US could recycle 10 million unused prescription drugs a year, report says

Long term care facilities in the United States waste about $2bn (£1.28bn; €1.61bn) in unexpired medicines every year, a report by the public radio show Marketplace said on 10 December.1

Other estimates, which included all sources of wasted medicines, showed that as much as $5bn worth of unexpired prescription drugs in unopened blister packs, bottles, and vials are incinerated or flushed down the toilet each year.2

Nursing homes discard these drugs when patients are discharged or if their prescription is discontinued or changed, or if the patient dies. Institutions are typically forbidden to give unused medicine to other patients even if the medicine is unexpired and in tamperproof packaging.

Marketplace highlighted the work of a nonprofit organization, Supporting Initiatives to Redistribute Unused Medicine (SIRUM), which redistributes prescription drugs to some of the estimated 50 million US residents who cannot afford their medicines.2 The organization, which has its headquarters at Stanford University in California, estimated that as many as 10 million prescriptions, worth about $700m, could be recycled.

The most common class of drugs used by long term care facilities is psychotropic medicines. Currently, 20% of nursing home residents with dementia are given an antipsychotic medicine for behavior control—an off label use of the drug.

David Antonuccio, clinical psychologist and professor emeritus of psychiatry and behavioral sciences at the University of Nevada School of Medicine, said that he was concerned about the emphasis the Marketplace report had placed on the benefits of antipsychotic and antidepressant medicines. While he applauded efforts to reduce medical waste, he said that overtreatment was currently a major form of medical waste and harm, adding that doctors should ensure that the project does not simply extend the problem to larger segments of the population.

He said that he was particularly concerned about a “prescribing cascade,” in which medicines are prescribed for the side effects of other medicines—sometimes leading to combinations of drugs that have never been studied for safety or effectiveness.

Antonuccio told The BMJ that antipsychotic drugs were too often used as a “chemical straitjacket” and that the goal of behavior management was to “have more alert patients so that you can find out what they need and want. That’s a much safer and better alternative.” He cited a program in Minnesota that had used behavioral methods to cut the use of antipsychotic medicines by 98% among 1200 nursing home residents with dementia. The residents who were successfully taken off the drugs showed improved alertness and sense of wellbeing.3

As well as increasing access to medicines for patients in need, SIRUM cited other benefits of recycling, including financial savings for institutions and reductions in pollution because of lowered manufacturing demand and reduced medical waste.