drug expiration dates

[TWR]

The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

“This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t. Pharmacies across the country — in major medical centers and in neighborhood strip malls — routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

Gerona and Cantrell, a pharmacist and toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.

ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted.  We’ve documented how hospitals oftendiscard pricey new supplies, how nursing homes trash valuable medications after patients pass away or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

Help Us Investigate Wasted Health Care Dollars

Experts say the United States might be squandering a quarter of the money spent on health care. That’s an estimated $765 billion a year. Do you believe you’ve encountered this waste? Tell us.

What if the system is destroying drugs 

[sas5814]

I have long thought expiration dates was more about selling more meds than any actual risk. Like all things there are a lot of variables that can change a drug's shelf life but it seems the dates we are using are somewhere between "best guess" and "fantasy".

[Reality Check 2]

I have seen Canadian codeine degrade - likely stored in heat, etc. Guy got a rash from 7 yr old codeine pills - the codeine, the vehicle in the drug, allergy? Who knows. 

Old eye drops left in the medicine cabinet are likely contaminated and I wouldn't use those. 

We used to send expired drugs to medical missions to other countries. They were ecstatic to have them. 

Again, I think a large portion of our medical issues are determined by lawyers.

[TWR]

The actual article was much longer than I posted.  Huge amounts of money is wasted (in Billions) on thrown out drugs.  The only ones that seemed to lose effect over time (after expiration) were inhalants like Albuterol and topical Diphenhydramine.

[CAAdmission]

I have often marveled that syringes have expiration dates. I guess the needle goes dull from photons hitting it...

[sk732]

I seem to recall from my younger days that some expiration dates are pretty finite, but many are a moving target as it were - tetracyclines, if they expire and are used, can actually cause an acute renal injury IIRC.  Some just lose some effectiveness.  Having said that, I remember a boss of mine telling me that they found some Korean War vintage morphine syrettes one day and Health Canada did some studies on them and they rated them at about 98% expected potency and still viable (1/4 grain dose)...these were made about 1950 and this was around Gulf War 1, so at least 40 years on.  I also did a little randomized study on some sterile equipment when I was taking it apart for reprocessing - the stuff in paper and cotton duck wrapping were still sterile past their best before dates...the syringes CJA alluded to would likely be unsterile if their steam paper was violated (water or something), but otherwise, I'm willing to bet they'd be useful well past their best before date.  I'd agree with RC2 and Scott - it's about non-medical people making medical decisions and ensuring a steady cycle of sales...look at the EpiPen as an example.

SK

[Zach]

I worked in a hospital pharmacy for a time and one of my jobs was digging through the shelves in the dispensary, finding drugs that had expired, and tossing them in the garbage. I don't know how long it had been since the last "spring cleaning", but I ended up tossing enough to fill one of those garbage cans that would have been in the cafeteria when you were in high school. The pharmacist didn't even care to double check what was being tossed... I suspect it was a case of whoever was doing the stocking being lazy (the oldest stuff was at the back of the bin, the newest stuff was at the front). 

What really got me is when he'd come over to answer a question, notice another medication, make a comment like "oh we've come to learn this one is not so good...", and just dump the entire bin. As if he wouldn't have tossed the stuff had he not been called over by it. 

Seemed like a very, very fast and loose system. Granted, I was just in the open dispensary. The good stuff was secured beyond another set of doors and only the pharmacists went back there. 

[cbrsmurf]

What pharmaceuticals should allow is for expired medications to be traded in.

 

For most drugs, the 99% of the cost is from R&D, marketing, etc.  It costs the pharmaceutical company very little to actually manufacture the drug.  But, they have no incentive to do that.  Our government should pass a bill that should allow trade-ins and just have the purchaser pay for the manufacturing cost for expired medications.