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Letters to the Editor
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Charitable donations
Reissuing returned medicines to developing countries
From Mrs P. Bradshaw, MRPharmS, and Dr A. Jarvis, FRCGP
As stated in The Pharmaceutical Journal of 18 September (p378), the
Department of Health is encouraging hospitals to reissue patients’ own
medicines to them after inspection by properly trained staff. Each year
community pharmacies receive from patients some of the £500m worth
of unused dispensed medicines which are then sent for incineration. Yet
more than one third of the world’s population have no access to
even the most reasonably priced generic medicines. Many governments in
Africa spend less than £3 a head on medicines, including vaccines,
for their populations.
There is a registered charity called Inter Care (www.intercare.org.uk)
that has been collecting appropriate returned medicines and samples from
GP surgeries for many years. These are inspected and sorted initially
by either a pharmacist or a doctor and then properly trained staff. If
suitable, with at least a year to run before the expiry date, and if
the packaging and contents are complete, they are dispatched. The recipients
are rural, resource-poor non-governmental health units in Africa. Each
unit is staffed by medically qualified personnel able to diagnose, prescribe
and dispense and each unit is visited and monitored by Inter Care staff.
Only essential medicines on the World Health Organization lists are selected
by Inter Care to send to Africa and also only those medicines specifically
requested by the units are sent to them.
Inter Care would like to arrange a pilot scheme to collect suitable returned
medicines from community pharmacies that would like to co-operate in
the scheme. However the Department of Health says that “medicines
should not be reused once they have been dispensed to patients, because
storage conditions are unknown and quality and safety cannot be guaranteed.
Yet the DoH is encouraging hospitals to reuse medicines that have been
stored in patients’ own homes. Furthermore, the minimum protective
standards for pharmaceutical packaging now state that the formulation
must remain stable and fully active after a minimum of six months at
40C and 75 per cent humidity. In the US, controlled reissuing of returned
patients’ medicines is already allowed.
Pamela Bradshaw
Trustee
Anthony Jarvis
Medical Director
Inter Care
(e-mail intercare@webleicester.co.uk)
Why donations are such a bad idea
From Ms C. M. Green, MRPharmS
The comparison that Geoff Crumplin and Joy Wingfield used in their Broad
spectrum article (PJ, 18 September, p378) was unhelpful both to their
own argument and to people in need of essential drugs overseas. I think
it is necessary to spell out just why donations of unwanted medicines
from UK patients are such a bad idea.
In the UK, when dispensed medicines are reissued, patients who have been
in hospital receive back the medicines that they brought in with them.
The medicines return to the storage conditions that they had been in
before admission. They are checked by a hospital pharmacist before discharge
and the patient takes with him, or her, only those medicines that he
or she needs. There is a concern about storage conditions in the patient’s
home, but there always is. The storage period is usually relatively short
since most medicines are only dispensed for periods of one week to three
months.
The concern about sending “left-overs” from one (rich) country
to another (less rich) country is that the medicines go to different
patients with different prescribers, often take a long time to get there
(in uncontrolled storage temperatures) and get stored for some time at
the destination before being dispensed. Medicines in their original cartons
should show an expiry date, but medicines that have been repacked into
dispensing cartons or bottles do not show expiry dates — there
is no requirement in the UK to include the expiry date on the dispensing
label.
This is not a new question, but it needs to be addressed again from time
to time to remind us about the problems. Drug donations have a lot of
disadvantages, and recycled dispensed medicines from individual patients
have more disadvantages than any other type of drug donation. Donation
of the money spent in collecting and sending such donations is much better
because it allows the recipients to access supplies of low-cost, good-quality
drugs appropriate to their needs.
Carolyn Green
Senior Programme Officer, Care & Support,
Care & Impact Mitigation Team,
International HIV/AIDS Alliance
www.aidsalliance.org
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The
Pharmaceutical Journal