Every few months, typically Friday nights around 6 p.m., nurse Deane Kirchner throws what she calls a drug party.
Except, she says, there’s nothing fun about it.
“I think if the public knew how we had to destroy so many drugs, they would be surprised,” says Kirchner, who works at the Lincoln Glen Skilled Nursing Facility in San Jose, California.
Like many nursing facilities around the country, Kirchner's has excess drugs on hand because a patient may have gone home before finishing a prescription, have had an allergic reaction three days into a 30-day supply – or have passed away.
And people in nursing homes typically take many medications. By law, nursing homes are forbidden from giving one patient's pills to another, even if the person down the hall has the same prescription.
So perfectly safe, up-to-date medications – already paid for, often by federal or state governments – are being discarded by more than 16,000 nursing homes and other long-term care facilities around the country.
Data on this is hard to come by, but University of Chicago researchers came up with an estimate for Marketplace: As much as $2 billion a year in drugs is being wasted at these long-term facilities.
Meds that could be reused are being thrown out while one in four people in the U.S. struggle to afford their prescriptions. That makes no sense to George Wang of California-based nonprofit Sirum, which wants to reduce prescription waste.
“I think lots of people can understand why there is such a desire to find an appropriate outlet to take that medicine and get it out of the waste stream and into someone’s hands,” he says.
About $700 million worth of medications could be salvaged each year – some 10 million prescriptions, according to Sirum.
The nonprofit says it has developed software to make it easy and cheap for nursing homes to ship unused drugs to pharmacies that will dispense the medicine to the uninsured or to those with low incomes.
Sirum’s not alone in this line of work.
“It’s such a simple concept, and it has really, really helped real people,” says Linda Johnston, the Tulsa County Director of Social Services, which oversees the county’s drug donation program.
For the last decade, Johnston has persuaded retired doctors to travel to the northeast corner of Oklahoma to pick up unused medications, redistributing $16 million worth to date.
Federal statistics show the most common class of drugs found in long-term care facilities are for behavioral health. Johnston says these psych drugs can mean the difference between remaining employed and being laid off or staying healthy at home instead of being incarcerated in a facility.
“The shameful thing is to waste it, shameful thing is to flush it down the toilet,” she says. Johnston means that literally – unused drugs are flushed down the toilet.
But even if drugs are delivered to people in need, it doesn’t solve the simple problem that taxpayers continue paying for drugs that don’t need to be bought.
This corner of healthcare is so upside down, pharmacists can sometimes make more money being inefficient. University of Chicago economist Rena Conti says this is an old story in healthcare. With twisted financial incentives often come snarls of waste.
“Given the kind of patchwork of incentives they are facing, there’s no reason we should see them investing in actually reducing waste in a systematic way. If we want to solve this problem for real there needs to be some clear and concise guidance across federal and state policy on how to deal with these issues,” she says.
Pharmacists face a choice: maximize revenue and waste perfectly good drugs, or invest in better technology and lose money, Conti says. But using technology to recycle drugs would come with its own cost, one that might not outweigh wasting drugs.
What Johnston does know is that drug donation makes a difference. She says she often thinks about a young man who got anti-depression medication this way.
“He wanted me to know he was not going to commit suicide, because he had his medication, he could take it,” she says.
Today, he’s enrolled in school working towards his dream, earning a college degree, she says.
CORRECTION: A previous version of this story misspelled Deane Kirchner's last name. The text has been corrected.