In Denver there is a program that supplies hospitals internationally with expired drugs and equipment that would otherwise be without. It's been going on for decades and saved many lives.
The Myth of Drug Expiration Dates
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Re: The Myth of Drug Expiration Dates
#22The cynic in me suspects that if this gains too much traction, drug manufacturers will simply start adding self destruct compounds to all of their formulations "for our safety". In fact, some of them have track records of such "ethical" behavior, it wouldn't even surprise me if they turned them poisonous vs simply inactivating them.
The only solution is to fix the economic incentives so that drug manufacturers want to make less wasteful medicines. Same with preventing planned obsolescence. The only solution is to encourage more competition.
Re: The Myth of Drug Expiration Dates
#23I always assumed that the expiration date was partly legal, in the way that you only have 1 year within which you can legally have the drug in your system. I mean, if I am prescribed oxycontin, can I legally have the drug in my system for the rest of my life?
I'm pretty sure it's never illegal to have a drug in your system (besides something secondary like a DUI). It's only possession that's illegal.
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Re: The Myth of Drug Expiration Dates
#24> The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations. What kind of reporting is this? Anything less than 100% is not "as potent as when manufactured", and the sentence implies some of those dozen weren't close to 100%. > The idea that drugs expire on specified dates goes back at…
I wonder for certain drugs how much of a difference 98% potency is vs 100%. Surely that 2% must matter. Also, what does it mean to be less potent? It's still the same drug right? So does that just mean the pill contains less of it somehow?
>I wonder for certain drugs how much of a difference 98% potency is vs 100%. Surely that 2% must matter.
Why is this a "surely"? On a scale of 100%, 2% is 2% because it's not hugely significant.
Re: The Myth of Drug Expiration Dates
#25> The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations. What kind of reporting is this? Anything less than 100% is not "as potent as when manufactured", and the sentence implies some of those dozen weren't close to 100%. > The idea that drugs expire on specified dates goes back at…
When working with biological systems, most of the time your acceptable error margin is between 10-25%. There are a few compounds (like fentanyl or LSD) where the dosages are so small and the compound so potent that 10-25% makes a difference but for the majority, precision isn't that critical. The ones where it does matter are tightly controlled and clinically applied by a professional with active monitoring.
The only drugs that weren't within 10% of their original concentrations, according to the study, were amphetamines and aspirin. I can't think of any uses off the top of my head for those two where even 25% would make much of a difference to outcomes - amphetamines are mostly used as general purpose stimulants or to treat ADD and aspirin is not the blood thinner of choice for life and death situations. With amphetamines especially, what you eat and small factors like blood pH can have a massive impact on their effectiveness so we're already talking 10-20% differences day by day, let alone person to person.
Re: The Myth of Drug Expiration Dates
#26I always assumed that the expiration date was partly legal, in the way that you only have 1 year within which you can legally have the drug in your system. I mean, if I am prescribed oxycontin, can I legally have the drug in my system for the rest of my life?
I thought it it was illegal to have certain controlled substances past the prescription. So if you were prescribed a month's supply of oxycontin and got pulled over with it on your passenger seat a year later, you were breaking the law.
Re: The Myth of Drug Expiration Dates
#27Another facet to this is "Medication Adherence" which is defined generally as taking medication properly, but which the drug industry defines as taking all of your medication, and getting a refill for more. Speaking only as a lobbyist who has (regrettably) worked for a Pharmacy Benefit Manager in the past, there is tremendous amount of money and thought being put into how to get patients to take all of their medication. The belief is that this will lead to patients refiling that prescriptions, oh and probably help them overall, but refills are the number one priority for the drug industry.
Re: The Myth of Drug Expiration Dates
#28Earlier quoted context omitted.
I wonder for certain drugs how much of a difference 98% potency is vs 100%. Surely that 2% must matter. Also, what does it mean to be less potent? It's still the same drug right? So does that just mean the pill contains less of it somehow?
No drug where a 2% difference matters can be administered outside of a monitored hospital setting. There are too many variables that affect the drug uptake far more than 2%, such as body weight (100 pound person will have 3x the drug dosage of a 300 pound person), drug absorption (based on body chemistry, other food eaten, etc.) and the actual intake dosage itself (Eye drops, for example, can have a 500-fold variance…
> There are too many variables that affect the drug uptake far more than 2%, such as (...)
...or in case of tablets that come in 2x/4x the dose and you need to cut them in half/four pieces, the precision of your cut and amount of tablet dust that is lost.
Re: The Myth of Drug Expiration Dates
#29It seems that a law simply allowing private testing of drugs for efficacy, the same way the federal government is allowed to, would go a long way to saving money here. Hospital systems and HMOs are large enough to save millions for a bit of testing, and once enough data is gathered they can easily and safely adjust their retention policies.
Hospital systems and HMOs turn their inventory fast enough that inventory control can probably handle their problem. Small hospitals and pharmacies probably suffer more from expirations.
Aren't there many drugs that hospitals need to have at hand, but are rarely used? Things like antivenins, anti-rabies serums, or other agents that are only reached for in extreme cases. It may not be a high proportion compared to what hospitals are using on a daily basis, of course (but they might be proportionally more expensive, too).
Re: The Myth of Drug Expiration Dates
#30Earlier quoted context omitted.
I wonder for certain drugs how much of a difference 98% potency is vs 100%. Surely that 2% must matter. Also, what does it mean to be less potent? It's still the same drug right? So does that just mean the pill contains less of it somehow?
You can get a rough idea of the required precision by checking if the dose is weight dependent. If it isn't, 2% won't matter.
And if 2% does matter, you'd better make sure you can measure both the dose and your weight to better than that accuracy.