by Kimberly Allen, RN
Last week the government agency responsible for the welfare of children here in Honduras paid an unannounced visit to one of our local orphanages. Their biggest complaint was there were medications with expiration dates that had past, but it wasn’t only medications they told the director he had to dispose of there was also numerous bottles of hand sanitizer that had to go because it was past the expiration date. Hand sanitizer, really? Does that even expire? Unfortunately Honduras is a country with a limited supply of medications and it relies heavily on donations. Most of the medications donated are either close to or just past their expiration dates. However, all the pharmacists and doctors that have visited from the US have told us that these medications are still good long past their expiration dates.
Foreign countries are not the only places you’ll find expired medications, they are in medicine cabinets across the US too. As a nurse, one of the very first things you learn in your medication rotation is to always check the expiration date before giving any medication. This becomes an automatic habit that you practice once you’re out working whether it is in an acute care, longterm care or home setting. There were many homes that when I checked their medicine cabinets had expired medications. When I would tell them they shouldn’t use them past the expiration date they would scoff at me. They were unwilling to simply toss what they called “perfectly good medicine.” Despite my teaching and company policy, I agreed and since they were private homes I couldn’t force them to toss them only recommend and advise of the potential dangers. But in truth are they really dangerous? Most of the evidence says no.
So why is there an expiration date and how is it determined? In 1979, a law was passed requiring all drug manufacturers to put an expiration date on all drugs manufactured whether prescription or over the counter. This date represents the time when the manufacturer will guarantee the total safety and potency of the drug ends. Part of the problem is there’s nothing in the law regulating the parameters of the date. The average expiration date is 3 years after manufacture, then the drug is supposed to be discarded. However, according to the FDA the establishment of expiration dates was a a means to establish testing and reporting guidelines as well as creating a safety net, not to prove the the drug was still safe and effective until that date. It was not intended to indicate that the drug is no longer effective after that date. However, that said there are some medications like nitroglycerin, epinephrine and insulin that breakdown rather rapidly and should not be used after the expiration date. These drugs are the exception not the rule. There are numerous studies available indicating that almost all drugs are still effective long past their expiration date. Probably the largest study was done by the US military in conjunction with the FDA. At the time the military was told it had over a billion dollars worth of medications that were past their expiration dates and that they needed to get rid of them. The tests indicated that more than 90% of the medications continued to be safe and effective long past their expiration date. In fact, the FDA created the Shelf-life Extension Program permitting the military to retain medications for over 23 years past the expiration date. However, many ingredients in these medications were still good 40years later and counting. Aspirin and amphetamine were the only medications that didn’t make the 90% potency cut off.
There are several other studies that have all reached the same conclusion causing researchers to recommend a broad extension of the expiration dates on numerous medications both prescription and over the counter adding that ” given that Americans currently spend more than $300 billion annually on prescription medications extending drug expiration dates could yield enormous healthcare expenditure savings.”
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.