Do politicians really care about the sick and elderly?

Why does U.S. law require perfectly good medicine that could be given to the poor and elderly be destroyed?

In the eighties and early nineties a group of us violated the law and risk being arrested picking up the medication of people who died of A.I.D.S. and passing it on to those living with A.I.D.S. who could not afford medication. We would have someone stay at the home when we knew the patient was about to die and secure the medicine before public health care workers arrived.

Public health care workers, nursing homes and hospices must destroy medicines of deceased patients according to U.S. law. Nursing homes, public health care workers, and hospices must also destroy unused medicine when doctors prescribe a new medication or stop a medication. Some medications can be sent back to the pharmacy if the facility has an in-house pharmacy, but most medicines (hundreds of pounds daily) are destroyed.

In my opinion this profits no one but the pharmaceutical companies. The government claim they are protecting Americans from outdated medication or possible errors in distribution. Ask someone who cannot afford to purchase their medications because of insurance co-pays or do not have insurance if they would prefer the medicine to be destroyed or distributed by charitable organizations or selected pharmacy’s for free or a low cost. In a free society why don’t the people in need of these medications have a choice?  

There are people who have to choose each month whether they will buy medications or buy groceries. It is estimated 50 million people in the U.S. fail to fill needed prescriptions each year because of the cost.

Some with cardiovascular disease have said they take less medicine than prescribed due to cost and fifty percent of them were more likely to experience angina, strokes or non-fatal heart attacks. For many others, cutting back on medicine led to faster health declines, increased hospitalizations and premature death.

Even Medicare Part D medication is destroyed. Why can’t the government devise a program where the medication is returned to a government pharmacy (Veteran Administration) and be utilized. This would save millions of Medicare Part D funds yearly. Is this because the pharmaceutical companies do not want such programs developed?

Injectable drugs in syringes packed in tamper proof packaging are destroyed. I do not understand why medication in tamper proof packaging must be destroyed. It seems to me to be a total waste. The government claims they do not want these drugs to fall into the hands of the wrong people who may abuse them.

The D.E.A. destroyed 6400 pounds of medication picked up in one week in nursing homes and long care centers in two counties in the state of New York. Nationwide they collected and destroyed 742,497 pounds last year. This does not include medication facilities that were allowed to destroy unused medications in-house. I cannot even make an intelligent guess of what 742,497 pounds of prescription drugs would cost retail, but I am sure it would be in the billions of dollars.

There is a nonprofit organization called Sirum, which was founded by three young Stanford graduates who use the internet to try and match patient and medicine.  Their goal is to save lives by saving unused medications. They are using technology to bridge this gap between surplus and need. The medications are sent to selected clinics to be distributed. They charge 25% of the retail cost for the drugs they recycle.

Forty states have enacted laws authorizing the reuse of medication. The State of Iowa recycled $52 million in unused drugs to the poor last year. These programs are small and are State authorized and not authorized by the Federal government.  Change is coming, but it is slow because people fear recourse from the Federal government.  Few in the medical industry know about these small recycle programs and only about 25 medications are allowed to be recycled.

Previously sold, but unused medication, brought back to special pharmacies for resale or donation could provide a low-cost source for patent protected medicines. Pharmacies in Mexico and Canada are doing brisk business from Americans crossing the borders to buy medicine. Internet pharmacies are also doing a brisk business in the United States selling both reimported American made medications and low-cost foreign-made products. Which do you think is safer foreign made medications without government regulations or recycled American medications with government regulations that are perfectly good? 

Other countries have opted for pharmaceutical price controls and/or curtailing patent protection, but such actions run counter to American free-market ideology and political realities. Plus lobbyist are too strong in the United States to ever allow this to happen. 

Leftover drugs prescribed for American patients with HIV are now being recycled for use overseas. 'Aid for AIDS in Manhattan' — a nonprofit group with branches in Italy, Spain and Switzerland collects drugs after US patients with HIV switch prescriptions, stop medications, or die. The group passes these very expensive retroviral medicines along to more than 500 people with HIV throughout Africa, the Caribbean, and Latin America. American law makes it illegal to redistribute these medications to the poor in the United States, but says nothing about exporting them. If these drugs are not safe for Americans to take then why is our government allowing people in Third World Countries to take them?

Nursing homes and other healthcare facilities are not the only possible sources of recyclable medicines. A more important source may be medication in consumers' homes that is unused. As I said earlier we collected thousands of dollars of medications in homes. 

“Expired medication” also represents a potentially large source of supply of medicine for a recycling program. As things stand now, expiration dates get a lot of emphasis. For instance, there is a campaign, cosponsored by some drug retailers, that urges people to discard tablets or capsules when they reach the date on the label. It turns out that the date on the label is often much earlier than the official expiration date. Pharmaceutical companies admit most drugs would be okay to use 18 to 24 months after the expiration date.  Very expensive medications are being dumped, being wasted.

Obviously, much discussion and planning is needed before medicine recycling could become a reality on a large scale for example new laws, regulations about what might be recycled, individual pill packaging for the selected items, rules about who might be eligible to return medication, who might be able to purchase it, rules for exchanging the old pills for a new prescription and how to pay for the infrastructure support.

It might be wise to concentrate at first on recycling from nursing homes and other facilities where there is an unbroken chain of accountability for the medicine. Such medication has never been out of the hands of accountable healthcare workers, and there is a clear trail of when it was purchased for whom and why it was not used. Recycled medicine would have to be individually packaged or still in its sealed original container.

Federal law could be changed. Individual tablet and capsule tamper-resistant packaging, including bar code identification of manufacturer, date of manufacture, expiration date, medication name, and dosage would bring us close to the possibility of recycling appropriately chosen medications. Such a system, combined with appropriate safeguards to assure product authenticity, is worth discussing.

We will never know if any plan for medicine recycling can be safely done unless we begin the discussion. This means we would have to overcome the greed of pharmaceutical corporations and retailers of medication.