Destruction of ‘wrongly stored’ unused medicines at taxpayers expense

"The issue of unused medicines is only reflecting the chaos with which the health sector was administered during the years.

"Lack of policy and planning, lack of efficient structures and also a lack of adequate managerial systems in place, have been dominating the sector for many years."

Shadow minister for health Marie Louise Coleiro Preca said in reply to a question by MaltaToday on the destruction of unused medicines.

"Furthermore, the awkward situation that the public health sector is in today is of great concern to the Maltese taxpayers, who contribute millions of euros a year for the provision amongst other services, free medicine," she added.

Health Minister Joe Cassar last week said "there were around 80 different types of medicine worth over €10,000 planned to be destroyed. And this was likely to be only the tip of the iceberg, since many people kept unused medicine at home".

Cassar said the boxes had been returned by members of the public in the past three months out of good will, in the belief that they could be reused, and the concerned authorities could not redistribute these medicines as they were not sure whether patients had stored them under the right temperature at home.

But the lingering question is: why haven't the majority of these returned perfectly sealed boxes of medicines, with the exception of expired drugs, been retested to verify whether they are good or not to consume?

The ministry's spokesperson Graziella Camilleri said that "the department constantly strives to ensure that the medicines dispensed to patients are of the highest quality. And such quality depends on the storage conditions of the medicinal products.

"The storage conditions are rigorously checked on a regular basis to ensure quality. Once a medicine leaves controlled storage conditions (pharmacy), its quality can no longer be guaranteed and it would not be totally safe or ethical to dispense it to another patient.

"Re-testing the quality, safety and efficacy of any returned tablets would be too costly and would therefore not be economically feasible."

The ministry was also asked if it considered coming up with a drive to collect unused medicines from the public, instead of depending on the public to return them. This drive would be essential in ensuring that medicinal products are disposed in the right way, not leaving a bad effect on the environment.

"Although the responsibility for the appropriate collection of waste does not fall within the remit of the Health Authorities, the authorities would be ready to support any such initiative."

According to Coleiro Preca, redistributing unused medicines would not be in accordance to European standards.

"Quality control is not quality assurance. There are a number of EU directives that regulate this matter."

However, Coleiro Preca added that "hundreds of thousands of euros were being spent annually on medicines which are being hoarded because they are not utilised by the individuals in their homes and other medicines go down the drain because they are not consumed and hence they are expired on the shelves of government stores. 

"On the other hand, about 632 different medicines were out of stock in 2011. In simple words: shortages lead to hoarding, and hoarding leads to unused medicine. 

"When shortages of medicine prevail - and this situation has been prevailing for many years now - people do not trust the system, hence they hoard. What is occurring in the health sector - and particularly regarding the management of free medicine - seriously needs to be addressed by government, and the present administration is morally obliged to tell the whole truth to the public."

Coleiro Preca added that "this is imperative, because what the government is stating is very confusing. As an example, in February 2011 the minister of health had announced that a specialised agency for medicine was to be set up. A year on, nobody has heard anything else about it".

"In January 2012, the same health minister announced that the government 'was embarking on a new process for procurement that will enable us to get medications faster and cheaper'. In sharp contrast, in a report by the The Times dated 18 January 2012, Karl Farrugia, CEO of procurement of supplies within the Ministry of Health, stated that this unit was in place for only five months and has only started to analyse the best possible way to reform the procurement process."

On whether she agreed that the government was doing little in spreading awareness when it came to decreasing medicinal waste, Coleiro Preca said that government had a "golden opportunity" to raise awareness, with the introduction of the Pharmacy of Your Choice. However, it has missed out on it. The introduction of the POYC system should have been used by government to create discussion and launch an educational campaign aimed at both the pharmacist and the patient.

"Unfortunately, the POYC has never been integrated into one national system whereby it promotes awareness and education regarding the proper use of medicine. 

"Initially, government had introduced the system as a pilot project. However, it had not appraised and evaluated the outcomes and hence changed what was obvious to be changed. Government has used the system as another partisan tool for some cheap political propaganda."

Some €69 million are spent on free medicines every year - equivalent to €170 per person.