Medications provide life-saving interventions and improve quality of life for
millions. Yet, evidence increasingly
suggests that large amounts of prescription medications remain unused, unwanted
or expired. Additionally, prescription abuse and suicides from these drugs are
at an all time high. Their presence in the water is causing harm to aquatic
life and while not therapeutic, may influence efficacy of medications when we
need them most. Almost all of the
interventions have
focused on a downstream approach, with mail-in or community
collections, that are infrequent, require significant interagency coordination,
and do not address decreasing the amount of medications by prescribing or
dispensing less. The purpose of this study is to identify the frequency of
prescription “switching” in five drug classes (antidepressants, lipid-control,
hypertension, diabetes, and pain medications) using retrospective review of
pharmacy records at a Veterans Administration healthcare facility.
Methods were piloted on a small data set,
refined and applied on data sets of several thousand records.
Preliminary results suggest that switching
occurs at least 10% of the time (higher for some prescriptions) for each
classification of drugs, generally on day 10 to 14.
Policy implications are: 1) short cycling of
prescriptions (writing a shorter supply of medications for NEW scripts until
correct dosage and drug is determined) would decrease unused medications; 2)
potential cost savings; and 3) reduce potential for waste and diversion; 4) and
decrease medication disposal into the environment.
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