All unused dispensed prescription drugs have to be incinerated – that's got Phil all fired up
‘Let's recycle these drugs,
and collect a few QOF points too'
Our council, in its wisdom, has just delivered great big brown wheelie bins to all the houses in our terrace. Diogenes, in his barrel, would have considered one an impressively luxurious town house.
The council is under great pressure to boost recycling, and this latest container is for ‘garden waste'. No matter that we all have gardens of such postage-stamp provenance that we, in our street, could comfortably pack up our front gardens in a suitcase and take them on holiday with us.
It made me wonder why we make no effort at all to recycle a resource that costs vastly more, and causes more waste to the NHS than practically anything else – the drugs we prescribe to our patients.
One of my colleagues told me a salutary story. He went to visit a patient of his the day she died, and the lady's daughter said: ‘Would you please get rid of these when you leave, doctor?' She handed over two black bin-bags full of what my colleague described politely as ‘sod-off' prescriptions; bottles of simple linctus, courses of tetracycline, throat sprays, topical NSAIDS, antihistamines, clotrimazole cream, vitamin tablets, evening primrose oil, all those prescriptions we issue when time is short and there's nothing wrong with the patient. He was confronted with a decade's worth of untouched useless medication, and the hard evidence of hundreds of consultations where the hidden agenda had been well and truly ignored. He told me he had never been so embarrassed.
The local chemist could do nothing with any of this, except incinerate it. ‘But none of them have been even opened!' argued my colleague. ‘Doesn't matter,' replied the pharmacist, pragmatically. ‘It's been dispensed. I've got to burn it.'
This is madness: 10 per cent of the NHS budget goes on drugs. I have heard estimates that only about half of the drugs we issue ever get swallowed. We all know this is true.
This week I spent ages explaining why I wanted to start one of my patients on a ß-blocker. I did the rationale and explained the side-effects and arranged the follow-up. The patient was happy enough until she went into the chemists and presented the prescription. The drugs were placed on the counter. ‘I've had these before,' my patient suddenly recalled, recognising the pattern on the box. ‘They made me feel crap.' She left them where they lay, and the chemist had no alternative but to take them back and burn the lot of them.
We've all visited houses where there is a nine-inch stack of boxes of untouched statins on the bedside table. We've all seen drawers full of virgin steroid inhalers, at £15 a puffer.
Does this make economic sense? Should we be burning Accuhalers, and at the same time collecting twigs from the garden for shredding? Let's collect them up, these expensive drugs, and send them round again. We can save the NHS a few bob, and, more to the point, collect a few QOF points for our pharmacological prudence.
firstname.lastname@example.orgPhil Peverley is a GP in Sunderland