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Recycling: the next community pharmacy service?

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By Lin-Nam Wang

Last month, theNHS Sustainability Development Unit (I didn’t even know there was one!)published the results of a survey, which revealed that half (52%) of the peoplein England would be likely to accept medicines returned by other patientsprovided they had been safety checked. That surprised me. I know it would neverdo for patients like Mrs I-only-want-Goldshield -thyroxine. And, I have to say,thinking back to when I used to deliver oxygen and saw how some people live (yuk!),I don’t think it would do for me.

Had these 52per cent never seen that Channel 4 programme “How clean is your house”?  Surely the survey couldn’t be right.

I decided todo my own, very crude survey. I asked 20 of my patients the same question andwas even more surprised when two-thirds told me that they would be willing toaccept reissued medicines.  

Apparently,according to the sustainability unit director, the idea of reusing medicineswas dismissed in the past on the assumption that patients wouldn’t agree.Perhaps the times in which we now live have fostered new attitudes.

So, it’s apossibility that, some time in the future, some of us may be asked, not only tobe medicines suppliers and disposers but also medicines recyclers. Becausewhere would people return these medicines? Pharmacies would seem the logicalplace.

But then whatwould happen to them? Would they be checked and put back onto our shelves? Notgreat for safety to have lots of different packs of the same drug in a pharmacy,so would we only take back medicines we have dispensed? And would pharmaciesthen need to reimburse the NHS?

Or would themedicines be sent to some central unit? It would all have to be worthwhileeconomically. No point spending time inspecting an 80p pack of atenolol andpaying for it to be transported to a central hub. So there might be a “takeback” list of medicines that cost, say, over £25 per pack. The “green” side ofthings might also need addressing: would the carbon emissions be less thanthose from incineration?

If theresponsibility of ensuring the returned medicines were safe to reissue fell tous, how would we do this? There would have to be a checklist. Where would wefind the time? And would we be paid for it? Perhaps manufacturers of expensivemedicines could incorporate devices in packaging that change colour whenexposed to heat.

The wholething could be a logistical nightmare.

Then there wouldalways be Mrs I-only-want-Goldshield-thyroxine to deal with. If she is giventhe choice not to accept reissued medicines, how will we reassure her that her boxesare virginal? And, if there were to be no choice, I guess I’d need to get over myown peculiar pickiness when I need a prescription.

One positivething though. Currently, pharmacists are not allowed to donate returnedmedicines to developing countries. It said so in the RPS standards, which werecarried over to the GPhC for an interim period. Again, there are loads ofissues here – too many to go into in a lowly blog, so see the WHO report ifyou’re interested – but one reason for the rule is ethical: if we aren’twilling to reuse medicines in our fellow citizens, surely we shouldn’t then bedumping them on other countries.

Nevertheless,the RPS also said that, during a flu pandemic, medicines returned to pharmaciesby patients could be reused. And I notice that in the GPhC’s consultation on standards for registered pharmacies that thespecific wording about not supplying a returned medicine to another patient hasbeen removed. If adopted as is, might this provide the loophole that permitsmedicines recycling?

In an idealworld, there would be no need to consider taking back medicines because patients,supported by their pharmacist, would be 100 per cent adherent. But right now pressuresto save money are building and the topic of medicines reuse is hotting up. Weneed to start thinking about all the issues so that, if medicines reuse gets offthe blocks, pharmacy is ready to participate in the discussions.



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