Employers Zero Exposure for ALL WORKERS Cleaning Staff 12. It is a crime to throw an empty chemotherapy container in the trash. 13. Yet chemo patients are sent home after treatments without knowing: Chemo drugs are excreted in active form for 48 hours after each treatment. 14. Yet chemo patients are sent home after treatments without knowing: Families, pets, and caregivers are at risk of exposure to DNA-damaging chemicals. 15. Yet chemo patients are sent home after treatments without knowing: Pregnant women, babies, and small children are particularly vulnerable. 16. Yet chemo patients are sent home after treatments without knowing: Public drinking water supplies become contaminated. 17. Septic systems and wastewater treatment plants CANNOT REMOVE cytotoxic chemicals. 18. The US Geological Survey and the US EPA conducted a study to find the source of the contaminants. 19. In 2008 Cancer Fish were found on Cape Cod 20. The fish had extremely high levels of DNA damage caused by genotoxic chemicals. 21. Residents on Cape Cod have extraordinarily high rates of cancer. 22. 80% of the households on Cape Cod are entirely dependent on onsite septic systems. 23. Results suggest the genotoxic material was coming from surrounding residential septic systems 24. Danger of Exposure to Patients Excretia Organizations must manage their hazardous wastes and this extends to patients receiving highly excretable chemotherapy drugs 25. Danger of Exposure to Patients Excreta Safe administration of high alert and hazardous medications includes informing family about proper disposal when new medications are started (MM.06.06.01, MM.01.01.03) 26. Danger of Exposure to Patients Excreta Education/learning needs assessment must include safe use and disposal both during and after hospital discharge ( PC.02.03.01) 27. Danger of Exposure to Patients Excreta Cautionary labels covering proper disposal and danger to others must be provided to patients and others with whom the patient may contact (MM.05.01.09) 28. Danger of Exposure to Patients Excreta Organizations are required to be in compliance with law and regulation regarding proper use, handling and disposal of such medications including education of patients receiving high alert and hazardous medications (EC.02.02.01, LD.04.01.01) 29. In 2013, WHO warns of disastrous ecological consequences. 30. Cytotoxic Chemo Drugs Genotoxic Waste is: 31. Genotoxic Waste is: Empty Chemo Vials and IV Bags 32. Genotoxic Waste is: Used Chemo Gloves 33. Genotoxic Waste is: Patient Urine, Feces, and Vomit *For 48 Hours 34. Who is responsible for Genotoxic waste management, including urine, feces, and vomit Chief Pharmacist June 5, 2014 Pharma-Cycle, LLC 34 35. Who is responsible for the cost of managing Genotoxic waste: Health-Care Providers June 5, 2014 Pharma-Cycle, LLC 35 36. Rhode Island defines Extremely Hazardous Waste as Cytotoxic Chemotherapy Agents 37. Rhode Island Pending Legislation would protect families and our drinking water supply from Cytotoxic Chemotherapy Agents 38. Capture the chemicals before they get into the water 39. Cytotoxic Safety Kit Control Contaminated Waste at Source Urine and stool samples for 48 hours after each treatment 40. This is a worldwide problem with a local solution. Pharma-Cycle, LLC 55 John Clarke Road Middletown, RI 02842 Jim Mullowney (800) 409-0431 jmullowney@pharma-cycle.com www.pharma-cycle.com