Allow Docs to Recycle Chemo Pills, Already

Doing It 'on the Sly'

Nick Mulcahy

January 09, 2019

It is a "medically sound" idea to empower physicians to safely recycle highly expensive oral chemotherapies and thereby increase access and minimize waste, write a group of oncologists in a commentary published online December 19 in the Oncologist.

In other words, physicians should be able take discarded oral cancer drugs from one patient and pass them onto another — without a pharmacy intermediary, say the authors, led by Jodi Layton, MD, of Tulane University in New Orleans, Louisiana.

This will require "considerable relaxation or amendment of the rules and regulations that govern typical pharmacies and physician dispensing," they acknowledge.

Currently, this proposal causes legal tangles, the authors admit, but some physicians "ignore the issue" and recycle illegally or in a legal gray zone.

That's true, said Elizabeth Lindquist, PharmD, of the SwedishAmerican Regional Cancer Center Pharmacy in Rockford, Illinois.

"Physicians are already doing this on the sly," she told Medscape Medical News.

Like the essay authors, Lindquist is an advocate for not wasting prescription drugs, because recycling makes "compelling economic and environmental sense." She maintains a national presence, which is not affiliated with her employer, about drug recycling on Twitter (@EALindquist).

However, she has doubts about the feasibility of the essayists' proposal.

"I'm unsure as to why the authors would promote physician-based recycling initiatives when they face the same barriers as drug-repository pharmacies. Physician-based recycling is also less efficient, giving access only to patients of those physicians," she said.

Layton and colleagues say that some American locales have programs to facilitate cancer drug recycling. But "we have not seen those programs benefit our patients," writes the team, which includes academics from the University of Minnesota in Minneapolis and the Oregon Health and Sciences University in Portland.

This academic group is in search of a system that "allows safe and efficient recycling" and that is medically acceptable.

"Any entity pursuing this would need a thoughtfully designed program with an infrastructure that allows tracking of oral antineoplastics from point of prescription, dispensing, and then return of unused prescriptions once the treatment is no longer indicated," Layton told Medscape Medical News.

That's very important, agreed Philip Baker, PharmD, of the Good Shepard Pharmacy, a nonprofit in Nashville, Tennessee.

But the bigger challenge, he commented to Medscape Medical News, is creating a system that is "self-sustainable."

"Any system dependent upon volunteer labor or external funding will be temporary and limited (local) in scope," Baker said.

Baker is on the avant garde of American drug recycling, specifically, cancer drug recycling, as previously reported by Medscape Medical News.

He is one of the founders of RemediChain, a nonprofit devoted to facilitating redistribution of leftover oral chemotherapies. In short, the organization takes from patients with money (who are deceased or are not getting results from therapy) and gives to the less fortunate.

"At RemediChain, we're proposing a national network of mail-order pharmacies, one per state, to centralize the donation and dispensing processes in each state," he said.

Currently, the organization has functional operations in two states: Tennessee and Iowa.

Baker explained that one centralized pharmacy in each state allows for operations at a fraction of the expense of multiple local physician-run pharmacies; the latter is the model that the essayists propose.

A centralized pharmacy is also more efficient at redistributing donated drugs before they expire, he added. Each pharmacy can work directly with state departments of health and medical/pharmacy boards as a single point of contact to ensure compliance and that all parties are protected from liability.

Essay author Layton echoed these ideas: "I think a more national level approach could expand the scope of this project."

SafeNetRx: Recycling With Oncologists' Help

In Iowa, RemediChain affiliate SafeNetRx covers the entire state for various types of drugs. It has been running a chemo-specific recycling program in Des Moines, partnering with 12 oncology centers. The organization has brought in more than $1 million in donated oral chemotherapy drugs and has redispensed a nearly equal amount, said Baker.

SafeNetRx has operated since 2007, said CEO Jon-Michael Rossman. "We operate as a centralized repository that serves as a clearinghouse for the collection, inspection, and distribution of donated medications," he told Medscape Medical News in an email. Medications, including cancer drugs, are provided to uninsured and underinsured patients with incomes less than 200% of the federal poverty level.

The essayists want to attack the problem of cancer drug recycling from all angles and even get manufacturers involved. For example, they want to see more oral chemotherapies packaged in blister packs.

"Such an approach could not only minimize waste of dispensing but also improve safety and efficacy of redistribution of such packaged individual pills," they argue.

Recycling oral chemotherapies is a win-win, say the essay authors. "We submit that no one loses from such an arrangement because the medication would otherwise be thrown away and the receiving patients would not have purchased the medications anyway," they write.

The authors have disclosed no relevant financial relationships.

Oncologist. Published online December 19, 2018. Full text

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