Medication safety beyond the illness
~ The cost of unused medication ~
Unused prescription medicines cost the National Health Service (NHS) over £300 million every year — a figure that could pay for over 80,000 hip replacements or nearly 12,000 community nurses. However, many people don’t understand the risks and implications posed by improper medication disposal. Here, Oliver Pittock, managing director of leading pharmacy consumables supplier Valley Northern, looks at how unused or unwanted medication should be disposed of and why.
The NHS budget being spent on prescription drugs is rising faster than it can realistically afford. A study carried out by The King’s Fund in 2018 states that England has seen an increase in spending on medication, rising from £13 billion in 2010/11 to £17.4 billion in 2016/17.
The growth – an average of five per cent each year – demonstrates a stark contrast to the rise in overall NHS budget, which amounts to a mere one per cent. However, the Department of Health reports that £110 million worth of this medication is returned to pharmacies, £90 million is stored in homes, and £50 million is disposed of by care homes.
These figures don’t take into account the increased costs if medicine is not correctly taken. If medicine is left unused, a patient’s symptoms could worsen and additional treatments could be needed to treat them.
Pharmaceutical waste can be divided into five subtypes. Non-compliance is when a patient does not take medicines as prescribed, for example taking it at irregular intervals or in incorrect doses. If a patient stops taking their medication because of adverse side-effects or personal beliefs, or due to forgetfulness, the waste is classed as either intentional or unintentional non-adherence. When a patient passes away, their treatment is changed, or if they stockpile medicines “just in case”, the wasted medication is described as non-preventable or preventable waste.
The causes of waste vary from inefficient prescribing to patient recovery. Pharmaceutical waste can occur at any stage of the process — from prescription to disposal — and can arise through failures in existing dispensing processes or patient behaviours. When reviewing the causes and types of pharmaceutical waste it is clear that prescriber, dispenser and patient all play a part in waste creation.
The dangers of waste
Even if they are never opened, once a patient leaves a pharmacy their medicines cannot be recycled or used by anyone else. Any that are correctly returned must still be destroyed, as once the medicine has left the pharmacy, storage conditions cannot be guaranteed.
Some medicines are sensitive to heat, light or moisture and can become less effective if not stored properly. It is also not possible to guarantee the quality of medicines on physical inspection alone.
If a patient chooses to dispose of medication themselves, the consequences could be serious. Results from a recent medication adherence survey highlight just how many of us choose to take disposal into our own hands.
According to the results, only six per cent of patients speak to their doctor, pharmacist or healthcare professional to alert them that they have failed to finish a prescribed course of medication. Even more worryingly, a further six per cent admit to giving leftover medication to someone they know, which could result in serious health consequences.
Improper disposal of medication does not only have an impact on health. As one in three people confess to disposing of unused medication themselves, with some admitting to flushing it down the toilet, it is not only money that is disappearing down the drain. As the incorrectly disposed drugs risk ending up in ground, or even worse drinking, water, it is essential that unwanted medication is properly disposed of.
Although redistributing medication is ruled out, healthcare professionals are exploring other methods to help reduce waste. For example, if a patient begins a new course of medication that they haven’t taken before, their GP or pharmacist should arrange a Medicines Use Review (MUR). An MUR provides the opportunity for clinicians to evaluate the medication, and make sure that it best suits the patient’s needs. This is particularly necessary for those receiving medicines for long-term conditions, as it can help limit the volume of unwanted repeat prescriptions if the medication is not having the desired effect.
While prescriptions are free in Wales and Scotland, many believe that patients would value their prescription more if they paid for it. A small fee could therefore be the answer to reducing patient stockpiling. However, this would require changes in the way pharmacies interact with patients, and prescription payments remains a controversial topic.
While there are challenges to overcome when considering changes in dispensing, this does not prevent pharmacies from raising awareness on medication waste. It also remains vital that medication is disposed of safety and correctly.
The Royal Pharmaceutical Society guidance for pharmacists on the safe destruction of drugs explains that “pharmacists are strongly advised to denature controlled drugs and render them irretrievable as soon as possible”.
Despite this guidance, many denaturing kits simply encapsulate drugs in a gel, meaning it is possible for someone to retrieve and use the substance if they were to break into the kit. If a drug is still in its active form because it has not been correctly destroyed, it could still be consumed.
To prevent unwanted medication from causing harm, an effective denaturing method must be used by pharmacists. Products such as Valley Northern’s Denaturing Kits ensure the safe and correct disposal of unwanted medication by destroying the drug rather than encapsulating it, reducing its risk to both public health and the environment.
How you can help
While pharmacies need to act to ensure that unused medications are correctly disposed of, helping to reduce medicine waste is in the hands of consumers. In many cases, communication is key.
To help combat waste ensued from unwanted repeat prescriptions, a patient should let their GP or pharmacist know if they have stopped taking their medicine as prescribed. Patients should also make a conscious effort to check what medication they have at home before re-ordering and discuss their medication with their doctor on a regular basis to make sure that what they are being prescribed is still relevant to their needs.
These actions may seem simple, but when we consider the cost of unused medication, the impact could be huge. The fate of medicine waste does not just lay in the hands of pharmacies, and it is essential that all NHS-users act collectively and think more carefully about their prescriptions.
While stockpiling medication for a rainy day may seem like a smart idea, the number of life-changing procedures that could be carried out in its place really puts the value of medication into perspective.
Editor’s note: If you want to ensure you keep up to date with all the latest news, opinion focussed content and case studies from Valley Northern, visit the company’s website here: https://www.valleynorthern.com/latest-news
For further information contact: Helen Rafferty
Valley Northern Limited, Carver Road, Astonfields, Stafford, ST16 3BP
Telephone: +44 (0)1785 250 123
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1 St Mary's Place, St Mary's Grove, Stafford, Staffordshire, ST16 2AR
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About Valley Northern: Valley Northern supplies pharmacies and other healthcare establishments with a range of medical dispensers, medical disposables, packaging and other equipment from its headquarters in Staffordshire.
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