Wasted: Sensible Solutions for Unused Prescription Drugs

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Most of us keep all of our medicine in a designated location in the house. Be it the medicine cabinet in the bathroom, the kitchen shelf just above the coffee maker, or the gallon-sized plastic bag we tend to see patients bring during their office visits, most of us have prescription drugs and over-the-counter medications stockpiled somewhere.

But when was the last time you took a moment to organize that medicine cabinet, figure out which medicines you are no longer taking, and review expiration dates?

There are safe ways to dispose of expired and unused medications. (No, I am not talking about flushing them down the toilet.)

The U.S. Drug Enforcement Administration (DEA) hosts a semi-annual National Prescription Drug Take Back Day, where you can take your expired and unused drugs to a designated collection site in your community to be disposed of appropriately. Typically, collection sites are at local police stations, fire stations, pharmacies, clinics, or hospitals. Collection sites are community-specific and can be found on the DEA website.

The most recent National Prescription Drug Take Back Day wrapped up on Saturday, April 29, and program organizers are waiting to see just how many drugs were collected. This time last year, the DEA set an all-time collection record.

On May 6, 2016, Americans turned in more unused prescription drugs than on any of the previous 10 events since it began in 2010, demonstrating their understanding of the value of this service. The DEA and over 4,200 of its state, local, and tribal law enforcement partners collected 893,498 pounds of unwanted medicines—about 447 tons—at almost 5,400 sites spread through all 50 states, beating its previous high of 390 tons in the spring of 2014 by 57 tons, or more than 114,000 pounds.

447 tons is roughly equal to the weight of five NASA Space Shuttles. With growing awareness of the opioid epidemic in our country, it is certainly possible that the record may have been broken again this year.

As future physicians, it will be important for us to spread the word and continue to facilitate awareness of community disposal programs like this to our patients. According to the DEA, the majority of prescription drug abusers report in surveys that they get their drugs from friends and family. By cleaning out medicine cabinets and disposing of medications appropriately, we can reduce accidents, thefts, and the misuse and abuse of these medicines—including the opioid painkillers that accounted for over 33,000 deaths in 2015.

Proper disposal of expired medications is crucial, but what if there were other, more efficient, more cost-effective options for the medications that are not expired and go unused? What if unused prescription drugs could be recycled and redistributed?

A recent ProPublica investigation found that nursing homes waste millions of dollars in prescription drugs every year. Marshall Allen, the author of the investigation, recently gave an interview on NPR. Medications are discontinued for many reasons, including when a patient passes away or gets discharged, “and so in most nursing homes around the country, they just throw those drugs away,” said Allen.

With the rising costs of healthcare and the unprecedented costs of prescription drugs these days, it is a little disturbing to hear that millions of dollars of perfectly good prescription drugs are literally being flushed down the toilet. As Allen reports, Medicare and other commercial insurance payers have already paid for the prescriptions, so why not recycle them?

That is exactly what a program in Iowa is doing. SafeNetRx retrieves unused prescription drugs and redistributes them to uninsured or underinsured patients for free. This program estimates that they receive close to $5 million worth of drugs in a year that they redistribute to communities in need.

“The National Academy of Medicine estimated in 2012 that the U.S. squanders more than a quarter of what it spends on health care – about $765 billion a year.”

Can you imagine what impact we could have on healthcare costs across the nation if we recycled and redistributed prescription drugs that would otherwise be thrown in the trash, incinerated, or flushed down the toilet?

When patients are non-compliant in taking their medication because they are unable to afford their prescription, they frequently wind up in the emergency room—putting greater financial strain on hospitals, taxpayers, and communities across the country.

From a health policy perspective, efforts have been made to pave the way for the donation and redistribution of drugs.

The National Conference of State Legislatures said 39 states had passed laws that allowed the donation of drugs. But almost half of these states with laws lack programs to get the drugs safely from one appropriate user to another, and many of those that do have programs are focused on cancer drugs, the analysis showed.

The logistics of such a program appear to be the biggest barrier to getting formalized prescription drug recycling off the ground, and this highlights a classic issue in writing health policy.

“It’s like people have created legislation and it’s a feel-good thing, but nobody’s come back to see why it’s not working,” says Mark Coggins of Diversicare, a chain of nursing homes in 10 states.

Though legislation to address these issues sometimes becomes law, too often it fails to provide adequate investment for carrying out the idea. In Iowa, SafeNetRx is state-funded for about $600,000 a year, and is considered a best-practice, common sense solution for recovering and redistributing prescription drugs to those most in need.

Many patients that benefit from the SafeNetRx program are saving hundreds, if not thousands, of dollars on prescription drugs (not to mention savings for the insurance companies), including low-income and fixed-income senior citizens with multiple chronic conditions.

The next time you clean out your medicine cabinet, or advise your patients to do so, consider where those medications could go. They could be thrown away, or they could go back in the hands of patients that need them the most. With little effort, you can be part of a life-saving solution that also saves millions of healthcare dollars.

If you’re interested in learning more and helping to solve this problem, I encourage you to explore what your state is doing to recover, recycle, and redistribute prescription drugs.

 

Image: Wise Rx Card

We Need to Take Supplements (Seriously)

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We’ve all seen the commercials. “Prevagen, a dietary supplement shown to improve memory, contains a unique ingredient originally discovered in jellyfish.*” What we often miss is the clarifying asterisk, that “these statements have not been evaluated by the Food and Drug Administration (FDA)” and that “this product is not intended to diagnose, treat, cure or prevent any disease.” The truth is that the supplement industry is built on the premise that you can equate supplements wit FDA-approved drugs which have been subjected to the rigors of research, development and clinical testing (or at least that you won’t be able to distinguish between the two).

Like Prevagen, only some of these false claims are charged as fraudulent—and often years after many hopeful Americans have been conned into buying the product. An article in The Atlantic this week discusses the booming dietary-supplement industry and its unencumbered sprint to free-market success at the cost of both credible science and our wallets. Dr. James Hamblin explains the case that many supplemental companies make when selling their product:

A metabolite that no one could ever get from food, and in which nearly 100% of people are deficient, represents a big market. And while consumers are waiting for clinical trials to play out, people don’t need to wait to buy [it].

What’s scary is that supplements are treated more like foods than like drugs by the FDA. They can go straight to market without requiring evidence of efficacy. When provoked, the men in suits pushing supplements will admit that their product is not a drug, but will often continue to make the argument that it is better than food. Again, Dr. Hamblin:

I reacted by asking him about broccoli and salads, and why those aren’t medical foods. They make people with diabetes and heart disease less sick, when used regularly. Conversely, chronic abuse of Pop-Tarts and Pepsi contributes to lethal disease. Eating mostly whole plants will protect most hearts more effectively than the most widely prescribed cardio-protective pharmaceuticals, statins, and yet food is not medication.

So a product that is treated like food—while claiming to be better than food—lacks credibility to be a drug. What can be done?

The future of the dietary-supplement industry might lie in the hands of Dr. Scott Gottlieb, President Trump’s pick to lead the FDA. Gottlieb has received criticism for taking millions of dollars from nearly 20 biopharma and health firms while vowing to fight the opioid crisis. He stands for a libertarian, regulation-free approach and even accused the FDA of evading the law.

But how can a free-market approach to supplements succeed when consumers in the marketplace are unable to tell when a product is actually helpful? As a future physician, I am terrified by the idea that a low-budget commercial for a product with no clinical evidence for efficacy can bear the same weight as my own medical advice developed over years of grueling education.

I’d like to believe that the answer is adequate patient education and more deliberate communication. I learned a lot about the power of “fake news” recently; but unfortunately, convincing those around me that the facts still matter may be one of the toughest tasks in my own career down the road.

Image: Harvard Health