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Millions wasted on discarded drugs

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Millions of dollars are being wasted on expensive subsidised pharmaceuticals that patients never use and instead throw out, an analysis of the nation’s medicines disposal program has found.

Costly prescription medicines for treating serious ailments including asthma, chronic obstructive pulmonary disease and high cholesterol are being discarded “in large quantities” despite being well within their use-by dates, according to a Monash University audit of medicines returned by patients to pharmacies for disposal.

In the first study of its kind, the research team gathered and analysed the contents of 686 bins provided to pharmacies under the National Return and Disposal of Unwanted Medicines (RUM) program. There are more than 10,170 bins supplied and serviced under the program, which encourages patients to return unwanted and expired medicines to pharmacies for safe disposal.

The study found that most (85 per cent) of the drugs discarded were scheduled medicines, and of these, the vast majority (81 per cent) were Schedule 4 prescription-only medications (and 2.3 per cent were Schedule 8 drugs whose possession is illegal without authority).

Underlining the extent of waste identified by the survey, almost half (44 per cent) of medicines thrown out through the RUM program had not expired.

The medicines most commonly disposed of included salbutamol, insulin, frusemide, frednisolone, salmeterol, paracetamol, warfarin, atorvastatin, cephalexin and amoxicillin.

While the study did not examine why consumers discarded such medicines, other research found common reasons include concerns about safety or effectiveness, the death of the patient, a change in therapy, or a patient’s decision that they no longer needed the medicine or accepted its side effects.

In all, the researchers estimated that just the top 31 medicines alone that were discarded were worth more than $2 million, including more than $270,000 worth of tiotropium, almost $250,000 worth of fluticasone/salmeterol, $173,000 of salbutamol, almost $178,000 of paracetamol and more than $114,000 of atorvastatin.

In a conclusion that could increase the focus on conditions for the public subsidy of prescription medicines, the researchers said the results showed a need for improvements in prescribing.

“The data suggest there may be significant financial wastage with some medicines prescribed under the PBS,” the Monash University report said. “Several high-cost PBS medicines were found to be discarded in large quantities, wit5h significant financial loss to the Government.”

The study authors said the large quantity of un-expired medicines discarded highlighted the need for more “rational” prescribing and improved patient adherence to treatment regimes.

They said that although there was more the Commonwealth and organisations like the National Prescribing Service needed to do, “pharmacists, together with medical practitioners, will have a pivotal role in optimising how medicines are prescribed and used [by] patients and minimising wastage”.

They warned that with an ageing population, the problem of medicine wastage and disposal was only likely to increase, underlining the need for improved prescription practices as well as greater promotion of ways to safely dispose of unwanted drugs.

Adrian Rollins