Alberta Looking At Ways To Cut Unused Pill Costs

By Robert Walker
The Medical Post, Jan. 21, 1997

EDMONTON - More than 204 tonnes of unused medications -- the weight equivalent of 60 full-size elephants -- have been handed in by Alberta patients over the last eight years, according to a study by the province's pharmacists and doctors.

And in another study, physicians estimate the cost to the Alberta health care system in suffering, illness and death of patients not taking their drugs is a massive $700 million to $900 million a year - a figure disputed by Alberta Health.

Drugs are the fastest rising cost in the health care system. The Alberta government and Alberta Medical Association are seeking ways to cut $50 million from provincial drug costs - and a report from a committee looking into the issue lies on Health Minister Halvar Jonson's desk.


Top of the list of drugs prescribed to patients, but not taken, are antibiotics, followed by painkillers and heart drugs, according to the study of unused medications by the Alberta Medical Association and the Alberta Pharmaceutical Association.

The study examines drugs returned under an ongoing province-wide program called EnviRx.

In one eight-week period alone, during a campaign for the return of unused drugs, 58 randomly selected drugstores collected medications worth $60,350, equivalent to $716,400 for the whole province.

The study showed people brought back an average 60% of drugs dispensed in the original prescription.
AMA president Dr. Kabir Jivraj said patient compliance with prescription instructions "is a real big issue" and patients need to be educated on why taking a particular medication is important. "This is a very useful piece of research which gives a much better feel for how big this problem is and why it occurs. Now we can start looking at strategies to put in place to deal with the issue."

Dr. Jivraj said a multi-disciplinary committee has submitted a report to the minister on ways of saving up to $50 million in drug costs.

He hopes the report will be dealt with by the end of the year -- followed by appropriate measures.

Alberta Health spokesman Garth Norris said the health minister strongly supports the used-drug roundup, begun in 1988. But Norris found it hard to believe patients not taking medications would cost the health system as much as $700 million to $900 million a year, although he added: "We recognize there are costs to the system through inappropriate use of medications and we would like to get that down."

"We still don't know what percentage of drug waste is not returned and we don't know how big the whole problem is," said Brian Carter, assistant registrar of the APA. "We got 20 tonnes this year. Is that 20% of wasted drugs, or 50% or more?"

Greg Eberhart, registrar of the APA, said he's pushing for a trial prescription program in Alberta, where pharmacists only supply a small proportion of a prescription at first to see if the patient can tolerate the drug.

Pilot program

A pilot program in Red Deer, halfway between Calgary and Edmonton, showed huge savings can be made by not giving the patient an expensive 60- to 90-day prescription right off the bat.

He's also behind a proposal to link pharmacists throughout the province to a computer network so they can check patient records to make sure a drug prescribed by one doctor won't react badly with another that the patient is already taking.

Eberhart stresses patients should build a good relationship with their pharmacist to ensure they understand how a drug works and why they need to take it.

Dr. David Hogan, head of the division of geriatric medicine at the University of Calgary, said it's often hard for patients to remember their medications two or three times a day for long periods of time. And perhaps simpler directions and better packaging would help.

"It is a fiction that our patients take medications as we prescribe them," Dr. Hoogan said.

Side effects

The doctor's responsibility is to explain why the medication is necessary and the patient's is to make sure they understand and comply with the prescription, he said. The pharmacist's job is to take time to explain side effects and dosages.

Dr. Hogan cited a national Canadian study published last year showing the cost to Canadian health care of patients not taking their medications totals a staggering $7 billion to $9 billion a year. Alberta's share of that would be about $700 million to $900 million, he said.

Drug Waste

Main reasons for drugs being returned to pharmacies:

Patient died: 26.6%
Product outdated or expired: 24.7%
Physician changed order: 11.6%
Patient felt better: 11.4%
Adverse or allergic reaction: 8%
Did not want to take it: 7.1%

Top types of unused drugs returned to Alberta pharmacists (as percentage of total number of returned drugs):

Anti-infectives: 12.6%
Analgesics: 11.5%
Cardiovascular: 10.4%
Antiarthritics: 7.7%
Antipasmodic/antisecretory: 6.2%

Source: Drug Use in the Elderly Quarterly, published by the AMA and APA

Copyright 1997 Maclean Hunter Publishing Limited
Reprinted with permission.

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