[Federal Register Volume 67, Number 212 (Friday, November 1, 2002)]
[Rules and Regulations]
[Pages 66550-66552]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-27745]


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CONSUMER PRODUCT SAFETY COMMISSION

16 CFR Part 1700


Poison Prevention Packaging Requirements; Exemption of Hormone 
Replacement Therapy Products

AGENCY: Consumer Product Safety Commission.

ACTION: Final rule.

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SUMMARY: The Commission is amending its child-resistant packaging 
requirements to exempt hormone replacement therapy (``HRT'') products 
containing one or more progestogen or estrogen substances. Current 
exemptions cover some HRT products, but not others. This rule would 
uniformly exempt from child resistant packaging requirements all HRT 
products that rely solely on the activity of one or more progestogen or 
estrogen substances.

[[Page 66551]]


DATES: The rule is effective November 1, 2002, and applies to products 
packaged on or after that date.

FOR FURTHER INFORMATION CONTACT: Geri Smith, Office of Compliance and 
Enforcement, Consumer Product Safety Commission, Washington, DC 20207; 
telephone (301) 504-0608 ext. 1160.

SUPPLEMENTARY INFORMATION:

A. Background

    The Poison Prevention Packaging Act of 1970 (``PPPA''), 15 U.S.C. 
1471-1476, authorizes the Commission to issue standards for the special 
packaging of household substances, such as drugs, when (1) Child 
resistant packaging is necessary to protect children from serious 
personal injury or illness due to the substance and (2) the special 
packaging is technically feasible, practicable, and appropriate for the 
substance. Accordingly, a Commission rule requires that oral 
prescription drugs be in child resistant (''CR'') packaging. 16 CFR 
1700.14(a)(10).
    The Commission's regulations allow exemptions from this requirement 
for substances that have low acute toxicity. 16 CFR 1702.1(b) and 
1702.7. Current regulations provide four PPPA exemptions for sex 
hormones: (1) Oral contraceptives in mnemonic packages containing one 
or more progestogen or estrogen substances; (2) conjugated estrogen 
tablets in mnemonic packages; (3) norethindrone acetate tablets in 
mnemonic packaging; and (4) medroxyprogesterone acetate tablets. 16 CFR 
1700.14(a)(10)(iv), (xvii), (xviii) and (xix). Some HRT products fall 
within these exemptions, but because of the way these exemptions are 
written, other HRT products currently require CR packaging.
    On February 19, 2002, the Commission published a notice of proposed 
rulemaking (``NPR'') proposing to exempt from the special packaging 
requirements HRT products containing one or more progestogen or 
estrogen substances. 67 FR 7319. This rule will make the exemption of 
HRT products more uniform by exempting all HRT products that rely 
solely on the activity of one or more progestogen or estrogen 
substances.\1\
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    \1\ Commissioner Thomas H. Moore issued a statement, which is on 
file in the Commission's Office of the Secretary, Room 501, 4330 
East-West Highway, Bethesda, Maryland 20814.
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B. HRT Products

    HRT is used to replace the estrogen and progesterone that normally 
decline following menopause (the cessation of menstruation). Women may 
experience a range of menopausal symptoms. Additionally, menopause 
accelerates bone depletion that commonly occurs with aging, leading to 
osteoporosis.
    HRT has been used to relieve a number of menopausal symptoms and 
help to prevent osteoporosis. HRT consists of using estrogen alone or 
various combinations of estrogens and progestins, similar to oral 
contraceptives. Some are natural hormones (e.g., estradiol) and others 
are semi-synthetic or synthetic (e.g., norgestimate). Since available 
HRT products contain estrogen/progestin combinations similar to oral 
contraceptives, it is reasonable and consistent to exempt them 
similarly.
    Recently, studies have raised questions about the health effects of 
HRT. A Women's Health Initiative study indicated that women treated for 
about 5 years with a combination of estrogen and progestin had an 
increased risk of breast cancer, heart disease, stroke and blood clots 
compared to placebo. While this study suggests that HRT may not be 
indicated for long term use, it did not examine different doses, 
different estrogen or progestins or alternative formulations. It is 
likely that physicians may consider prescribing short term hormone 
therapy for menopausal symptoms after evaluating the risks and benefits 
for individual patients. Because the acute toxicity of HRT is low and 
its use is likely to continue even with the questions raised about its 
long term use, the Commission believes that a rule uniformly exempting 
HRT products from CR packaging requirements is appropriate.

C. Toxicity Data

    Human toxic doses for estrogens or progestins have not been 
defined. Exposure summaries in the Poisindex[reg] for estrogens, 
progestins, and oral contraceptives state that acute toxicity is 
unlikely following overdosage. Gastrointestinal effects (e.g., nausea, 
vomiting, abdominal cramps) may occur after an acute overdose, but 
typically no treatment is necessary.
    The medical literature provides little information concerning acute 
overdosage of progestins or estrogens. One case mentioned in the NPR 
showed that a single dose of 160 mg estradiol valerate (80 tablets/2 mg 
each), ingested by a 19-year-old woman in a suicide attempt, produced 
little toxicity. The woman slept easily during the night of the 
ingestion and the next evening presented in the emergency clinic in 
generally good condition with nausea and a headache.
    For the NPR, the staff reviewed poisoning data from the American 
Association of Poison Control Centers (``AAPCC'') Toxic Exposure 
Surveillance System (``TESS'') showing acute exposures in children less 
than five years old to estrogens, progestins, and oral contraceptives 
from 1993 to 1998. There were no deaths and most of the exposures were 
non-toxic.
    For this final rule, the staff reviewed available AAPCC data since 
the NPR was published, and found no major outcomes or deaths in any of 
the hormone categories in 1999 and 2000 (the most recent data 
available).

D. Public Comment on the NPR

    The Commission received one comment in response to the NPR. It came 
from Berlex Laboratories, which wrote that it currently markets 
estrogen replacement therapy, long-acting contraception, and oral 
contraception products and plans to market an oral HRT product in the 
near future. Berlex states that the proposed exemption is ``beneficial 
in terms of cost and efficiency'' and provides ``drug producers greater 
flexibility in meeting the needs of the HRT patient population.''

E. Effective Date

    With this rule, the Commission issues an exemption from the child-
resistant packaging requirements generally applicable to oral 
prescription drugs. Thus, the rule imposes no new requirements, but 
lifts requirements currently in existence for some HRT products (some 
HRT products are already exempt from CR packaging requirements). Under 
these circumstances the Commission believes it is appropriate for the 
rule to become effective on the date it is published in the Federal 
Register.

F. Impact on Small Business

    As discussed in the NPR, the Commission preliminarily concluded 
that the proposed amendment exempting HRT products from special 
packaging requirements would not have a significant impact on a 
substantial number of small businesses or other small entities. This 
conclusion was based on the fact that the exemption would actually 
increase the packaging options for manufacturers because it would allow 
them to package the affected HRT products in non-CR packages. Thus, the 
exemption is not likely to have a significant impact on a substantial 
number of companies, regardless of size.

G. Environmental Considerations

    In the NPR, the Commission also discussed possible impact on the 
environment as required by the National

[[Page 66552]]

Environmental Policy Act, and in accordance with the Council on 
Environmental Quality regulations and CPSC procedures for environmental 
review. The Commission found that, because the rule would have no 
adverse effect on the environment, neither an environmental assessment 
nor an environmental impact statement is required.

H. Executive Orders

    According to Executive Order 12988 (February 5, 1996), agencies 
must state in clear language the preemptive effect, if any, of new 
regulations.
    The PPPA provides that, generally, when a special packaging 
standard issued under the PPPA is in effect, ``no State or political 
subdivision thereof shall have any authority either to establish or 
continue in effect, with respect to such household substance, any 
standard for special packaging (and any exemption therefrom and 
requirement related thereto) which is not identical to the [PPPA] 
standard.'' 15 U.S.C. 1476(a). A State or local standard may be 
excepted from this preemptive effect if (1) the State or local standard 
provides a higher degree of protection from the risk of injury or 
illness than the PPPA standard; and (2) the State or political 
subdivision applies to the Commission for an exemption from the PPPA's 
preemption clause and the Commission grants the exemption through a 
process specified at 16 CFR part 1061. 15 U.S.C. 1476(c)(1). In 
addition, the Federal government, or a State or local government, may 
establish and continue in effect a non-identical special packaging 
requirement that provides a higher degree of protection than the PPPA 
requirement for a household substance for the Federal, State or local 
government's own use. 15 U.S.C. 1476(b).
    Accordingly, with the exceptions noted above, the rule exempting 
HRT products from special packaging requirements would preempt non-
identical state or local special packaging standards for those 
products.
    The Commission has also evaluated the rule in light of the 
principles stated in Executive Order 13132 concerning federalism, even 
though that Order does not apply to independent regulatory agencies 
such as CPSC. The Commission does not expect that the rule will have 
any substantial direct effects on the States, the relationship between 
the national government and the States, or the distribution of power 
and responsibilities among various levels of government.

List of Subjects in 16 CFR Part 1700

    Consumer protection, Drugs, Infants and children, Packaging and 
containers, Poison prevention, Toxic substances.

    For the reasons given above, the Commission amends 16 CFR part 1700 
as follows:

PART 1700--[AMENDED]

    1. The authority citation for part 1700 continues to read as 
follows:

    Authority: Pub. L. 91-601, secs. 1-9, 84 Stat. 1670-74, 15 
U.S.C. 1471-76. Secs 1700.1 and 1700.14 also issued under Pub. L. 
92-573, sec. 30(a), 88 Stat. 1231. 15 U.S.C. 2079(a).


    2. The introductory text of paragraphs (a) and (a)(10) is 
republished. Section 1700.14 is amended by adding new paragraph 
(a)(10)(xxi) to read as follows:


Sec.  1700.14  Substances requiring special packaging.

    (a) Substances. The Commission has determined that the degree or 
nature of the hazard to children in the availability of the following 
substances, by reason of their packaging, is such that special 
packaging meeting the requirements of Sec.  1700.20(a) is required to 
protect children from serious personal injury or serious illness 
resulting from handling, using, or ingesting such substances, and the 
special packaging herein required is technically feasible, practicable, 
and appropriate for these substances:
* * * * *
    (10) Prescription Drugs. Any drug for human use that is in a dosage 
form intended for oral administration and that is required by Federal 
law to be dispensed only by or upon an oral or written prescription of 
a practitioner licensed by law to administer such drug shall be 
packaged in accordance with the provisions of Sec.  1700.15(a),(b), and 
(c), except for the following:
* * * * *
    (xxi) Hormone Replacement Therapy Products that rely solely upon 
the activity of one or more progestogen or estrogen substances.
* * * * *

    Dated: October 28, 2002.
Todd Stevenson,
Secretary, Consumer Product Safety Commission.

List of Relevant Documents

    1. Briefing memorandum from Jacqueline Ferrante, Ph.D., Directorate 
for Health Sciences, to the Commission, ``Final Rule to Exempt Hormone 
Replacement Therapy Products from the Special Packaging Requirements of 
the Poison Prevention Packaging Act,'' October 9, 2002.
    2. Memorandum from Robert Franklin, Directorate for Economic 
Analysis, to Jacqueline Ferrante, Ph.D., Project Manager, ``Small 
Business and Environmental Considerations Related to Exempting HRT 
Products from PPPA Requirements,'' September 9, 2002.

[FR Doc. 02-27745 Filed 10-31-02; 8:45 am]
BILLING CODE 6355-01-P