Don’t bin or flush unused medicine
If I take a peek in my first aid cabinet, it is fair to say that it’s somewhat shambolic. There are antibiotics in there that my dad left behind on his last visit; pain relief from my daughter’s broken ankle three years ago; bottles of Gaviscon halfused and no doubt well past their expiry date; and various open packets of vitamins and other supplements, dating back to who knows when.
The only reassuring thing about this is that I know I am not alone. I suspect if all households did the same, we would discover that most of us have unused, unwanted or expired medications, just sitting there gathering dust. So why is this such a problem, and what is the responsible thing to do with these drugs?
First the cost. As a country, we spend about $800 million a year on pharmaceuticals. Wasted medications cost us an estimated $40 million, so that’s 5 per cent of the total drug budget – not an insignificant amount when we think how that money could be used elsewhere in the health system.
Second, there are the risks of having these medications still in our possession – by ‘‘stockpiling’’ unused medicines, the chances are that someone will either end up using an expired (and therefore potentially ineffective) drug, or will accidentally use something for the wrong purpose or at the wrong dosage.
As packaging ages it becomes hard to read the directions correctly, pills can get put into different boxes, and the potential for overdosing is very real. Emergency departments frequently see children who ingest medicines accidentally, with potentially lethal consequences.
There are plenty of reasons we end up with cupboards full of unused drugs. Many patients will report stopping courses of medicines early when they feel better, rather than finishing them all as prescribed, which can leave multiple tablets unused – this is a particularly common problem when it comes to antibiotics.
For longer-term treatments, GPs frequently prescribe three months supply at a time, with good intentions as this way it ends up costing the patient less – the danger is that if the drug doesn’t suit the patient and they get unwanted side-effects, they will often stop it and get prescribed something else without returning the unused supply.
The horrifying side of all this is that many of us end up disposing of these medicines in a way that is dangerous to us and the environment – in fact, a recent survey in Australia showed that 65 per cent of people admitted to throwing their unused drugs into their garbage, and 23 per cent said they had flushed them down the toilet. I suspect our figures would be similar. Clearly this brings very real risks when we have potentially toxic medications in our water system, landfills and soil.
So what can we do to minimise the dangers?
As doctors, I think that we can take steps to mitigate some of the risks – prescribing shorter courses until someone is happy and established on their ongoing medication would be an easy habit to get into, and it should be common practice to remind patients who are switching medicines to take their old supply back to the pharmacy.
Pharmacists and prescribers should be educating patients around safety – not only safe storage of drugs, but also how to dispose of them properly. Unfortunately at present there is no consistent approach to this around the country, so processes will vary between DHBs. In many areas, medicines should be returned to the local pharmacy, which will have an agreement with either its wholesaler or another company to dispose of them safely by incineration, but this may not be the case everywhere.
Never throw drugs away – if you don’t know what the proper process is in your region, your pharmacist will, so please ask them.
Don’t stockpile – look through your medicine supply when you have a few minutes and get rid of anything that is no longer needed. It is fine to have good supplies of pain relief, antihistamines and other ‘‘emergency’’ medications as long as they are all in date and out of reach of small children, but don’t keep other unused medicines at home.
Encourage your local pharmacy to ‘‘recycle’’ their unused medicines and give back to those in need – there is a wonderful Christchurch-based charity called Medical Aid Abroad (maa.org.nz/) which accepts all unused, undamaged and in-date medicines from around New Zealand, and redistributes them to developing countries as needed.
Good luck with this! I’m off to clear out my old medical supplies and lobby my DHB to sign up with MAA. Dr Cathy Stephenson is a GP and forensic medical examiner.