A pharmacist is questioning the draconian system of rules that lead to $40 million worth of pharmaceutical waste in landfills every year
Medicine valued at $16,000 which could not be used by a patient was donated to a pharmacy - but had to go straight into the bin.
Two months worth of the expensive cancer medication was handed to a Christchurch pharmacy by the customer, hoping it could be used by somebody who needed it.
But although the medication was unused and with the seal unbroken, strict laws around the donation of dispensed medication meant the pharmacy had no choice but to get rid of it.
That was the moment pharmacist Puneet Saini knew something needed to change.
“I was appalled at that,” Saini said. “So I thought - what can be done about it?”
He started researching just how necessary these laws are, and discovered an estimated $40m of pharmaceutical waste goes to New Zealand landfills annually.
Now he is campaigning for mechanisms to be put in place to recoup some of that money, starting with a petition calling for the Government to amend its legislation around the donation of dispensed medicines.
It’s something that happens every day, according to Saini.
“Every day community pharmacies dispense millions of dollars’ worth of medicines to New Zealanders,” he said - and in situations where the patient dies or no longer needs treatment, they are often returned with the hope they will be reused for other Kiwis.
“But they are not reused,” said Saini. “They cannot be - the current legislation does not allow it.”
Minister for Health Andrew Little said medicine was not reused for reasons of public safety.
“Where medicines have been dispensed in a manufacturer’s original pack, have left the pharmacy and are returned by the customer, these should not be reused for other patients for safety reasons,” he said in Parliament in May.
"The most important consideration for medicines being dispensed and used by the public in New Zealand is the quality of those medicines," said a spokesperson from the Ministry of Health. "New medicines have been through a rigorous approval process to ensure they have met set standards of quality, efficacy and safety."
But Saini believes the risk of re-use can be mitigated, essentially saving New Zealanders millions.
The risk comes down to two factors, said Saini.
First, contamination. But according to Saini, this isn’t always an issue - “for medicines that come sealed or in a blister pack, it’s very difficult to contaminate them”.
The other risk factor is the temperature medications are stored at. Many simply need to be kept below 30 degrees, and in a temperate country where house temperature is often closely tied to the temperature outside, Saini thinks this poses little issue.
“Here in Christchurch, I can count the number of days of 30 degrees on my fingertips,” he said.
The Ministry of Health said for re-used medicine to meet safety standards, complex testing would be required.
"For dispensed medicines to meet these same standards for re-use, additional assurances would be required," said the ministry spokesperson. "These would include testing to ensure the medicine has been stored correctly and has not been contaminated or tampered with. These tests would be complex, cost more than the medicine itself, as well as destroying some of medicine in the process.
"In practice, it is not possible for re-used dispensed medicines to meet New Zealand’s standards for public safety."
Saini has been working with National Party health spokesperson Shane Reti to imagine what a medication redistribution system might look like.
“There are so many people out there who can’t afford medicines they might need,” Reti said - a sentiment echoed by the Ministry of Health’s 2016-2017 survey, which found almost 300,000 New Zealanders hadn’t filled a prescription due to cost over the past year.
“So rather than flush these medicines all down the toilet, do we need to work out a way to reuse them?”
Valuable medication such as oral chemotherapeutics could potentially be redistributed safely, said Reti, adding a system like this would “increase patients’ options and give people choices”, ultimately leading to better health outcomes.
The move could reduce harm to the environment as well, said Saini - as every tiny pill or capsule would have its own carbon footprint.
“They all have to go through a manufacturing process,” Saini said. “And with a lot of imports coming from countries like India or China, that power used is often from dirty carbon sources - and then of course it also needs to be shipped all the way here.”
Reti said he put the idea in his health manifesto last year, and is interested in seeing how the idea would work in New Zealand. He envisions an online reuse inventory, where people can look up the medicine they need and see if it can be provided at a more affordable rate.
“If the USA with their litigious environment got it through, why can’t we?” he said. “It’s a question of how do we get to yes.”
Since Georgia led the way in 1997, 38 US states have passed laws allowing for the reuse of medication - for example, Iowa, where since 2007 a programme has served 71,000 patients and redistributed NZ$26 million in free medication and supplies donated to people in need.
But with private healthcare reigning supreme in the United States, Saini said New Zealand would have to approach the problem a little differently.
“As we have a public healthcare system, it has to be the state which formulates the plan,” he said. “That may take a lot of work and maybe there’s always an inherent risk to it - but it seems crazy to not even talk about it.”
Ultimately he believed any inherent risk could be mitigated.
“I wouldn’t be suggesting it if I wasn’t happy with my three-year old daughter taking medicine from a programme like this,” he said.
Puneet Saini’s petition for legislating the donation of dispensed medicines is open until July 26.
