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Last post 4 weeks ago by delta1. 23 replies replies.
Excess Pharmaceuticals
dstieger Offline
#1 Posted:
Joined: 06-22-2007
Posts: 9,564
CSPAN had a discussion about drugs this morning. They had a DEA agent and there was good discussion. One caller, though, had a comment or question that wasn't really for the cop, but got me thinking about excess prescription drugs in this country. I have had all kinds of complaints about big pharma over the years, but I add another to the list today.

I don't have data, but I have a strong perception that MUCH more 'situational' or 'corrective' type medication is prescribed and bought than is actually used. Why isn't big pharma being held accountable for this???
-For the base $$ cost to patients and insurance of excessive prescribing.
-For the cost to the environment of improper disposal.
-For the cost to society by misuse and unnecessary addiction???

Maybe Vic or TW can help, but in my mind, I sort prescriptions into three categories:
1. Maintenance -- something taken every day or week or month...for years, or for life
2. Preventative -- similar to maintenance...probably for life or for the period of life that there's specific risk
3. Situational -- disease, pain, etc. -- short term, generally

I imagine excess of the first two is a problem, but probably not like it is for the third.

Except for some antibiotics (that have directions saying to 'take until gone'), I am not sure that I have ever taken all of a 'situational' prescription. Who doesn't have 'excess drugs' in the house? Who hasn't flushed drugs? Or tossed drugs in the trash? Or had some turn up 'missing'?

CVS and Walgreens started taking back drugs two years ago. That's a good thing....but in just over a year, they took back over 300 TONS of drugs. Putting aside the question of how those get 'disposed' of ...and the risks that may entail....that is a LOT of unused drugs. Probably much was OTC....IDK. But, I'm sure that's just the tip of the iceberg. Why aren't producers liable for cradle to grave....like most HAZMAT producers? I'm sure much of any over-prescribing is laid at doctors' feet -- but I gotta believe they are using guidelines from the pharm companies to a very large degree.

I realize that some people are now pretty pizzy that there Percocet prescriptions are smaller and harder to renew....but for the most part, wouldn't we all be better served by smaller/smarter doses, along with clear, systemic disposal opportunities?
DrafterX Offline
#2 Posted:
Joined: 10-18-2005
Posts: 87,408
I could sure use some Percocets about now... Mellow
ZRX1200 Offline
#3 Posted:
Joined: 07-08-2007
Posts: 48,614
You can’t expect producers to be liable because if any of these got put back into the care stream it would be insurance fraud.
ZRX1200 Offline
#4 Posted:
Joined: 07-08-2007
Posts: 48,614
I would like to see a system for a non profit administrator to control these for indigent care and for doctors without boarders
Speyside Offline
#5 Posted:
Joined: 03-16-2015
Posts: 7,384
Dave, about 1 year ago I had tendonitis bad in my right knee. The orthopaedic answer was your knee is shot, here is a Percocete prescription for the pain. See me in 3 months for another prescription. I did not accept that answer, so I never filled the prescription. The answer was a good tendonitis knee brace, and about 6 acupuncture sessions. I think this illustrates 2 things. He said I would take Percocete the rest of my life, addiction anyone? If I had filled the prescription I would not have known how to dispose of what I had not used.
DrafterX Offline
#6 Posted:
Joined: 10-18-2005
Posts: 87,408
Mellow
rfenst Online
#7 Posted:
Joined: 06-23-2007
Posts: 29,148
Speyside wrote:
Dave, about 1 year ago I had tendonitis bad in my right knee. The orthopaedic answer was your knee is shot, here is a Percocete prescription for the pain. See me in 3 months for another prescription. I did not accept that answer, so I never filled the prescription. The answer was a good tendonitis knee brace, and about 6 acupuncture sessions. I think this illustrates 2 things. He said I would take Percocete the rest of my life, addiction anyone? If I had filled the prescription I would not have known how to dispose of what I had not used.

How many pills did he prescribe?
Speyside Offline
#8 Posted:
Joined: 03-16-2015
Posts: 7,384
If memory serves me right 1 every 4 hours. So 6 per day, so 180 per month.
delta1 Offline
#9 Posted:
Joined: 11-23-2011
Posts: 16,093
is the "use by date" just another marketing tool to make people throw away more and buy more ... I don't remember any OTC drugs that had them until recently...
Ewok126 Offline
#10 Posted:
Joined: 06-25-2017
Posts: 4,112
Speyside wrote:
If memory serves me right 1 every 4 hours. So 6 per day, so 180 per month.


More than likely that would have also been PRN.
Ewok126 Offline
#11 Posted:
Joined: 06-25-2017
Posts: 4,112
delta1 wrote:
is the "use by date" just another marketing tool to make people throw away more and buy more ... I don't remember any OTC drugs that had them until recently...


Most drugs (pill Form) keep their potency decades after the expiration date. This is just the date that the company can guarantee the safety and potency. Also there are some exceptions to the rule such as insulin, liquid antibiotics, nitroglycerin, glucagon kits, Epinephrine etc. Those you trash after the expiration date. Law was passed in 1979 that all pharma companies had to put an expiration date on all their products including needles and such. You would chit your pants if you knew how many needle electrodes I had to trash due to this. At over 200 bucks a box, each box containing 20 needle electrodes, one surgery requires 28 needle electrodes minimum. Most days would consist of any where from 4 to 10 surgeries a day. I have thrown away TRASH BAGS full of these at a time due to reached expiration date. Where the leads still good? Sure they where but, if something went wrong during surgery and it was found out that I used an expired needle that was an instant lawsuit. Then Bye Bye credentials that took years to get and also Bye Bye company because one lost lawsuit would have closed the doors.
Speyside Offline
#12 Posted:
Joined: 03-16-2015
Posts: 7,384
I don't remember Chris, but you are probably right. It just wasn't an option I was willing to consider.
Ewok126 Offline
#13 Posted:
Joined: 06-25-2017
Posts: 4,112
Speyside wrote:
I don't remember Chris, but you are probably right. It just wasn't an option I was willing to consider.


I know what you mean brother all to well.

I feel the same way about my lorazepam. I have had them since I switched Dr's. They do work and work very well for me but, being what it is and such I only take them well, to be honest, when I run out of my natural stuff lol. Since I have switched to the "natural stuff" I have not had to take any pain pills or any anxiety pills. I very rarely have to take my sedation meds at night as well. The only meds I have to take now are my metformin for diabetes, my heart medication to keep my heart rate down, and my warfarin to thin my blood. I am going to have to start a lasix pill that my cardiologist prescribed today but that will be only as needed. The dang leg that they took the artery from to do my bypass has gotten to where it retains fluid a little bit so a little adema there.

So I have went from 11 pills a day to 3 a day, 4 a day when I do take the sedation med. Not a world record or nothing but better I would say for sure. At least in my op. Even though my head stays foggy all the time due to the stroke it is not as foggy as when I was having to take all those other medications. When I was taking all the others, it was like a dilantin overdose. I was like a freaking zombie.
delta1 Offline
#14 Posted:
Joined: 11-23-2011
Posts: 16,093
glad to know Ewok is doing better, taking less meds...


as for disposal....does the county of your residence hold periodic haz-mat collection events? in CA, most counties do, and they accept meds...just have to put them in separate marked containers from the other stuff...
Ewok126 Offline
#15 Posted:
Joined: 06-25-2017
Posts: 4,112
Here we just save em and give em out to the chidrens on halloween with a packet of sweet & Low to dip em in. That way the kids don't have to wait as long by drinking the water, or eating the steroid drug infested foods such as chickens, eggs, beef, etc. The young girls love it. I hear em saying all excited, "when I turn 10 I am going to have titts like my mama and all the lil fellers giving knuckle bumps and high 5's. It's so precious!
delta1 Offline
#16 Posted:
Joined: 11-23-2011
Posts: 16,093
gasp...lol...
ZRX1200 Offline
#17 Posted:
Joined: 07-08-2007
Posts: 48,614
Who hasn’t crushed up oxies for the trick or treaters to snort before getting candy?
victor809 Offline
#18 Posted:
Joined: 10-14-2011
Posts: 17,664
I wouldn't blame the pharma companies for the prescriptions the Drs are writing... Sure the companies want their products used, but I think a lot of times Drs are prescribing the drugs because patients in pain are much more difficult to deal with. I've gotten oxy or Percocet prescribed for any number of situations where I was in "pain"... I never took it after the first when it doesnt really change how I felt pain wise and doesn't make me high or anything fun.... I remember a Dr shot me up with morphine to straighten my nose once... I could see my pupils were dilated all to hell... But my damaged back still hurt like a m-f..

Additionally, ewok is correct, expiration is a test based date. Pharma companies would love a longer expiration date, that keeps them from worrying about inventory management as much. But if you have a 1 year expiration, you have to prove to the FDA that it's effectiveness remains over that year. That's $$.
teedubbya Offline
#19 Posted:
Joined: 08-14-2003
Posts: 84,659
When I worked for a managed care organization I spent a lot of time in Drs offices credentialling them or going over utilization data. I’d bring them nominal branded trinkets that were thrown in the trash by them as they got really cool stuff including really nice office wide meals from drug reps (often hot chicks). Our only tool was the financial carrot and stick of our formulary. The problem is every carrier had their own formulary which is a pain for providers and patients.

When I jumped in to a large not for profit health system my first project was to analyze all carriers formularies and to develop our own based on in general what was best across the board. Our docs were directed to follow one formulary... ours. It was better but not without issue. We had some battles on the contracting end, and while it was better as a whole there are always some losers. We did have to work to make some patients whole.

The other thing we did is forbid our physicians offices from scheduling or receiving drug rep visits. This was hugely effective but boy did the drug reps and some of the offices squawk. It sure shined light on the cockroaches.

Drug reps were welcome to schedule visits centrally to make their pitch but they were met with data and we looked at what made sense on or formulary. We specially instructed them to leave the swag and food behind and just bring information.

It was not without growing pains but we gained control over our drug costs (payment mechanisms are not all direct and vary from global budget to capitation to referral pool et). It’s evolved since I left but what we started is still largely in place. The drug world of medicine still has a little Wild West in it.


As for the OP I don’t have much more to offer. We do focus on the whole system in the opioid issue. Beginning middle and end. Beginning being prior to prescribing/dispensing, end being take back and destruction. There is no easy answer.
dstieger Offline
#20 Posted:
Joined: 06-22-2007
Posts: 9,564
I just wanna blow it all up. I know it isn't all evil, but I have so very little faith that big pharma is a net positive for our society. ....well, maybe a net positive, but at a cost that is obscene and unsustainable. And it's ugly and dirty...if it wasn't, you wouldn't have to block the sales/doc interactions. I want transparency in patient costs. I want to kneecap the insurance companies who enable the mess...I want commercials off of tv and radio...I get that R&D happens because of profit -- but, if the population is getting gouged by insulin prices, for example, I'm ok forcing drug companies to open the books and show how much profit gets pumped into R&D or capital improvements...and how much goes into the Slackers' pockets....laissez faire...until you pillage the system and rape the people who pay you
teedubbya Offline
#21 Posted:
Joined: 08-14-2003
Posts: 84,659
Can’t disagree with much/most of that
frankj1 Offline
#22 Posted:
Joined: 02-08-2007
Posts: 25,977
but how will I know if luminista is right for me?
delta1 Offline
#23 Posted:
Joined: 11-23-2011
Posts: 16,093
turn on your TV at 2am
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