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Monday, July 31, 2006
Do expired drugs still work?
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In Scott Holt's kitchen cabinet sits a vial of cholesterol medication, at least a year past the expiration date, and a bottle of ibuprofen that also had expired, he said, who knows when. Holt refuses to toss them out, though - not until he's done taking all the pills. "Shelf life," said Holt, a 44-year-old personal trainer from Portland, "is a very subjective thing." It's not unusual for people to clean out their refrigerators and closets more often than their medicine cabinets. A Harris poll, in fact, found that nearly half of Americans have used drugs past their prime. But the critical role that medication plays in people's lives begs the question: Do the drugs still work? Many drugs do last past the expiration date, according to experts, but exactly how long remains a guessing game. Pharmacists and toxicologists urge people to err on the side of caution, but the rising cost of health care has some patients and groups such as AARP, which represents older Americans, increasingly open to taking the risk. In a recent newsletter, the AARP suggested that Americans were throwing away billions of dollars' worth of perfectly good drugs by following manufacturers' expiration dates or "discard after" instructions from pharmacists. James Toedtman, the Washington, D.C.-based editor for AARP Bulletin, said replacing drugs is a burden for senior citizens struggling with a fixed income, high gas prices and the rising cost of living. "We've got to find ways to help people taking prescriptions better afford them," Toedtman said. "One way to do that is not to force them to buy expensive drugs every three months because of an expiration date that may or may not be based on fact or science." One argument for saving aging drugs dates back to 1985, when the Air Force was stuck with a large stockpile of drugs approaching their expiration dates. Though it opposes the use of expired drugs, the U.S. Food and Drug Administration found that many in the stockpile remained effective after the manufacturer's expiration date - in some cases, even several years later. The military ended up saving $263 million from 1993 to 1998. The life of the military stockpile was extended because it was stored under optimal conditions - carefully controlled room-temperature warehouses and, when necessary, refrigerators. This protects medication from heat, light and moisture - all of which can cause ingredients to degrade. But some pharmacists worry that this vigilance does not translate to the civilian world, where it's not uncommon to store drugs in hot glove compartments and the medicine cabinets of steamy bathrooms. "This affects the coating. It affects the integrity of the tablet and liquids too," said Betty Golub, co-owner of the Kennebunk Village Pharmacy. She not only tells all her customers to observe expiration dates, but helps them dispose of outdated drugs. In general, people should ditch their old drugs if they were not stored properly, said Mark Polley, director of pharmacy professional services at Hannaford Bros. But Polley said patients who take proper care of their drugs could extend their use beyond the expiration date, as long as it's understood that effectiveness may have been compromised. If a dozen sleeping tablets remained after a customer's bottle of sleeping pills expired, for example, they should be OK to use within a month or so, though six months would be pushing it, he said. "I would tell them to do that on a short-term basis but not as a matter of practice," said Polley, who has taken expired drugs himself. Polley allows some flexibility because, he said, expired drugs are at greater risk of losing potency than causing harm. Also, expiration dates from drug makers are conservative, and those from pharmacies even more so, he said. In Maine, the pharmacist lists a discard date one year from when the medication is dispensed, even if the manufacturer has set a later date. The pharmacy buys drugs in bulk from the manufacturer to fill patients' vials, so the thinking is that the viability of the medication has been compromised once a sealed bottle of manufacturer's drugs has been opened. In Florida, a pharmacist successfully lobbied the Legislature last year to drop the requirement that pharmacists use discard-after dates on prescription labels. There are certain drugs, though, that are well known for losing their powers with age. Nitroglycerin tablets, taken to prevent chest pain, decompose very quickly. So does epinephrine, which is used in the Epi-Pen, a self-injectable device used for bee sting allergies, said Portland toxicologist Dr. Karen Simone. Simone, who is managing director of the Northern New England Poison Center, said that patients with health conditions such as asthma and heart disease should not take their chances with expired drugs. But she added that in an emergency, old drugs may be the best option if that is all there is. "It's better to have one expired and probably not as effective," Simone said. To avoid the scenario, people should replace important drugs before they throw out the old ones. Holt takes no chances with expired drugs when it comes to his 3-year-old daughter. But to save money and avoid a trip to the doctor for a new prescription, he will keep taking expired drugs. "If it doesn't feel right, I can express that," Holt said.
Staff Writer Josie Huang can be contacted at 791-6364 or at:
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