Would you re-use medicines returned to the NHS?

Apparently over half of people would be happy to re-use prescription medicines returned by other patients, as long as they were safe. Is this the way to cut the amount of wasted NHS medication?

A recent survey by IPOS Mori found that 52% of people polled would be likely to accept re-issued medicines. Only 32% said they wouldn’t be happy to.

Previously re-issuing unused medicines hadn’t been considered due to the perception that patients wouldn’t agree with it. But with an estimated £300m lost due to wasted medication every year, the NHS needs to look at other options.

Being prescribed someone’s leftover medicine

I certainly wouldn’t dismiss re-issued medicines out of hand. But I would want to be 100% sure they were safe. And safety is more complex to ensure than you might think. It’s not just a case of saying that an unopened, in-date box is safe.

Temperature can change how some medicines work, so if they’ve been stored above the oven or near a radiator they might look fine, but they may no longer work properly. So there would need to be a way of identifying that a person’s medicines have been stored correctly.

Dr Bill Beeby, chair of the GPC prescribing subcommittee, says that the ‘amount of safety mechanisms needed for this would simply not be worth it for most low-cost medicines’.

Tackling wasted medication

So if re-issuing medicines won’t be cost-effective, what else can the NHS do to stop people from wasting their prescriptions?

Medicines remain unused for a number of reasons. Perhaps someone’s forgotten to stop a repeat prescription for a medication they no longer need. Or maybe it’s the result of a change of medication just after a repeat prescription has been collected. Or, sadly, perhaps someone has gone into hospital or died shortly after their prescription was delivered.

One way to stop medicine wastage could be a requirement to visit your doctor every time your prescription needs renewing. Then again, that would probably be a waste of time and resources greater than the cost of all those wasted medicines. Plus, I know I wouldn’t want to do that for my regular repeat prescription, which my pharmacist automatically collects.

What about increasing the price of prescriptions? That might put people off stockpiling medicine they no longer need. Of course, the flip side would be that some people wouldn’t be able to afford their medication.

There are no easy answers here, but re-issued medication could be an option. Would you accept another patient’s leftover medicine? And how do you think the NHS can help patients waste less medicine?

Would you be happy to re-use medicines returned to the NHS?

Yes (53%, 238 Votes)

No (34%, 152 Votes)

I don't know (13%, 60 Votes)

Total Voters: 454

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Comments

lessismore says:

24 April 2013

Who checks that the pharmacy has only requested the two things that you have ordered of your repeat prescription of five?

After another “Computer says No” session with GPs surgery – with an Easter holiday, a pharmacy that is only open weekdays that delivers which takes several days more, and a carer needing to help with ordering or any other collection I suggest that pills come in standard 30 packs not 28.

It would be easier for the GP’s surgery who are refusing if something has already been ordered that month without taking into account the amount of time it takes for the prescription to be written, filled and delivered to make the right decision.

Perhaps it would be of benefit to them as well to follow up on patients as they once did for a medication review.

Graham Woodcock says:

16 September 2016

After having a kidney transplant I had over a months supply of unopened boxes of peritoneal dialysis fluids at home, kept in clean dry conditions in my my house. I guess this must have cost the NHS thousands of pounds. The hospital says that the fluids will have to be disposed of because the prescription reuse rules does not allow them to use the fluids for other patients. All the fluids are in date. If it was deemed safe for me to use the fluids why is it not safe for other patients to use the fluids?

malcolm r says:

I suppose because the NHS don’t know how they have been stored, if they have been contaminated for example, so must play safe. A real problem (cost) is the over-prescription of drugs that may never be used. We are currently i believe limited to 1 month’s supply of general drugs; perhaps that is too much? However whilst drugs are largely dispensed free of charge there will be substantial waste. Maybe doctors need to be more careful about how they prescribe, particularly the use of repeat prescriptions and their review.

I wouldn’t want to use drugs that had been returned from a patient.

sue broady says:

4 January 2017

Most of the arguments against reuse concern medicines from people’s own homes, where storage can be less than ideal, however in nursing homes or prisons, for example they are stored correctly and unopened as in for example, morphine ampules with 3 years expiry are wasted without use, many drugs never see the patient or boxes are unopened, due to change in prescribed medication or ordered in case, it is a scandal to see these entirely usable drugs thrown away

Peter says:

26 July 2019

The same points could also apply to medicines in hospitals

Shou says:

10 April 2018

I think it’s very dangerous to health reusing old prescription drugs, and it could be do more harm than good for low-income people specially. Let me explain why. We know that many people can’t afford prescription drugs, even though they are funded by the NHS, but prescription drugs can be only purchased at pharmacies under a prescription authorization signed by the doctor.

As many people can’t afford meds due to cut-offs at healthcare and low wages, this situation is leading the less favored people to acquire his meds outside the pharmacy. And this is a dangerous practice because those drugs purchased at unathourized sites (e.g. black market, internet, etc.) can be expired, near to expiration, in poor conditions of keeping or innaccurately storaged, with broken packages, with no labels, etc. or can be a counterfeit item, which is more dangerous. In other words, those medications lack of health and legal guarantees and they can provoke poisoning, serious health problems and even death. And the consequences would be more expensive for the NHS and it will require more expenses. And it’s better to prevent than to cure. As an Spanish idiom said: Sometimes, the cheap comes out very expensive (A veces, lo barato sale muy caro). Even though I’m not wealthy, I disagree and I discourage the idea of reusing old medications due to health reasons. For me, health is more important than money and I’m a staunch defensor of the right to healtcare. Everybody has the right to access to healthcare, with no discrimination, even the people with low income has the right to receive healthcare assistance. That’s why I stand and I support NHS. If healthcare was a full right and not a luxury, nobody should take used meds.

Furthermore, this is not only a health issue, this is also a legal issue because, according to national laws, prescription drugs can only be dispatched by authorized pharmacists presenting the appropriate medical presciption by the patient. Nobody except the pharmacist are allowed to pack off medicines outside the pharmacy without authorization. In other words, individuals cannot sell out, dispatch, barter, give away nor buy a prescription drug. In general terms and according to the law, exchanging prescription drugs between individuals is like selling cocaine and the offenders can face a lot of legal consecuences as felony charges, high fines and prison. However, for people with low income there is a lot of programs of aids, programs and subsidies carried out by diverse charities and medical and pharmaceutical associations intended to pay the meds instead of searching them out at unathourized places or by individuals.

“Apparently over half of people would be happy to re-use prescription medicines returned by other patients, as long as they were safe.”
The key point here is “as long as they are safe” and it is simply too expensive and impractical to test for purity, a process which not only destroys much of the medicines but costs more than what individual packs of medicine are worth.
If safety cannot be guaranteed then the medicines should not be given to anybody, either in the NHS or abroad.
Appeals to collect unused medicines for use overseas, whilst well intended, can guarantee neither product purity nor patient safety. In addition the supply of medicines is governed within a legislative framework for reason of safety to society. This legislation does not permit the sale/supply of prescription only medicines other than via a registered Pharmacy or wholesaler. It would also be unlawful to even possess a controlled drug, i.e. a drug included within the misuse of drugs act, let alone supply a controlled drug. Those who arrange collections of unused medicines to be sent abroad need to be aware of such issues.

If the unwanted medicines returned from Care Homes or patients homes could be shown to be safe to use, then surely they should be used within the NHS rather than donated elsewhere, as the British taxpayer has funded them.

As things stand the most practical initial way forward is to attempt to reduce overprescribing where possible and to educate the public on the need to order medicines, as actually needed, rather than to stock up and hoard. Schemes based upon these principles by the NHS should be supported, i would suggest.

John Ward says:

27 July 2019

I agree with your general comments, Peter, but if pre-packed tablets are still within date and the seals on the packs are unbroken [any part-used packs should be rejected] I would have thought they would be safe for re-issue.

I think this could apply to more than just tablets; it would be difficult to prove the purity of medication in tubs or tubes without opening them but if there is an unbroken seal between the cap and the contents I would suggest it is safe as such products are not taken internally. Medicine in bottles would also be safe if within date and the cap seal was unbroken. A visual inspection should suffice; if they fail that there is no point in testing them. Certain categories of critical medication would probably need to be excluded from a re-issue policy.

Ian says:

Peter: just a quick question but given your obvious erudition I wonder if you noticed that this topic was seven years old and that the comment to which you replied was posted two and a half years ago? Most of the contributors to W?Cs comprise a fairly transient population, so with a small number of notable exceptions it’s unlikely that any of those posting are still around or checking contributions.

I’m not asking this with intent to ridicule; It’s a concern of mine that the dates on the posts are grey and as far from prominent as it’s possible to be.

Peter Cameron. says:

19 September 2021

! If the seal is unbroken, and within time limit of the item, common sense that that they should be reused ! Perhaps reduction of overall allocation dispensing fees may come into the equation. Why has that not been sorted by now ? £300m should be made public, that would make a lot of public anger and Govt. embarrassment, especially person (s) responsible.