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Unused Prescription Drugs Don't Have to Go to Waste

Trial program puts leftover meds in the hands of those who can't afford them

(HealthDay is the new name for HealthScoutNews.)

MONDAY, Aug. 18, 2003 (HealthDayNews) -- When Carol Kirschenbaum finished chemotherapy several years ago, she had hundreds of dollars worth of Zofran, an anti-nausea medication, left.

Rather than toss out the pills, which cost close to $30 each, Kirschenbaum gave them to her nurse. She, in turn, passed them onto another cancer patient who had no insurance to cover such a "luxury."

This type of exchange is not routine. But Kirschenbaum, in addition to being a patient, is also a doctor and the president of the North Carolina Committee to Defend Health Care, which supports universal health coverage. The nurse knew her, trusted her and was certain the medication was still good.

Most people have to throw their unused drugs away. When Janna Dieckmann's mother died two years ago, she left about $3,000 worth of brand-new asthma inhalers, which her daughter tried unsuccessfully to donate to a charity. In the end, Dieckmann, a nurse who is also asthmatic, used what she could and threw out the rest. "It's a shame," says the North Carolina resident. "People go begging."

According to research done by the Health Law and Policy Institute at the University of Houston, up to $10 million worth of unused prescription drugs are flushed away each year in Oklahoma alone.

"If you multiplied that by the big states, we're talking about millions and millions of dollars," says Paul Patton, executive director of the Tulsa County Medical Society in Oklahoma, which recently started a program to salvage some of these drugs.

Some organizations have been shipping unused recycled prescription medications overseas for years. Child Family Health International, for instance, started its "recovery program" in 1995. "We take medicines that have been opened but that are unused abroad," says Dr. Evaleen Jones, founder of the organization and a clinical assistant professor at Stanford. AID FOR AIDS, a nonprofit group based in New York City, collects recycled HIV drugs for use overseas.

Although various government and independent agencies, including the U.S. Food and Drug Administration (FDA) and the American Society of Consulting Pharmacists (ASCP), have guidelines on the use of leftover drugs, the regulations are usually formulated on a state-by-state basis. And most states require that they be destroyed.

"Each of the 50 states has a separate pharmacy practice act, but for the most part they all say that once the drug leaves a pharmacy, it can't be redispensed or resold," says Larry D. Sasich, a pharmacist and research analyst with Public Citizen. The reasoning has to do primarily with preserving the safety and effectiveness of the drugs and avoiding illicit profits from selling them illegally.

"When you start looking into the issue to see how we can safely reuse medicines, it's a lot more complicated than people realize because there is the issue of safety," says Tom Clark, director of policy and advocacy for the ASCP. The agency would support the return of unused drugs to the original dispensing pharmacy, but only if certain stringent measures were met. But, Clark admits, verifying that every single secondhand pill is safe is, admittedly, a time-consuming and labor-intensive project.

"It seems like a big waste when some of these medicines are destroyed," Clark admits. But he adds this caveat: "People are interested in doing it but, as they get into it and find out how complex it is, it's not easy to find a solution."

Health officials in Tulsa County, Okla., are finding out just how complex the task is. But their breakthrough plan is also showing how it is, in fact, possible.

"It came to our attention six or seven years ago that there was this enormous amount of unused drugs that were not being used. They were quite literally being flushed down the toilet and we realized at the same time, we had indigent people in the community who needed those drugs but could not afford them," says Patton, who has been involved since the start. "We started to see how we could connect the two -- to take drugs from where they were no longer needed to where they were needed without flushing them down the toilet."

There were several obstacles to overcome. "The bureaucracy that is in place to protect us is prepared to protect us whether it kills us or not," Patton says. "We began with the state basically saying, 'It ain't going to happen. You cannot do it. The FDA won't allow it.' We spent six years. We now have passed [state] laws that allow us to do it. And it is now happening."

It slowly became clear to Patton and his colleagues that the FDA "rules" that people were afraid of were actually only position statements. Then it became a matter of persuading state legislators to change existing statutes to allow some recycling of drugs from nursing homes to the county pharmacy, and the program was on its way.

The trial program -- its sponsors have two years to prove that it works -- officially started about a year ago and runs like this: When a nursing home finds it has extra medication (from a resident who has discontinued that particular drug, or has moved or died), it calls the county pharmacy. The pharmacy sends one of four retired physicians to pick up the meds, which the pharmacy then distributes to indigent citizens for free.

Dr. George Prothro, former director of the Tulsa City County Health Department and one of the volunteer drivers, says the timing of the pick-ups varies but generally works out to about once a week.

There are numerous restrictions. The county pharmacy will only take medications that are in individual units (for example, blister wrapped), not loose in bottles. It also will only accept about 25 medications (narcotics are not included on the list) although "that turns out to be a substantial number of actual pills," says Linda Johnston, director of social services for Tulsa County. The county pharmacist then examines the donations for signs of tampering.

"We're very comfortable that we've created a system that removes any opportunity for there to be some altering of medicine," Johnston says. "There's adequate security in the nursing home, so we think we've got the trail in place."

Right now, there are roughly 50 nursing homes in Tulsa County involved in the program. But the program's sponsors are hoping that, if the trial proves successful, the law could be extended to include recycled drugs from hospices and other institutions.

Just a week ago, Johnston says, a woman burst into tears in her office when the county pharmacy was able to give her the medication she needed (worth about $200) for free.

"From my point of view, the drugs that were not destroyed are now being used by people who couldn't afford them. It's a success," Patton says. "Clearly, there's a long way to go and we can only do better. We're just elated."

More information

For more on some of the organizations mentioned in this article, visit the Tulsa County Medical Examiner, Child Family Health International or AID FOR AIDS.

SOURCES: Carol Kirschenbaum, M.D., internist, president, North Carolina Committee to Defend Health Care, and board member, Physicians for a National Health Program, Durham, N.C.; Larry D. Sasich, Pharm.D., pharmacist and research analyst, Public Citizen, Washington, D.C.; Paul Patton, executive director, Tulsa County Medical Society, Oklahoma; Janna Dieckmann, Chapel Hill, N.C.; Linda Johnston, director, social services, Tulsa County, Oklahoma; George Prothro, M.D., former director, Tulsa City County Health Department, and former professor, family practice, University of Oklahoma Medical School, Oklahoma City; Evaleen Jones, M.D., founder and president, Child Family Health International, San Francisco, and clinical assistant professor, Stanford University School of Medicine, Stanford, Calif.; Tom Clark, R.Ph., director, policy and advocacy, American Society of Consultant Pharmacists, Alexandria, Va.
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