Medicines waste – the tip of a very large iceberg

The Guardian reports of the approximately £150 million of medicines returned to pharmacists each year that are “wasted” and destroyed by incineration rather than re-issued.

It is, of course, a tale of woe that is really just the tip of a massive iceberg. The majority of unwanted medicines are not returned to the pharmacy for disposal, but stockpiled in a bathroom cabinet – they might be of use in the future, for the patient of for another family member – or discarded directly into a black sack or down the toilet.

Add to this, the perhaps greater quantities of over-the-counter products that can be similarly harmful and polluting, and the iceberg grows. As so often happens, the onus of responsibility is put on the consumer but that is wholly wrong. If prescription medicines are being unused then there is an equal degree of inappropriate and incorrect prescribing that must be corrected.

Patients must take their medicines as prescribed and the dangers of not taking a full course of medicine are well known. However, the liberal issue of unnecessary medicines by GPs who are too quick to reach for the prescription pad must be the focus of attention since this is the root of the problem and the most obvious control point. That GPs simply do not have enough time for their patients is no doubt a significant contributory factor but one too often used in defence of sloppy prescribing practice.

These vast quantities of unwanted medicines create a huge problem. Unwanted extra costs in supply, dispensing and disposal. Adverse environmental effects, though largely ignored by the regulators who prefer to limit their attention to easier and less diffuse targets. And the potential ill-effects of old or outdated medicines stored in the home that might be consumed when hopelessly out-of-date, at any time by an inquisitive child resulting is accidental self poisoning, or by an adult intent on a more deliberate course of action.

There are many administrative and safety issues – discussed previously on the Clinical Waste Discussion Forum. GPs not doing their job properly, everyone blaming the patient, who in almost entirely blameless and certainly not a target for control. The re-issue of  unwanted medicines is a complex issue that must consider patient safety, the uncertainties of storage of sometimes quite sensitive medicinal products while the languish in the home, even the risk of adulteration, the thorny matter of liability and the additional costs of checking and reissue.

But in all of this, perhaps we might stop blaming the patient for their audacity of asking to see their GP only to be fobbed off with an unnecessary prescription.




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