Unused medications may lead to abuse, overdoses

Painkillers, antibiotics and cardiovascular medications made up the bulk of unused first-time prescriptions turned in during a recent National Drug Take-Back event, according to a study published in the July-August issue of The American Journal of Pharmacy Benefits.

“The accumulation of unused medications has the potential for negative consequences, including drug diversion and unintended poisonings, wasted healthcare resources, and harm to the environment,” wrote the authors, led by Kimberly A. Burns, RPh, JD, of Lake Erie College of Osteopathic Medicine in Erie, Pa.

As a result, they sought to learn more about which drugs tend to be the most squandered and who prescribes them. They focused their research on first-fill prescriptions, defined as a prescription filled by a pharmacy only once and subsequently not finished, refilled or acquired again.

They surveyed individuals at four northwestern Pennsylvania sites participating in a U.S. Drug Enforcement Agency National Drug Take-Back event in April 2012. Participants answered questions about why the drugs were not used, who prescribed it and whether they specifically requested the medications. Researchers then determined the quantity and whether the medication was a brand-name drug and a controlled substance.

The researchers collected 531 first-fill prescriptions at the event. Most of the medications were painkillers (34 percent, with 84 percent of those being opioids). Antimicrobials made up 13 percent of the prescriptions and cardiovascular medications made up 8 percent.

The types of medications with the highest average percent returned relative to the original number of pills were metabolic bone disease agents, hormonal agents and central nervous agents. The average percent returned of the original number prescribed was 67 percent for family physicians and 73 percent for specialists. The most common reason for not finishing medications was a resolution of the medical condition.

The authors expressed concern about the high percentage of opioid prescriptions left unfinished, citing a statistic that since 2003, more people have died from an overdose of these drugs than from overdoses of heroin and cocaine combined.

“The results of our study imply that opioid analgesics might comprise a large amount of the controlled substance medications remaining in medicine cabinets throughout this country,” they wrote.

In addition to overdoses, the unfinished opioid prescriptions can lead to inappropriate use by friends and relatives, they explained.

But they also suggested that the large numbers of unfinished medications for chronic conditions, such as heart conditions, may warrant more patient education.

And while the federal and state governments continue to address the problem of unused medications, the authors argued that their study can offer insight into the issue. “Continuing to address first-fill quantities may be one strategy to address this national concern.”

They also supported efforts by state and federal agencies to limit the quantity on first-time prescriptions.