What happens to all those drugs that, for innumerable reasons, remain unused by patients?
According to a recent Department of Health study, these amount to a staggering £300m a year. Presumably most are brought back at some time to a GP surgery or pharmacy. And from there? To landfill or incineration.
So where does the moral responsibility lie: with patients ordering and not taking medicines, or with the NHS for incinerating, at further cost, unopened packs of medication? Should we be discarding drugs that are pre-packed in sealed blister packs with expiry dates and can be kept at room temperature for years? Well, that's what the regulations demand. So are there any alternatives to this reprehensible and wasteful practice?
Many would argue that it would make more sense to recycle unused drugs within the NHS. However that policy, for a number of regulatory reasons, has been vetoed. We have also tried to reduce waste by limiting prescriptions to a maximum of one month's supply at any one time. Yet this has made little difference to overall waste and may also create an undesirable worry in our patients' minds that, with £7.40 for each item dispensed, it is yet another tax on the working people of the UK.
Yet, for many years, there has been a little-known alternative of such simplicity that it is almost criminal that it has not been more widely publicised. I am talking about recycling unused drugs by sending them to Third World countries that have minimal resources for buying in such medication directly from pharmaceutical manufacturers. One such charity doing just this is InterCare.
InterCare has been providing unused drugs to rural clinics in sub-Saharan Africa for nearly 30 years. It was set up in Leicester in 1974 by two far-sighted GPs who, even then, were appalled by the waste that was taking place within NHS prescribing. Since then it has built up an excellent business model, recycling returned medication with at least 15 months' sell-by date before expiry, through its central warehouse for onward postage. The charity, through decades of experience, has produced a seamless pathway that minimises waste and ensures that consistent supplies get through to the clinics where they are needed. In every way it is a model of probity.
It would be nice if such a worthy medical charity were better supported by the profession. It provides such a simple yet elegant answer, be it only partial, to an almost immoral problem of waste, that it would be irrational not to use it. This letter was never meant to be a charity appeal, although I can now appreciate, on rereading it, that it may sound as such. I would prefer to think that it is more of an appeal to logic and common sense – attributes that GPs have always had in abundance.
For more details, visit intercare.org.uk
From Dr James Sherifi