Go green, America: Time to share all unused medications

Dr Melissa Walton-Shirley

Disclosures

June 10, 2010

A favorite patient of mine passed away recently. He had inoperable coronary artery disease and was on multiple medications, many of which were expensive. They included statins, beta blockers, clopidogrel, fish oil, and long-acting niacin, worth well over $300. This reliable, compliant family would like to do something to help others, like donating this medication to individuals who cannot afford it. Instead, their charitable gesture is in a stranglehold because we are over regulated on this issue. These medications are headed to the local trash dump where they will sit for decades in unrecycled plastic bottles, or worse, flushed down the toilet, increasing groundwater contamination. Throwing these medications away makes about as much sense as setting fire to a five-inch stack of crisp five-dollar bills. In reality, we do it many times every minute in America.

Unused medications become available from an abundance of resources.  Doctors switch medications frequently. Patients are sometimes "cured" of their disease process, some become allergic or intolerant to medications, and other patients die. These drugs could be both a gold mine and a lifeline for so many. Interestingly, I could bequeath to you my nearly complete set of Steven King novels at an estimated value of $200, but I'd be scrutinized if I bequeathed $3000 worth of unused breast-cancer medication to anyone who needed it.

Wasting medication is not just a moral or ethical issue. Distributing unused medication has had a significant impact for some states that already allow for individual donations to repositories. Oregon gave away over one-million-dollars worth of drugs in just one year. Iowa collected $290 000 worth of meds in 2007 and helped over 700 patients. I read that in Baton Rouge, one charitable pharmacy filled over 38 000 prescriptions valued at over two million dollars in one year. However, the real value of unused medication is not measured in the purchase cost.  Up to 60% of uninsured individuals skip or stop their medications due to expense, and emergency rooms are forced to deal with the aftermath of noncompliance. In one study, one-third of uninsured ER patients admitted to skipping or quitting their meds compared with only 15% of the insured patients who visited the ER. With ER costs skyrocketing combined with overcrowding, the ramifications are staggering. The cost of just one preventable admission for stroke or congestive heart failure exacerbation can range in the tens of thousands of dollars. Think how many of these admissions could be avoided if only medication regimens could continue uninterrupted.

Although 37 states have already addressed the issue of sharing unused medications, much like primary angioplasty, the practice is not widely implemented. Some states have a limited agreement between hospitals, pharmacies, and nursing homes. Others have done a fantastic job with regulation that not only allows for individuals to donate their unused meds to charities but they've also provided legal protection against litigation for a poor outcome in a Good Samaritan–like protective provision. Just last week, a patient told me they felt better on a new beta blocker I prescribed for them. The unused beta blocker bottle sits idly on a shelf, a monument to waste and inefficiency and a daily reminder of my cowardice due to a reluctance to pass it on to others.

For now, I can ask you for your heart and other organs after you pass away and perhaps even explant your pacemaker to ship outside the US, but heaven forbid that I take your Zebeta or Plavix and give it to someone living on a fixed income. Surely to goodness in this day and age of advanced methods of medication identification such as internet access to information on pill colors, shapes, and coding, we could figure out something that is so potentially simple and overwhelmingly helpful. If my daughters, age 17 and 22, with no formal training, can hand out medications in Peru this week to lines of needy sick individuals, we can surely figure out a way to do this in America.

Since "going green" is the new battle cry for generation Xers, we'd better realize that the real "green" in the healthcare industry is rooted in compliance and affordability. If only we could muster the same enthusiasm for rescuing a bottle of rosuvastatin as we have for an empty milk carton, we'd really make a difference for all of humanity.

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