/ Health

Would you re-use medicines returned to the NHS?

Blue drugs in tin

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
Profile photo of wavechange
Member

I have seen a number of cases of elderly patients hoarding medicines, and all were intelligent people. One told me that it was as a habit developed during wartime shortages! The worst example was a relative who must have accumulated about two years’ supply of about 8 drugs and continued to ask for repeat prescriptions despite my best efforts. That person actually had a recent copy of the British National Formulary on the bookshelf, and this gives the approximate price of drugs. Fortunately none of the drugs were expensive and the user had them carefully stored in date order.

My present GP uses the prescription counterfoil to indicate when the next prescription is due. I could accumulate certain drugs where I vary the dose in agreement with my GP, but I avoid accumulating more than I need to cover for holidays. I hope that most GPs now do the same to help discourage the drug hoarders.

Having heard about the state of some houses from speaking to people like service engineers and health visitors I would not like to use anyone’s left over drugs. Better to focus on avoiding unnecessary prescriptions, I think. I urge everyone to have a look and see what your parents and elderly friends have in their cupboards.

Profile photo of brat673
Member

My wife has a large number of drugs and frequently has to alter them or tries a new one only to find it unsuitable after a short period. Then having ordered the next supplies to end up with a sealed box to go to waste. The pharmacy will not take drugs back even if they have made a mistake!
Another point I would comment on is the delivery of prescriptions. If chemists can deliver for free are they being paid too much???

Member
Phil says:
7 February 2012

The chain of custody has been broken and there’s no guarantee that the NHS is even buying back the same medication or that it hasn’t been tampered with in some way. Sounds like an ideal opportunity for crooks, terrorists and psychopaths to do mischief.

By way of comparison owners of self catering holiday accommodation are recommended if not required to throw away any food left behind if the seals have been broken. To re-issue returned medication sounds like a non-starter to me.

Profile photo of lessismore
Member

Hospitals prescribe and change patients’ medications when in hospital. A medication record card is sent home with the patient. Unfortunately in our experience this often does not agree with the medications sent home with the patient. A discharge note is also sent home and a copy of this is also sent to the GP. So medication record card and discharge note need comparing as well as drugs brought home TOGETHER with the repeat prescription note which is what the patient uses to order their drugs.

If the Doctor’s Surgery READ the discharge notes they would be able to make the alterations to the repeat prescription note. My impression is that they just file them (but I don’t even know that).

Unfortunately patients are now being discharged from hospital when they are not well enough to attend the local Doctor’s Surgery to discuss their medication. These patients are often elderly with hearing and eyesight problems as well as mobility problems – and possibly memory problems as well. (Don’t forget that good eyesight and hearing also aids memory.) So discussion needs to be face to face.

Patients therefore rely on the pharmacy to deliver the drugs as they no longer drive. They don’t like to burden friends and family with this and also don’t want to change their routines once established.
Endless strange people seem to charge into the house in a great hurry and nobody knows exactly who they are and where they came from and what exactly their job is and if they had to explain each time they would never get anything done. In one county the “District Nurse” is seven qualified nurses; in another 11 most of whom are Health Care Assistants. We don’t all live in one county – we never have – and we also move from time to time.

When you can’t hear properly and can’t see properly and have been married for more that 60 years you tend to depend on each other so you like to go to appointments together. Then you can discuss exactly what you heard AND understood from the meeting. Hospital transport won’t allow this. Hospital appointments are sent out at times that hospital transport can’t get you there and this causes the unnecessary angst and trouble of telephone calls dealing with strange telephone systems. Too many hospital appointments are a waste of time – they’ve lost your notes so can’t comment; you need to come back in; you don’t need to come back in. Many of these family have accompanied you on – major logistics and time taken off work for and a long wait (1hr) for 3 minutes of consultants’ time. You don’t know who you are meeting; and afterwards you argue over who you met – you thought the consultant you met last time was the man himself. What a complete waste.

Different people bring in equipment and medication and then when you are running out you are told to order from the Surgery only you don’t know what exactly to order. You don’t know the technical names – eg lancet – or what size because the previous ones didn’t come in any packaging showing this.

You end up not knowing who has prescribed what, for what and whether it should be on a repeat prescription or not.

I can understand why people hoard and why people end up taking the wrong drugs.

Profile photo of lessismore
Member

Oh and the carer had to spend the whole morning on the phone and up at the Doctor’s Surgery in order to get exactly the right lancets ordered.

(Maybe it doesn’t make a lot of difference but how the heck and why the heck should everyone else know that?)

Profile photo of lessismore
Member

You can encourage your GP’s Surgery to register so that unused in-date drugs can be used by a charity. There are other charities to donate to too. This is better than getting your pharmacy to dispose of them. (You are not supposed to flush them down the loo, They are considered to be Hazardous Waste.)

“This is taken from https://gov.uk/

Unused drugs and medicines
If medicines are flushed down the toilet, traces of them can end up in water courses like rivers or the sea.
You can take any out-of-date or unwanted medicines to your local pharmacy, who will dispose of them safely. You can also donate certain, in-date medicines to Inter Care, a charity that uses them in developing countries. The link below shows you medicines that Inter Care accepts.
Inter Care prefers to receive medicines through GPs who are registered to donate with them, so check with your GP first. If they aren’t registered, you can encourage them to do so, or post accepted medicines directly to Inter Care. For details on both of these options, see ‘How to donate medicines to Inter Care’.
What medicines can and can’t be donated: Inter CareOpens new window
How to donate medicines to Inter CareOpens new window”

You will need to visit the government website to use the links.

Profile photo of alexcreed
Member

I would be too worried the re-issued pills weren’t what they said they were. Mix ups could be serious and even with the strictest checks not every individual pill could be tested to make sure it was as described and that would worry me.

Profile photo of Elizapip
Member

My father had an operation about a year ago and had about 6 boxes of unopened packets of bandages and plastic tubing etc. all packed, sealed and in unopened boxes.

I took them to the local pharmacy attached to the medical practice and they said they were not allowed to use or dispense them but they would dispose of them.

I can understand the worry about medication and how it may have been stored – but sealed bandages etc. ?? A terrible waste.

Profile photo of lessismore
Member

So agree. The District Nurse who visited may be better able to make use of things like this.

Profile photo of richard
Member

A couple of points –

Many drugs now are individually sealed in strips – so I cannot see why such items cannot be re-issued if in date – particularly as some of them are VERY expensive (like £2000 a month).

I am also a person who will use ‘old’ tablets – You see I remember the time before the NHS when medicines were NOT free and were often too expensive to afford.

I do hate to point out that attitudes learned as a young person will very often stay with you – irrespective of changes afterwards.

Profile photo of lessismore
Member

Drugs are even more complicated now because we are using generic ones – so the packets and names on the outside may not be the same from one packet to another.

They also don’t seem to come in the same numbers – or because they come in strips you don’t get a month’s supply of each of them. I have seen, but rarely, a few odd pills cut of a strip to that the correct number are given. When you have all the right number for a month you can order “all of them” off the repeat prescription as you will be running out of them all together and won’t have to struggle with all their names.

When pills were loose and people could multiply and count it was easier to get the right amount!

With some of these pills now you need a course in how to get into the packaging. The change to the packaging of Lansoprazole last year resulted in a mass of hundreds and thousands type little balls all over the dining table and: “Can you have a look at that packaging to see why I am now having so much difficulty with it?” Why? Several pills lost there.

Actually you will find that they sometimes have to find and use “spare” pills in hospital because it is so difficult to get patients’ pills – so there can be an amount of passing on of pills that isn’t official or officially recognised. Wouldn’t it be better to teach people to look out for different strengths and names and to understand their drugs rather than: “Don’t take anyone else’s drugs”? People need to be checking that they are getting the right drugs from the pharmacy. I’ve had an inhaler that was “to be swallowed with a glass of water”. They also need to be reading about possible side-effects and be aware that you might need to report these and anything you else you think might be a side-effect on a special form available from your pharmacy. Are you diabetic and taking a drug which depletes your body of the vitamin B12 for instance? Is your Doctor doing anything about this? etc etc.

Profile photo of wavechange
Member

We are getting off topic but you make some important points, Lessismore. On simpler matters:

– Pills should be a standard size, shape and colour, irrespective of the manufacturer. It’s great that the NHS is saving money by using generic drugs but no good if the patient is confused by getting different pills when they have a repeat prescription. Old people often have to cope with a variety of pills.

– Different strengths must be clearly identified to avoid mistakes.

– Any reused pills need to be checked very carefully in case they have found their way into the wrong box.

– Wherever possible, boxes should be sealed when they are received by the customer. That means not opening the packet to add or remove pills, so let’s standardise on packaging rather than having some drugs in packs of 28 and others in packs of 30.

– Expiry date should be much clearer, so that older packets are used first.

I can’t match Lessismore’s inhaler to be swallowed with water but I have had a box of pills marked:
Pack 1 of 1. Use this pack first. I did.

Profile photo of Jo Gibney
Member

I was interested to spot this in the news today, as well as (more) about trying to cut antibiotic use:
http://www.bbc.co.uk/news/health-16962465
and
http://www.dailymail.co.uk/health/article-2098764/Unnecessary-prescriptions-costing-NHS-8MILLION-year.html

Profile photo of lessismore
Member

I think it would be worth finding out how many different drugs people are taking. As a young person I took very few – usually antibiotics (though not very often) or creams for irritations. However I have now met elderly people who take an enormous number of different ones on repeat prescription. These are the people who were told that the NHS would look after them for life and who are now living to be 100+. These people are getting a poor deal – they may be getting the prescriptions handed out but they are not getting the other care which might actually save a lot of the use and waste of these drugs.

Years ago I threw away iron tablets because they made me feel so sick. The info didn’t tell me and it wasn’t until much later that I met someone who said that often happened and that you should take them with or after food.

I think that we should be warned more that pills often cause other problems – and have a better idea of the cost of our drugs.

It is not true as in the BBC link above that drugs have to be incinerated. I have seen other places that they can be donated to. http://www.myzerowaste.com has some listed.

Are we paying enough for our drugs? It is politics which keeps a lot of these charges low.

I do wonder when I see a packet of paracetamol in the supermarket for 49p how much it costs if it comes via prescription. (Not the cost of the prescription to the patient which is sometimes charged for and sometimes free at point of service. How much does the pharmacy charge for that packet of paracetamol?)

Profile photo of lessismore
Member

You can see how the situation is not as simple as it might seem at the outset. It would be better to be available to AVOID more of the waste. It has to be better with most surgeries only allowing a month’s prescription now at a time.

You can also see my frustration at trying to deal with three different counties, miles and miles apart with different hospital systems to get my head around. Where is the template?

And I’m supposed to be able to hold down a job and pay my taxes and support myself until I am allowed to retire. I am just one person yelling out!

Profile photo of provpeter
Member

If a person is hoarding drugs they either do not require them in the first instance (over prescribed) or they are not following the regime laid down by their health professional. In both case this could compromise their health. This may also be a waste of NHS resources which may not be so extensive if the person was obliged to pay the market price. Freebies always encourage waste and abuse and dilutes essential resources that would better benefit those who are seriously ill.

Profile photo of lessismore
Member

It isn’t necessarily hoarding though is it? It is just poor management all round. You don’t want the wrong ones and then there is the difficulty of getting rid of them safely and without waste of resources and guilt.

Profile photo of richard
Member

Umm……

I’m well past the “three score years and ten” age and don’t normally take pills or medication – I seem fairly robust.

About 10 years ago I went to the doctors for some migraine pills – He prescribed “Ibuprofen” in an enormous pack of 96 pills for free – I still have 86 all in their airtight wrappings left – used two a couple of days ago Still worked well.

Profile photo of lessismore
Member

Just spent a weekend sorting out pills again.

Several of them have a dosage which depends on how serious a problem is: ie amount of pain and amount of skin irritation.

It is therefore difficult although these are on a repeat prescription to gauge the number which will be used each month. So you could find that you need to order twice in a month. This can caquse problems if you have a Doctor’s practice with LIttle Britain tendencies: Computer says ‘No’. Unfortunately instead of scaling down and being more selective it is far easier to just order everything each time. More approachability/flexibility would be useful.

Profile photo of lessismore
Member

Oh and just found another problem where one tablet three times a day is noted as 28 tablets. I think this was a change from one tablet a day to three. You would have thought that there should be software to eliminate this problem so that the person entering the info would have to deliberately override if there was something different being prescribed eg just 10 tablets. I tend to be with parents at weekends so unable to do anything (needs to be in earshot) and also action will need to be confirmed more than once. The Surgery and Surgery’s closest pharmacy are also closed at the weekend. The stock of this drug is therefore out of sync with the rest on the repeat prescription.

Member
Anon says:
16 August 2012

Yesterday I collected a prescription from Boots. At home I opened the box and found one of the 14 day blister packs had been cut into pieces. I had assumed this had either been tampered with or someone had previously used the product and returned it.

Boots say that it is now common practice to make up boxes from spare ‘off-cuts’. Previously if a doctor had prescribed 20 tablets, but the tablets are only available in quantities of 28 then 8 tablets were wasted.

What they do now is to cut off the 20 for the patient and mix the spare 8 with other off-cuts to make up a full box of 28 again.

This is incredibly dangerous and there is some money grubbing going on with this too. It seems that since 1st July 2012 pharmacists are now paid 10p per split box. They can claim an allowance of 10p per box to cover the time and costs involved in ‘cutting packs’ in order to make good a full box.

So there you go. Not only are pharmacists now ‘saving the NHS millions’ but they are also profiting from this process.

But is this a good thing? NO! It is extremely dangerous.

Boots never informed me that I was to have box made up of split packs. When I opened it I assumed the worst. I assumed it had either been tampered with or the stock was old. They did not even bother to put in an instruction / safety leaflet, but which was in one of the other boxes. Now what if I only required one box and that did not have the instructions / safety leaflet? Here are a few more concerns.

1. The pack should have contained 2 x 14 tablet blister packs. These packs are sealed and written on the foil is the name and dosage of the tablets. When the packs are split this information is lost. I received half a pack (which did mention the name and dosage) and four other pieces which did not (they only had on them ‘Tue’, ‘Thu’ etc.) Even though the tablets looked the same there is no way of knowing that they were the right tablets or if they were in date.

2. It creates an opportunity for error. If a pharmacist is mixing split packs and the pieces did not have the name printed on it there could be mixing of different tablets.

3. The blister pack allows you to clearly see if you had taken your tablet that day. But this pack was not complete. I had five Tuesdays but only three Wednesday.

Profile photo of wavechange
Member

You are not alone. Next time I have a medication review I will ask my GP to prescribe 30 pills rather than 28 so that I get a full box, so that I don’t get a couple cut off or a box full of odds and ends.

Member
Chris says:
17 August 2012

Perhaps having the dose and medication type on every seperate blister would be a good way of avoiding these dangers? After all, there is no other way of avoiding this problem really. I’d prefer them to split my pack than waste any tablets.

Member
Anon says:
17 August 2012

Chris,

That is not practical. Some of the pieces that were given to me were just bigger than the size of the tablets. All that was printed on them was ‘Mon’ or ‘Fri’ so there would be no room to print TabletXYZ 50mg.

Profile photo of wavechange
Member

The pill manufacturers, pharmacists and GPs could sort out this problem if they put their minds to it. In the meantime, I suggest a pill box to sort out medication a week in advance.

Other problems that should be resolved include:

– the different appearance (size/shape/colour) of the same drugs supplied by different manufacturers, which is likely to confuse the elderly. Unless the GP specifies a particular brand, the pharmacist can supply whichever make they can buy most cheaply.

– instructions in tiny print, which those with poor sight will struggle with and the rest of us are likely to ignore.

Profile photo of lessismore
Member

Had difficulty ordering pills for parent the other day. Tried to do it at the surgery with the prescription list as was there on a weekday. Quite short on one of the pills so tried to order all for delivery by pharmacist. Wasn’t allowed to. A case of “Computer says No”. Result: Parent didn’t order and rationed said pill in short supply. Well I guess that’s a way of saving money. Good job it was only the indigestion pill.

Why aren’t people being told to check the packs that they receive from the pharmacist? We had one drug where the strength being prescribed was doubled but I don’t think that two packs of the drug were delivered. This has happened before when the extra tablets definitely weren’t – and also when a reduced strength was supposed to be being prescribed – and the same strength turned up – causing grief.

Who checks whether the pharmacy asks for all on your prescription or just the few items that you requested when you have your repeat prescription lodged with a pharmacy?

Profile photo of lessismore
Member

Had a great laugh last year when listening to BBC satire Polyoaks. The pharmacist had lost the plot. He was fed up with all the long and difficult trade names for exactly the same drug. So he decided to re-name them. I think he decided that all anti-depressants should be called Derek…

I would desperately like to hear that episode again.

Member
Os says:
5 April 2013

I have had prescriptions a number of times when the packet showed clear signs of being relabelled, which is illegal. I have also worked at a chemist shop where the practice was common!
This lines the pharmacists pocket in a big way as he will get paid twice!
Unless this common practice is controlled in some way there is know way that unused prescriptions can be recycled.

Profile photo of lessismore
Member

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.

Member
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?

Profile photo of malcolm r
Member

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.

Member
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