Wasted medications, wasted resource

In Canada, almost anything can be recycled; however, medication is not currently recycled in community practice. For many years, US hospitals in some states have taken unused medication and redispensed it without an issue.¹ In 2010, Canadians spent $31.1 billion on drugs.² It is estimated that 3% to 7% of medications intended for patients goes unused in the United States and that similar wastage could cost Canada approximately $8 billion annually.^3,4 In the current economic climate, the government is searching for ways to improve and pay for public health care. Recycling medication is a solution that sacrifices neither quality nor finances.

A Health Canada study from 2000 revealed that more than 10% of Canadians had no insurance, while another 10% were considered underinsured (those spending 2.5% of their gross family income for drugs are considered underinsured and those paying 4.5% are considered uninsured).⁵ Medications are not covered for outpatients, resulting in a situation where those who cannot afford medications have adherence issues. The lack of a publicly funded program to pay for medications for marginalized Canadians puts them at increased risk of health problems, stress and hospitalization.

In 38 US states, there have been medication recycling programs in place dating as far back as 1997.³ In Tulsa, Oklahoma, alone, 6000 prescriptions were collected in 2005, which resulted in a savings of $1.4 million.⁶ In this program, drugs were collected from nursing homes and then distributed to patients in need via a central pharmacy.¹ The nursing home residents sign a consent form to release their medication to the recycling program. Those who wish to participate in the program must sign a consent form acknowledging they understand the purpose of the program and that the pharmacy, pharmacist and manufacturers are not held responsible for medications that have been donated in good faith.

To ensure patient safety, all states that have legislation concerning drug recycling contain provisions: that all collected donations must have an expiration date and not be expired, that a licensed pharmacist is part of the verification and distribution process, that each patient who receives a drug must have a valid prescription and that controlled substances cannot be collected. In some states, only drugs that are packaged in unit doses and have not left the circle of care can be collected, so that the safety of the medicines can be ensured. In the 3 years that the Iowa Prescription Drug Corporation has been distributing recycled drugs, there has been no evidence that patient safety has been compromised.¹ Currently, laws in most provinces prevent an initiative like this from taking place because it is professional misconduct to redispense and resell medication. These laws have been put in place to protect the public, but are we really protecting the segments of the population unable to afford medication?

Canadians who lack insurance, for instance when they are unemployed or their finances are not sufficient, can be put under unnecessary stress by needing to find ways to pay for potentially lifesaving medication. Although a recycling program would not resolve access to medication as fully as universal prescription coverage, it would fill a void for those Canadians who would otherwise have to make difficult financial decisions. A Canadian recycling program, run by a not-for-profit organization to prevent double-billing, would not put added pressure on government and would save patients money and improve their health without putting them at increased risk. We need to implement a program like this in Canada to ensure that everybody who needs medication can access it. ■