People's hope for prescription drugs goes up in flames

Medicines burn at the dump in Santa Barbara

A tragedy played out late last week at the garbage dump in Santa Barbara, Honduras, where three big truckloads carrying tons of expired pharmaceutical drugs were burned. 

This comes less than a month after another story in the Honduran media about publicly funded prescription drugs valued at almost 13 million lempiras - $660,000 - being thrown out during 2010-11 due to expiration even while countless sick, poor Hondurans waited in vain for the medicines they'd been prescribed but couldn't afford.

You only have to contract dengue fever once to empathize with how miserable life would be if you couldn't afford a few tabs of acetaminophen to get you through the worst of it. And there are a heck of a lot of people in this country who would be in that situation, even though $1.50 will get you 100.

But this is far from being just about pain management after the mosquitoes get you. It's about vast quantities of drugs essential for people's well-being and health - paid for in many cases by international non-profits doing aid work in Honduras - that never make it into the hands of the people they're intended for, or anyone else's hands for that matter. 

You need only spend a few days at the children's home where I help out to get a sense how little access average people have to medicines. There's a public health system of sorts here (although I think it's safe to say that nobody who can afford private care would ever use it) but medicine isn't covered. 

Right now, at least half the kids at the home appear to have impetigo. But even a tube of antibiotic cream to clear up that highly contagious skin condition is a luxury. 

And some of the children clearly have chronic, debilitating health conditions that are much more serious than impetigo. Unfortunately, even if they were ever properly diagnosed - a rare luxury in itself - whatever medications they need wouldn't be available   unless somebody was picking up the bill.

And perhaps the worst of it is that the whole issue of drug expiry is something of a myth. I did a Google search to find out more about drug expiration dates after reading the sad Santa Barbara story this morning, and pulled up no less than a Harvard Medical  School report that puts the lie to this business of expired medicine being ineffective or  dangerous. 

"Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military," notes the 2003 report.  "With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90 per cent of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date."

It turns out that a law was passed in the U.S. in 1979 requiring all drug manufacturers to stamp an expiration date on their products, "the date at which the manufacturer can still guarantee the full potency and safety of the drug." And from that rather arbitrary decision, we can trace a line all the way to 2012 and the foolish decision to burn a warehouse full of drugs that many, many people could have used.

The Harvard report says the potency of drugs do diminish over time, but the expiry date stamped on the package has little relation to when that will actually happen. 

"It's true the effectiveness of a drug may decrease over time, but much of the original potency still remains even a decade after the expiration date. Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long-lasting as the ones tested by the military."

Alas, nobody in the Honduras health system did the same Google search before calling in the truckers to haul away the "expired" prescription drugs. A tremendous waste of international resources. A tremendous loss to millions of Hondurans who are essentially living without health care.