April 30th is National Take Back Day in the US. Take back events encourage consumers/patients to return unused medicines that are lying around their homes to pharmacies, so that they can be disposed of properly. This reminded me of a recent experience that troubled me enormously.
Last Friday, as usual, I popped into my local pharmacist to pick up my partner’s repeat prescriptions. Infuriatingly, for the umpteenth time, the contents of the bag contained two prescriptions that he has not required for at least 12 months. Despite cancelling these numerous times by telephoning or visiting the doctor’s surgery in person, the boxes of unneeded pills appear in the bag every month. On trying to return the unopened boxes of pills to the pharmacist – I hadn’t even left the premises – I was informed that they would be disposed of as, once dispensed, they cannot be reused. Even if the boxes and packaging are unopened and obviously brand new, the medicines must be destroyed. I was flabbergasted – what a terrible waste of valuable resources. And this led me to thinking – what is the actual cost of unused medicines?
I was shocked to find that in a 2010 report, the cost of unused medicines to the NHS was estimated to be a staggering £300 million each year.1 This estimate includes approximately £110 million worth of medicines returned to pharmacies, £90 million worth of unused prescriptions being stored in homes and £50 million worth of medicines disposed of by care homes. What’s worse is that, in a system which is so resource constrained, £300 million could provide:
- 11,778 more community nurses or
- 19,799 more drug treatment courses for breast cancer or
- 80,906 more hip replacements or
- 101,351 more knee replacements
- 300,000 more drug treatment courses for Alzheimer's or
- 312,175 more cataract operations.2
Similar assessments of medicines wastage have been conducted in other parts of the UK.3 In Wales, more than 250 tons of out-of-date, surplus and unused medicines are returned to dispensing General Practitioner (GP) surgeries and pharmacies annually, amounting to a cost of approximately £50 million. The annual cost of unused medicines in Northern Ireland and Scotland is estimated to be £2.5 million and £44 million, respectively.
However, this issue is not localised to the UK and studies have been conducted in a number of developed markets including the US, Switzerland and New Zealand. A recent US study, conducted in the summer of 2015, assessed the cost of unused medicines in South Carolina using a web-based survey with 238 individuals at one health sciences institution and a paper-based survey with 68 individuals at planned drug take-back events at three community pharmacies.4 Although the sample size was relatively small, the findings of the study were startling - two out of three dispensed medications remained unused with the reasons for non-use given as:
- improved disease or condition - 42 per cent
- side effects - seven per cent
- forgetfulness - six per cent.
When projected up to the national level, the estimated cost of unused medicines, borne largely by private medical insurers, were alarming and ranged from $2.4 billion for elderly patients taking five prescription medications, to $5.4 billion for the 52 per cent of the US adult population taking one prescription medication a day. However, there are other risks which potentially outweigh the direct financial cost of unused medicines.
The clinical impact of medicines going unused for patients with chronic conditions requiring long-term, continuous maintenance such as hypertension, diabetes, cholesterol, heart disease and mental health problems are potentially huge. These all require effective management to prevent symptoms from escalating and complications developing. By not taking their medication, patients are compromising the effectiveness of their treatment, which can impede improvement or result in deterioration in health. Some potential knock-on effects for the health care systems are increased demand on hospitals and GP surgeries.
Disappointingly, according to a report published in 2003 by the World Health Organisation (WHO), adherence to long-term therapies for chronic illnesses in developed countries is around 50%.5 In developing countries rates are even lower. In the UK the Aston Medication Adherence Study (AMAS), conducted by Aston Pharmacy School, examined levels of non- or low adherence in patients with dyslipidaemia, type 2 diabetes and or hypothyroidism, living in the Heart of Birmingham.6 The analysis was based on over a million anonymised prescriptions, more than 7,000, mailed patient questionnaires and seven focus groups, plus a literature review. In line with the US study findings, the researchers identified that a quarter to a third of patients were non-adherent. When considering the cost, extrapolating to the national population, they estimated that non-adherence is likely to be costing the NHS more than £500 million a year.
Most compelling of all, a recent US Food and Drug Administration (FDA) announcement highlighted the devastating effects of unused medicines to families and people visiting their homes.7 Over the last 20 years, 12 incidents of hospitalisation and, devastatingly, 12 deaths have been caused by accidental exposure to the powerful pain medications found in fentanyl patches. Most of these occurred in children under two years of age.
Although a US based initiative, National Take Back Day provides an opportunity to reflect on what you can do to help reduce the impact of unused medicines in the UK. There are a number of easy ways to play your part, and I’d encourage you to read the Medicines Waste UK campaign website. But, if you don’t have time, here are three simple steps:
- Only order the medicines that you need - let your GP or Pharmacist know if you’ve stopped taking your medicine, hopefully unlike me, this will be straightforward!
- Remember that unused medicines cannot be recycled – don’t be under the misconception that if you take an unopened box of pills back, they can simply be given to the next patient.
- Keep unused medicines out of the way - don’t stockpile and keep them away from children.
1 Evaluation of the Scale, Causes and Costs of Waste Medicines, York Health Economics Consortium and School of Pharmacy, University of London, 2010. See: http://discovery.ucl.ac.uk/1350234/1/Evaluation_of_NHS_Medicines_Waste__web_publication_version.pdf
2 Only order what you need, Medicines Waste UK. See: http://www.medicinewaste.com/didyouknow
3 Patient Liaison group: Dispensed but unopened medicines, British Medical Association website, accessed 27 April 2016. See: http://www.bma.org.uk/about-the-bma/how-we-work/professional-activities-and-special-interest/patient-liaison-group/dispensed-but-unopened-medications
4 Taking stock of medication wastage: Unused medications in US households, Anandi V. Law et al, Research in Social and Administrative Pharmacy, vol 11, Issue 4, p571-578, July–August 2015. See: http://www.sciencedirect.com/science/article/pii/S1551741114003337
5 Adherence to long-term therapies: Evidence for action, World Health Organisation, 2003. See: http://www.who.int/chp/knowledge/publications/adherence_introduction.pdf?ua=1
6 Drug non-adherence "costing NHS £500M+ a year", Lynne Taylor, PharmaTimes Digital, February 19 2013. See: http://www.pharmatimes.com/Article/13-02-19/Drug_non-adherence_costing_NHS_£500M_a_year.aspx
7 National Drug Take Back Day: A Great Time to Dispose of Prescription Medications Cluttering Your Cabinets, Douglas C. Throckmorton, M.D, FDA Voice, April 25, 2016. See: http://blogs.fda.gov/fdavoice/index.php/2016/04/national-drug-take-back-day-a-great-time-to-dispose-of-prescription-medications-cluttering-your-cabinets/?source=govdelivery&utm_medium=email&utm_source=govdelivery