ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted. We’ve documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients die or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.
What if the system is destroying drugs that are technically “expired” but could still be safely used?
In his lab, Gerona ran tests on the decades-old drugs, including some now defunct brands such as the diet pills Obocell (once pitched to doctors with a portly figurine called “Mr. Obocell”) and Bamadex. Overall, the bottles contained 14 different compounds, including antihistamines, pain relievers and stimulants. All the drugs tested were in their original sealed containers.
The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations.
“Lo and behold,” Cantrell says, “The active ingredients are pretty darn stable.”
Cantrell and Gerona knew their findings had big implications. Perhaps no area of health care has provoked as much anger in recent years as prescription drugs. The news media are rife with stories of medications priced out of reach or of shortages of crucial drugs, sometimes because producing them is no longer profitable.
Tossing such drugs when they expire is doubly hard. One pharmacist at Newton-Wellesley Hospital outside Boston said the 240-bed facility is able to return some expired drugs for credit but had to destroy about $200,000 worth last year. A commentary in the journal Mayo Clinic Proceedings cited similar losses at the nearby Tufts Medical Center. Play that out at hospitals across the country and the tab is significant: about $800 million per year. And that doesn’t include the costs of expired drugs at long-term-care and retail pharmacies and in consumer medicine cabinets.
I’ve had aspirin that was 10+ years old and it was still effective...............
My wife is a pharmacist. She has told me that generally drugs past the expiration date have usually lost 10% of their effectiveness.
It would have to be, in most circumstances. Although, I think it would depend a bit on the specific details of degradation a stored drug experiences.
Think of this: Most medicines come with an expiration date that is suitable with some safety margin for half-assed storage in an uncontrolled, hot environment. Like, a medicine cabinet in a non-air-conditioned Texas or Florida home.
Most storage, on the other hand, occurs at around 70 degrees F, where you’d expect chemical reactions to be much slower. Roughly speaking, a rise/drop of 10 degrees (C) doubles/halves the rate of most chemical reactions. So, in most cases, you can tack at least a few years onto any stated expiration date without much worry.
Great article. Thanks for the post.
As an occasional sufferer of seasonal allergies, I can assure you that Benadryl has a short shelf-life after the expiration date. The stuff will not work well, or at all, shortly after its use date.
Antibiotics, on the other hand, seem to last many years after its expiration date.
I think it strongly depends on the particular drug.
Some are fine and effective for many years, some indeed have a limited time during which they are effective.
But it is not reasonable to have a blanket x years of effectiveness assigned to each drug.
US military came to the same money-saving conclusion from what I recall...
I wonder how ‘expiration’ dates or ‘use by’ dates are determined.
For quick shelf-life projects, such as fresh fruits and veggies, milk, fresh meats, etc., and even frozen products those dates can be determined by testing. But, for a can of corn, for example, it may be good years after the recommended date.
Penicillin can be dangerous past its expiration date. Not sure how long past, but I’ve heard that’s true for that medicine at least.
It's conclusion was "many prescription pharmaceuticals retain their full potency for decades beyond their manufacturer-ascribed expiration dates."
Stability of Active Ingredients in Long-Expired Prescription Medications
After having some personal experience with doxycycline that had gone past its expiration date, I think this topic needs a little more research and a lot more specificity. Be careful. Putting expired drugs into your body may be hazardous to your health.
If one were to look at history, medics during WWII collected urine from patients that had been treated with penicillin and used the urine on subsequent patients. Some drugs are stable even when excreted. Every drug should have a realistic shelf life and it isn’t too hard to study that shelf life. The USAF already has an effective plan for stored food and the template for the drugs is already in place.
Some Medical Research Drs I know and I were discussing the Epi-pen price hike that was in the news a year or so ago. We talked about how expensive they were and that they had a shelf life of 2 years. They told me not really. The 2-year life is what the manufacturer has been able to statistically demonstrate to the FDA based on testing.
As they explained, drug manufacturers have really no incentive to be able to sell extremely long shelf life drugs. Even if a drug could last for 10, 15 or 20 years, why should a manufacturer go to the required testing and documentation to seek an FDA approval for a long shelf life? The Drug manufacturers go for a reasonable length shelf life based on seasonal usage patterns, and the time it takes from manufacturing to warehousing and distribution to the final retail outlet.
Specifically, they said if they had a 4 year old Epi-pen and I suddenly saw someone attacked by a swarm of bees and go into shock, they would use the Epi-pen past its pull date. Likely if might at worst be only 95% as effective as a similar drug within its pull date. Still if would probably save a life anyway.
Expiration dates are arbitrary and usually have more lawyer input into the process than science. Not uncommon to see foreign countries buying these up in large numbers.
My late ex-FIL was a drug rep who started a program in his company to collect expired meds from hospitals and sent them to medical missionaries in 3rd world countries.
He said the degradation of quality was so minimal it was insignificant. The Pharma companies ended it when their lawyers found out.
I have a 14 year old bottle of Amoxicillin Capsules my parents picked up for me from Mexico that still work. Recently found and took one and it cleared up my abscessed tooth till I could get a prescription from Dentist.
What this article fails to mention is that some of the degradation products are toxic. One of the antibiotics (doxycycline?) produces a toxin that targets the liver, IIRC.
As a survivalist and overall smart guy, I stockpile my prescription meds for when ‘it’ happens (in my case, blood pressure). So articles like this convince me that I’m doing the right thing. Obviously I use only the older drugs (now only several years old), but they’re still working fine. Once I have enough stockpiled to get me to the end, I’ll be through having to deal with doctors and physicals anymore.