Americans spend some $200 billion annually on prescription drugs. Since 1997, in an effort to keep a lid on costs, 37 states have enacted legislation allowing patients, their families and health care facilities to recycle good, unused pills through local pharmacies for donation to patients lacking sufficient insurance. Thousands of patients could in principle benefit from these “drug repository” laws. But as well intentioned as these efforts are, practical problems have prevented widespread implementation of such programs.

The guidelines for these laws, which began thanks to the lobbying efforts of families of cancer patients, are fairly consistent throughout the country. Donated medications must be in sealed, tamper-evident packaging and usually must be within no more than six months of their expiration date. Pharmacies are not held liable should the drug’s next owner come to unexpected harm from the medication. Some repositories accept cancer drugs only; others take all prescriptions (minus narcotics and sleep aids). Some states accept unused pills from home medicine cabinets, whereas others, as a safety measure, permit donations only from professional facilities such as nursing homes.

Under the rules, Iowa collected more than 300,000 pills with a retail value of approximately $290,000 in 2007 and distributed them to some 780 patients. Recycling medicines from Tulsa-area nursing homes saves Oklahoma about $120,000 a year. These successes, though, are small when compared with the potential of the practice. According to the American Cancer Society, as of June 2008 only about one third of the states with repository laws had up-and-running programs.

Part of the problem is money: pharmacies accepting donations do not want to incur the cost of hazardous waste disposal if the drugs go unused. With no reimbursement code for handling and processing donated meds, pharmacies have to be willing to operate as a repository on a completely charitable basis. And despite the letter of the law, many pharmacists fear lawsuits if the drugs prove faulty. Storing the drugs, especially when refrigeration is required, also poses its own issues and costs.

Physicians themselves have felt reluctant to steer patients toward the repositories. Many consider donated drugs too risky because their pedigree cannot be established. “We don’t give any drug to anybody without knowing exactly where it’s been at all times,” says Roger Lyons, a private hematologist and oncologist in San Antonio, who regards the process as akin to filling prescriptions through the Internet or foreign pharmacies. “I am ultimately responsible for making sure a patient under my care gets the right medicine, so I’m not taking the risk.” Lyons also sees little need for repositories: “There are very few patients for whom we can’t get free drugs if they can’t otherwise afford it.”

The inability to ensure a ready supply is also problematic. Doug Englebert, who oversees Wisconsin’s drug repository program, notes that patients could suffer a potentially harmful gap in treatment if a pharmacy has a donated drug one month but not the next. Physicians, he says, “might have concerns with a repository because it’s not a guaranteed supply.”

Englebert cites some of the legal demands as hampering the usefulness of these programs. For example, the exclusion of drugs due to expire in less than six months, which dramatically reduces the supply of eligible donations, may be overly cautious because many of the medicines would be claimed and used well within that time frame. Because the tamper-evident seal cannot be broken, even a nearly full bottle cannot be given. The requirement essentially limits donations to pills sealed in blister packs—otherwise known in the industry as unit-dose packaging.

“There are very few medications that are in unit-dose packaging,” Englebert remarks, “and so therefore very few that are eligible for donation.” In addition, the lack of funding renders many programs cumbersome. Without databases of participating pharmacies and their current inventory, for instance, would-be recipients need to call every registered outlet to inquire whether their prescription is available.

3 Comments

1. 1. Teriss 12:30 PM 1/29/09

   That 200 billion dollars worth of drugs ends up in our drinking water, lakes and streams. The water purification systems do not remove pharma drugs from drinking water. It is high time that the pharmaceuticals pay for removing their waste from our water, as most of the drugs end up in the toilet. We are far over medicated, and over subscribed in this country, its time to spend money on organic foods, not chemical foods and stop this "drugging of America". Test studies reveal that fish are growing breasts, and anti-depressants, arthritic medication, even Viagra is in your tap water, don't drink it. Lets get some laws to clean up our water, and those drug companies should be the ones paying for it.

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2. 2. GrantMartinez 10:32 AM 6/28/09

   It is high time that the pharmaceuticals pay for removing their waste from our water, as most of the drugs end up in the toilet. We are far over medicated, and over subscribed in this country, its time to spend money on organic foods, not chemical foods and stop this "drugging of America". <a href="http://npdrugs.com">No RX Drugs</a>

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3. 3. Poupon 11:14 AM 3/20/11

   I am trying to donate dozens of new bottles of medicine that were prescribed to my FIL just before his recent death. Neither the rehab center where he passed, nor the independent living center where he lived, knew of his program. Clearly information about this program is not being distributed where it should be.
   
   My response to the pharmacist who claimed this is like ordering drugs on the internet is no, it is not. Large profits are involved in internet drug sales; none at all are involved in donations. You have NO problem filling a dozen prescriptions for a patient and then two days later filing a completely diffent set of them for the same patient when he is switched to a new doctor or hospital, do you? In my fil's case, he went, in the matter of a month, between his own doctors, to first one hospital and then another and then into rehab, then back to the second hospital and back to the rehab center. Each time his pharmacy profited by filling a completely new set of meds. Some went to the hospital, and inexplicably, some were delivered to his apartment. Only a fraction were consumed. All were billed to the American public, because they were paid for by medicare.
   
   The bottom line is that pharmaceutical companies need to be offering financial support to this program, including adveretising it. They need to be footing the bill for a campaign to stop people from flushing unused meds down toilets. And pharmacists need to do their part by participating in this program and letting
   every person who picks up a prescription know about it. I know I have filled prescriptions I never used, because it was discovered I had something else, or in a recent case, was told by my electrophysiologist not to take the type drug my GP preescribed.
   
   There also needs to be better support for families when a member dies. We're viewed by the general public as sharks looking for inheritance, when, in many, if not most cases, the family would love help donating the many things that elders own that thrift shops can't or won't accept. Every facility that cares for elderly or terminally ill people ought to have a list of places that would benefit from warm coats, blankets, walkers, etc.
   

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