Would you throw away a week in the Bahamas?

Pills/money artwork Knowing the cost of drugs might prompt different behaviour, Ms Wang suggests

Would you throw away a week in the Bahamas? It is estimated that in England £300m of medicines are wasted each year, and that half of this is avoidable.

In this week's Scrubbing Up, Lin-Nam Wang, community pharmacist and senior contributions editor at The Pharmaceutical Journal, says that current strategies to reduce medicines waste are not enough and explains why she believes NHS patients need to be told how much their medicines cost.

Last month, a man came into my pharmacy and handed me a black bin-bag.

Inside was £2,250.

Ok, so it wasn't in cash, it was in medicines.

Among the stash were 30 unopened boxes of a drug that would have lasted the patient seven months at her prescribed dose. But this was no windfall for the pharmacy - since we can't guarantee how medicines have been stored in patients' homes, they have to be sent for incineration.

Such events make me despair.

And they make me angry that, when we face cuts to services, and over a year since the publication of a Department of Health commissioned report on medicines waste, our system is still letting things like this happen.

'Time to talk'

I admit that in my 15 or so years in pharmacy this "patient return" has taken first prize, but talk to any community pharmacist and he or she will tell you that having to dispose of hundreds of pounds' worth of unwanted medicines is not uncommon.

In this case, the patient, who had died, had been dispensed repeat prescriptions again and again. Some bags had not even been opened.

There are so many holes in the net this patient could have slipped through and the reasons for waste can be complex but in a recent poll of members of the Royal Pharmaceutical Society 57% thought patients are to blame for medicines waste.

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We need to take a different approach and make individuals aware of exactly how much their medicines cost. ”

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Various strategies have been proposed to prevent waste, including limiting prescribing to 28 days (a policy that some primary care trusts have introduced, but which can cause patients inconvenience).

And, since 2006, over 120 campaigns have been run, asking people to "only order what you need". But clearly this is not enough.

It's time to talk about the money

The crux of the problem is that most people don't have a clue how much their medicines cost. I doubt that this patient was aware of the value of what she had been hoarding.

Human nature is such that when no value is attributed to something people take it for granted - when something is free, people behave more irresponsibly.

We're so lucky to have a system that allows free medicines - and long may it continue - but I'm told by colleagues in countries where people have to pay for medicines that they don't see this sort of waste.


The debate on prescription charges will continue but, in the meantime, we need to take a different approach and make individuals aware of exactly how much their medicines cost.

Telling people that saving £300m could pay for 80,906 hip operations is water off a duck's back - the amount is too huge for most people to comprehend and a hip op is something many can't relate to.

Pharmacies could print some extra wording on medicines labels. Something like:

"This box of medicine costs the NHS £XX. Please look after YOUR NHS: don't keep more than two months' worth of medicines."

And perhaps pharmacists should be saying things like: "These tablets need to be taken every day for you to get the best from them. And, just so you know, each box is worth £28".

Will it work? Here is what was in the bin-bag -

What was in the bin-bag

Imagine it sitting in your home.

Now picture, instead, the latest 17in, 2.4GHz MacBook Pro, or a Cartier Love ring in pink gold and diamonds, or tickets for a week on Paradise Island in the Bahamas.

Some might class these items as luxuries so let me put it in perspective: we're talking half a years' worth of food and alcohol for the average family of four.

Would you want to hand any of these to your pharmacist for incineration?

We can only truly have "no decision about me without me" in the NHS if people are fully informed. And that includes telling them how much their medicines cost.


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  • rate this

    Comment number 135.

    The worst example identified in the article is the instance where the patient had died and had prescriptions that would have lasted for SEVEN MONTHS. The person(s) who over prescribed to this ludicrous level should be helo to account.

  • rate this

    Comment number 134.

    A patient in the UK is unlikely to store their drugs over 30oC, which for most drugs won't cause much degradation - obviously there are exceptions. In fact, temperature excursions often occur during shipping and are assessed using stability data. I don't see why the regulatory bodies don't issue guidelines to pharmacists, seeing as they receive stability studies in the submission.

  • rate this

    Comment number 133.

    @132 Whatever you think about the merits or otherwise of US style private healthcare, chucking stuff away can never be a good thing. I don't support the US system but I bet no pharmacist there has ever experienced the kind of obscene waste the writer of this article reported.

  • rate this

    Comment number 132.

    The system is turning people into prescription junkies, so chucking stuff away isn't a bad thing.

    Once the NHS has been privatised our night time TV will be like in the USA, Legalised corporate dealers bombarding society with their legalised dime bags of crack

  • rate this

    Comment number 131.

    There'd be a lot less waste if everyone except the very poorest (and that doesn't include most pensioners, who all get free prescriptions) had to pay a modest charge for their medication. Too many people think "free at the point of delivery" means "costs nothing". They need to understand that drugs are expensive and taxpayers are shelling out.

  • rate this

    Comment number 130.

    @125 be real, "big pharma" are businesses, not public companies, if there was no scope for profit we wouldn't have the drug formulary we have today, and with the current redundnacies in the sector, the profits aren't what you'd expect, and @ denarabin, yes it's against GPhC guidelines and that pharmacist would be struck off if it was known

  • rate this

    Comment number 129.

    It is appreciated that vast amounts of money is wasted in unused medications, however, restricting prescriptions to 28 days (Lincolnshire) leaves patients begging at Surgeries for sufficent medication to go on holiday on short notice deals!

  • rate this

    Comment number 128.

    119.Lewis Fitzroy
    4 Hours ago
    My local chemist {private} allways sells back to others what you bring back he said they is no time dated on pills he has done this for years
    Isn't that illegal (possibly even criminal), or at least a reason for not going back there again?

  • rate this

    Comment number 127.

    What is the problem? Too much medicine, flush it down the loo, give the bugs a treat
    Surely, if everyone did that, you'd end up polluting the ground water from which many people's drinking water comes. They say that if you drink tap water in London the odds are that your not the first by a long way to have drunk it.

  • Comment number 126.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 125.

    It is very good idea to label the cost of medicine, that will not happen because that will make people realize the profit the pharmaceutical companies are making.

  • rate this

    Comment number 124.

    I would have thought that the increasing reluctance of doctors to prescribe medicines would offset any wastage. Compared to even 10 years ago, when they gave out prescriptions pretty freely, doctors seem to be very reluctant to prescribe, preferring first to tell you to go home and try taking some over-the-counter product for a while first.

  • rate this

    Comment number 123.

    @120 Merkin Muffley

    This poster appears to have a medical degree from the University of Madeup Nonsense. This is utter rubbish. From someone with a Cambridge medical degree and a Royal College fellowship.

  • rate this

    Comment number 122.

    Nemesis - Re: comment106, the prescription charge is £7.40, about 80% of prescriptions are dispensed free for the patient due to exemptions, the average cost of a medicine to the NHS is around £13.50, and on the inhalers - some are under the £7.40, but many inhalers which I supply to around half my patients are over £60 each, maybe your lack of knowledge justifies the aim of the article?

  • rate this

    Comment number 121.

    Has anyone costed out if it is more cost effective to prescribe monthly or not? Dispensing drs will onlt give 1 month at a time - probably more expensive to the NHS if you are on low cost generic drugs & inconvenient to patients.

  • rate this

    Comment number 120.

    . . . as regards antibiotic resistance, your doctor can take a bloodtest, have it analysed by the pathology dept at your nearest hospital and then prescribe the specific antibiotic for your condition, including any local resistance patterns. It takes less than 24hrs. This is instead of prescribing a broad spectrum drug which may have limited effect

  • rate this

    Comment number 119.

    My local chemist {private} allways sells back to others what you bring back he said they is no time dated on pills he has done this for years.

  • Comment number 118.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 117.

    #110 the emphasis is on 'average storage conditions'. At room temperature I'd believe the US military totally. The problem is the one or two people who've stored them next to the boiler. Add to that the fact that many drugs cost pennies (penicillin especially) and the small risk of fakes or deliberately tampered medication being returned & its just not worth the law suit.

  • rate this

    Comment number 116.


    Who are these generous prescribers? I am constantly low on asthma meds as I can only have 2 inhalers presecribed at a time"

    Same here. I'm only allowed 1 item at a time now (years ago they used to allow more). One of my steroid inhalers only lasts 3 weeks. It's a pain ...


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