Old Pills Finding New Medicine Cabinets
By STEPHANIE STROM
Published: May 18, 2005
As the cost of prescription drugs climbs, more of the nation's officials and consumers are weighing how to salvage at least $1 billion worth of unused drugs that are being flushed down the toilet each year.
Though the Food and Drug Administration generally forbids the redistribution of prescription drugs once they are dispensed to consumers, states are free to set their own policies for drugs controlled by nursing homes, long-term-care centers and other pharmacies.
"They seem content to let the states be laboratories, and that works out rather well because the dollars the states are saving are in a lot of cases federal dollars," said James Cooley, chief of staff for Diane Delisi, a Texas state representative and the author of legislation to expand Texas's limited drug recovery program, which may pass within a week.
Several states, including Oklahoma, Louisiana and Ohio, have passed legislation in the last few years allowing unused drugs to be recovered from those organizations for distribution primarily to poor patients.
Nebraska even permits consumers to return unused drugs if they are in tamper-resistant packaging, like the blister package most familiar in over-the-counter medicines, skirting the F.D.A. prohibition.
Recovery has been modest, but California, Maine, Washington and other states are pondering similar programs in hopes of lowering health care costs, however marginally.
Other supporters are trying to push the idea further. An inventor in Massachusetts is seeking a patent on a system that would knit together existing technologies to address the myriad issues of drug redistribution.
"We recycle newspapers, we recycle soda cans, we recycle plastic," said Moshe Alamaro, the inventor, who is a visiting scientist at the Massachusetts Institute of Technology. "It's ludicrous not to recycle expensive drugs."
Mr. Alamaro added, "It should be criminal to throw these drugs away, and instead it's required."
The concept has more skeptics than believers. The hurdles include concerns about patient safety and privacy, the lack of an infrastructure to process and redistribute drugs, and administrative requirements.
"I don't want to sound overly negative, but there are lots of obstacles," said Susan McCann, administrator of the Missouri Bureau of Narcotics and Dangerous Drugs, which is struggling to begin the state's redistribution program.
To sidestep the questions of recycling, Representative Tim Murphy, a Republican who represents Pennsylvania in Congress, suggests that the federal government take a different tack and make it easier for doctors to prescribe small quantities of drugs initially to determine whether a patient can use them.
Monthly or longer prescriptions, now encouraged and sometimes mandated by states and insurers to hold down costs, lead to waste that could be curbed through redistribution.
The amounts discarded are unknown. Though many states require nursing homes, hospitals and consumers to follow specified procedures for drug disposal, the rules add costs and are largely ignored, state health officials and others say.
A study published in the Journal of Family Medicine in 2001 estimated that $1 billion a year in drugs prescribed to the elderly are thrown away, and Mr. Alamaro estimates that a more ambitious system for drug recycling could recapture 5 percent of the nation's prescriptions, or about $6 billion worth annually.
Existing programs are a long way from that, however. The prevailing method of dispensing prescription medicine in bottles leaves it too vulnerable to tampering and contamination for any chance of recovery.
Pharmacies, the most likely candidates for redistribution, have little incentive to take on the administrative burdens and potential liabilities.
And states have not committed to developing the databases and other systems that would be needed, much less wrestled with how to ensure adequate supplies of drugs for patients to continue a regimen.
"It doesn't matter how safe the drugs are, how many of them there are or how neat and crisp the records are, if there isn't a database to tell patients what's available and where it is," Ms. McCann said.
Published: May 18, 2005
As the cost of prescription drugs climbs, more of the nation's officials and consumers are weighing how to salvage at least $1 billion worth of unused drugs that are being flushed down the toilet each year.
Though the Food and Drug Administration generally forbids the redistribution of prescription drugs once they are dispensed to consumers, states are free to set their own policies for drugs controlled by nursing homes, long-term-care centers and other pharmacies.
"They seem content to let the states be laboratories, and that works out rather well because the dollars the states are saving are in a lot of cases federal dollars," said James Cooley, chief of staff for Diane Delisi, a Texas state representative and the author of legislation to expand Texas's limited drug recovery program, which may pass within a week.
Several states, including Oklahoma, Louisiana and Ohio, have passed legislation in the last few years allowing unused drugs to be recovered from those organizations for distribution primarily to poor patients.
Nebraska even permits consumers to return unused drugs if they are in tamper-resistant packaging, like the blister package most familiar in over-the-counter medicines, skirting the F.D.A. prohibition.
Recovery has been modest, but California, Maine, Washington and other states are pondering similar programs in hopes of lowering health care costs, however marginally.
Other supporters are trying to push the idea further. An inventor in Massachusetts is seeking a patent on a system that would knit together existing technologies to address the myriad issues of drug redistribution.
"We recycle newspapers, we recycle soda cans, we recycle plastic," said Moshe Alamaro, the inventor, who is a visiting scientist at the Massachusetts Institute of Technology. "It's ludicrous not to recycle expensive drugs."
Mr. Alamaro added, "It should be criminal to throw these drugs away, and instead it's required."
The concept has more skeptics than believers. The hurdles include concerns about patient safety and privacy, the lack of an infrastructure to process and redistribute drugs, and administrative requirements.
"I don't want to sound overly negative, but there are lots of obstacles," said Susan McCann, administrator of the Missouri Bureau of Narcotics and Dangerous Drugs, which is struggling to begin the state's redistribution program.
To sidestep the questions of recycling, Representative Tim Murphy, a Republican who represents Pennsylvania in Congress, suggests that the federal government take a different tack and make it easier for doctors to prescribe small quantities of drugs initially to determine whether a patient can use them.
Monthly or longer prescriptions, now encouraged and sometimes mandated by states and insurers to hold down costs, lead to waste that could be curbed through redistribution.
The amounts discarded are unknown. Though many states require nursing homes, hospitals and consumers to follow specified procedures for drug disposal, the rules add costs and are largely ignored, state health officials and others say.
A study published in the Journal of Family Medicine in 2001 estimated that $1 billion a year in drugs prescribed to the elderly are thrown away, and Mr. Alamaro estimates that a more ambitious system for drug recycling could recapture 5 percent of the nation's prescriptions, or about $6 billion worth annually.
Existing programs are a long way from that, however. The prevailing method of dispensing prescription medicine in bottles leaves it too vulnerable to tampering and contamination for any chance of recovery.
Pharmacies, the most likely candidates for redistribution, have little incentive to take on the administrative burdens and potential liabilities.
And states have not committed to developing the databases and other systems that would be needed, much less wrestled with how to ensure adequate supplies of drugs for patients to continue a regimen.
"It doesn't matter how safe the drugs are, how many of them there are or how neat and crisp the records are, if there isn't a database to tell patients what's available and where it is," Ms. McCann said.
NY Times
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