You couldn't be more "right on" here!  One other point to make, right or wrong, is that if America did more of this "pill sharing", so many people wouldn't travel to Canada or Mexico to get "cheaper"medicine. (I never really could figure this out--how much does it cost to travel there to get the medicine?)

If we could turn the medications in to a pharmacy to have it verified as being "that" medicine, slap a new label on the same pill bottle, what's the problem with giving it away, or paying a nominal (no more than a couple of dollars) fee for the verification and relabeling, and get some use out of those pills?  In this economy, I would rather give the statins I was given samples of even though I vehemently said I could not take them away to someone who can take them but can't afford them.  Meanwhile, they just sit there.  Of course, I could just hand them over, and ask the person not to tell who they came from.  But I could bear the guilt of that and face federal charges!

I doubt this will go anywhere, just like our blog on what healthcare should be like......

Becky

DR. Melissa

Sorry to hear your patient passed away. I posted on your Mind over Metal post and hope to get some feedback. Concerning unused medications, i have some, and I did a stress test 2 weeks ago at my cardiologist office quite a large group of doctors in inverness, florida. I noticed a sign posted saying they were not accepting unused medications for liability reasons. I did not pay much attention until i read your post about this. I don't know what the laws are in florida on this i will check, we are fixing to fire our congress woman and hopefully some state politicians here and i may start with the new ones after november. But like I am finding out per the previous post by Becky change is difficult, it really is frustrating me.

Thanks for your excellent posts.

Rick

Rick,

I hope you can start a grassroots movement to promote the utlilization of unused medications.  If the entire nation would embrace it, lives and money could be saved.  I'm so glad you enjoy our heartfelt blogs and thank you for posting.

Glad to hear from you Becky as always.  I think our exchanges are at least stimulating for thought! We should not give up on trying to make a positive change....ever!

Melissa

Hello,

As I observe the crisis in the US and Canadian health systems, I continue to be amazed that industry can so easily convince people that any notion of sharing is akin to socialism, and "better dead than red" continues to be a pervasive ideology.  In Canada, despite having a health care system for all, we are being crippled by the costs associated with purchasing goods and services from private corporations.  The issue of sharing medications is a prime example of "forced waste" by the corporate lobby.

Your comments regarding the secondary costs of not taking appropriate medications on the acute care system are bang on, and in an era where length of stay and readmissions are squarely in the sights of hospital administration, "radica" ideas such as sharing medications require the attention of all.

 I wish you luck down there in overcoming the "McCarthyism of healthcare" for the benefit of all.

 David, Calgary Canada

I agree with your concerns.  The cost of "saving" on the cost of medications could be more than offset by the health consequences of degraded medications, or improperly stored (e.g. wrong drug in bottle) or a host of other unforseen actions on the behalf of the original customer.

I also see the burden of trying to manage all these returned medications falling on the pharmacist.  What a nightmare, not only from a liability aspect, but also from a logistical aspect. 

One way to prevent drug identification errors is to require all medication is dispensed in unit-dose containers, much like some over-the-counter drugs are packaged.  That way, each dose is correctly labeled and the expiration could be included.

The down-side is that this is a less "green" use of materials.  Instead of using recyclable plastic vials, manufacturer's would have to switch to packaging material that is not recyclable.

 Always keep in mind the law of unintended consequences.  A solution to one problem may create other problems.

I agree with these concerns but there should absolutely be a grass roots movement to open up more dialogue about the safety and feasibility of dispensing unused medications.

I see too many patients at our free clinic who may or may not be continuing their meds on their "off" months from clinic.  We try to utilize meds on $4 lists when possible and educate about what can happen when certain drugs are discontinued abruptly.  But I still worry.  It would be great if free clinics had more resources (like unused meds) and patients did not have to have "off" months.  I would think that this would also translate into cost savings at university hospitals as more patients were able to take meds regularly and reduce the number of complications.

Great topic!

Melissa,

I love your postings.  I agree completely. If I could add one more facet to this?  Many people are told to flush their unused meds into the toilet, assuming that waste systems can remove it.  We know that is not true.

I would like to see an initiative that all pharmacies have sealed recycling bins behind the counter (one for scrips with time left, one for past expiration.   These bins could be sent to a central plant attached to a local school of pharmacology, to have drugs examined and verified by student pharmacists and put into labeled individual dispensing cannisters, or disposed of safely if needed.

Usable drugs can go anywhere it is legal - to clinics, in the US or outside the US.  The issue of how the drug was stored is a valid one and quite complicated.  Perhaps we start a program with the drugs that are not as storage sensitive and with the widest customer base.  Better some than none.

 The cost for a program such as this could be paid by three sources who either suffer the consequences or enjoy the profit of pharmaceuticals:  the drug companies, the retailers and the waste treatment (government) who is ultimately responsible for our water system safety.  

 One more consideration is theft of addictive drugs.  Perhaps logging the entry at donation into a computer by the donator, and verified by the pharmacist, creates a form of accountability when the shipment gets sent to the processing center.

 All I know is that drugs are polluting our water and getting into ALL of us.  Who is paying for that? The waste and the pollution could be managed together.

Mary, Los Gatos, CA

Mary,

Thanks so much and I'm so glad you enjoy our blogs.  Interestingly, our local Barren River Health district offered an opportunity for correct disposal of drugs in order to avoid ground water contamination.  I know it is something that is being considered in a sort of a grass roots movement.  

 Additionally, narcotics and sleep meds are excluded from the programs .  

I appreciate your post and agree with your observations.   Hope you have a great week.

Melissa

Cindy,

 I can't thank you enough. There are only three parties who understand the importance and the impact this program could have: patients who can't afford their meds, physicians who prescribe them, nurses and other health care providers who must care for the poor "frequent fliers" that we get patched up and feeling better after a very expensive hospital admission only to see then relapse in 3-4 weeks and return, each time, in worse shape than the preceding admit.

Cynthiai,

I understand your concerns and they are not without merit. However, where there is a will, there is a way. I'd say that since congestive heart failure is our most expensive DRG, the number of patients who are readmitted because of lack of medications far far exceeds the numbers of patients who might be hurt due to storeage issues. Those drugs to my knowledge like ace inhibitors, arbs, beta blockers don't really need much special attention I don't think.  Besides, this program is working well in several other states. I don't think we need to reinvent the wheel.  I think we need to gives this program some wings and wheels and get rolling. 

Melissa

Hello :)

since I started practice I do that all the time; returned medication or medication from abroad close to validity term can go a long way !

but i'm not in USA so I can do that. 

now, seriously, i don't know what I would do without samples from pharma companies and without returns.

I loved the article!

Michelle,

Congratulations for practicing compassionate medicine. I've always thought I'd love to practice outside the US just for a while to be able to see how it feels to be unimpeded by the constraints built into our health care system.

Best of luck and so glad you liked the piece! Thanks for reading!

Melissa

My first thought on reading this article was about my own elderly mother. She takes a small truckload of drugs every day, has no clue which pills are for which diagnosis, has been known to accidentally dump her pills all over her fuzzy carpet before shovelling them back into the container (any old pill container) and lately she's taken to dumping all the pink ones together and all the pale yellow ones together because this makes some kind of sense to her. 

What has saved my mother, and certainly saved her children much anxiety, is the bubble pack that her pharmacy now prepares for her.

And this kind of bubble pack is the only way I can see this recycling of prescription drugs might safely work (despite the environmentally-unfriendly over-packaging this would require). But this would ensure that the medications are correctly labelled and dated and are untouched by who-knows-what-kind of human hands.

As Cynthia says, there are considerable safety issues unless we are absolutely certain that what the package label says is indeed what's inside the package.

Thanks for this!

Carolyn Thomas

www.myheartsisters.org

Thanks for posting Carolyn.  I agree that safety should always come first but I think that  the risk of missing one's amiodarone prescribed for Vtach far outweighs a packaging issue.  I hope we can get the ball rolling on this soon in our state!

Melissa

Nice work dude...you just rock...the post by you are just waooOOOOOOO…

<a href=http://bilingualresourcesgroup.com/">Business translation</a>