Is it wrong to use expired drugs?
Well, . . .
When paramedics ran out of a critical drug used to treat irregular heartbeats, the Bend Fire Department in Central Oregon dug into its stash of expired medications, loaded up the trucks and kept treating patients.[1]
Is this safe?
The first concern related to expired drugs is whether they are potentially harmful if consumed. Reassuringly, there is no published data to suggest harms from use of drug formulations after their expiry data.[2]
Rather than ask that question, EMS agencies have generally assumed that the expiration date is sacred and that giving drugs past the expiration date is evil. This is CYA vs. competent patient care.
I don’t know what I’m doing, but there is a rule that could be trouble for me, so I will enforce it as if it is more important than the things that cannot be as easily measured, such as competence.
Some EMS agencies are recognizing that this is not good for patients.
What is the potency of expired medications?
That is not a simple question.
Do we even know the potency of our medications that have not yet expired?
What is the mean kinetic temperature that they have been stored at?
If we have not controlled the mean kinetic temperature, haven’t we violated something much more important than an expiration date?
What changes about a medication, when the medication expires?
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Emergency responders in various jurisdictions have reported turning to last resort practices as they struggle to deal with a shortage of drug supplies created by manufacturing delays and industry changes. Some are injecting expired medications or substituting alternatives. Others are simply going without.[1]
Oh, No! Don’t tell the lawyers, because the patients will own the EMS organizations!
What happens in the real work, rather than in the fevered imaginations of the whiners, who use a fear of lawyers to argue against everything except incompetence?
For some reason, these whiners do not see incompetence as something that carries any legal liability.
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“We’ve never (before) had to go diving back into the bin to try to retrieve expired boxes of drugs,” said Tom Wright, emergency medical services coordinator for the Bend Fire Department, which has been administering outdated medicines for about a year. “We had the backing of our insurance company that giving expired drugs is better than giving no drugs at all.”
He said that medics have not reported any adverse reactions.[1]
No bad outcomes means no justification for a law suit to go to trial.
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It was good fortune that no one around Mayer, Ariz., called 911 to report a seizure during the three weeks this year that the local fire district had no drugs to treat the condition.[1]
Consider the possibilities –
Are they required to carry the medication?
Was there a bad outcome?
To be continued in Part II.
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Footnotes:
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[1] Paramedics turn to expired drugs due to shortages
boston.com
By Jonathan J. Cooper
Associated Press / July 12, 2012
Article
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[2] Should you take expiry dates seriously?
Science-Based Pharmacy
Thursday, May 10th, 2012
Article
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I’d argue against using expired medication without some analysis on a couple of points. Your typical post argues that if a treatment has not been proven beneficial to the patient, don’t use it. In this post, you seem to argue the opposite: expired medications may or may not be beneficial to the patient, so use them as a last resort. Some medications become toxic with age (antibiotics), so the choice to use expired medications adds a level of complexity to use. This should be done with proper analysis and could require training beyond pre-hospital pharmacology to assess.
Would allowing medications to be used past there expiration date incentivize an ambulance service to choose to delay ordering medications that are available? The service could save a little money even if the medications were a little less potent. That puts the paramedic in a position of making a judgment on every medication – is it expired and if/when expired, is it still potent?
Well, on the legal side of negligence is the clause of “did harm occur?” and if no harm happened with an expired medication, but harm occurred by not giving a drug because it was expired … ad nauseum … _______ <— insert circular logic here
Anonymous,
Are you suggesting that our legal system is flawed?
.
“Some medications become toxic with age (antibiotics), so the choice to use expired medications adds a level of complexity to use.”
Patently false. Antibiotics do not become toxic. There was a concern dating back to the early ’60s that expired tetracycline could possibly cause kidney damage, but that was never confirmed. The particular formulation of tetracycline in question is no longer manufactured.
Length of time since expiry would probably be key, but that can only be decided when we have some research into the subject. My logical question would be: “This medication expired at 00:00 on 01 August 2012. Did the potency degrade enough in the one second between 23:59.59 on 31 July 2012 and 00:00 on 01 August that the medication is no longer safe to use?” Statistically-speaking, that one second is completely insignificant. If the answer is no, then what is to say that using a medication that is one day, one week, one month, or one year past its date of expiry, is any less safe to use than that medication that doesn’t expire for one more minute?
What logical conclusions CAN be drawn? The same conclusions as, say, “The dose for Lidocaine is 1 mg-1.5 mg per kg; therefore, if a swing in dose of 0.5 mg/kg is an acceptable range, then there’s no reason to believe that a dose of 2.0 mg/kg would be any less safe than a dose of 1.5 mg/kg, although it would, according to protocol, be an overdose.” (This, of course, is predicated on the assumption that Lidocaine is EVER safe, or EVER effective).
Needles and angiocaths also have expiration dates, but I’ve been told that they only refer to the length of time that the manufacturer can guarantee the product’s sterility. If an angiocath is expired, but the package is intact, is the needle inherently less-safe to use than an angiocath that is NOT expired, and also has intact packaging?
We can ask these kinds of questions all day long, but will we come to any conclusions or make any adjustments to our ways of doing things until research is done? Will drug manufacturers support the research, or will them oppose it, knowing that if it’s shown that the drugs don’t degrade, they’ll lose out on profitability because they won’t have to replace drugs as often?
Canned goods might expire but have been repeatedly shown to be safe for human consumption for YEARS after their “best by” dates. Not that drugs are in the same boat as canned corn, but since I’ve been talking logic, I figured “What the hell!”