Mail Order Drugs – Why isn’t this issue in the national spotlight?
A comment on a recent blog post about the Express Scripts/Medco merger brought up a point so important it deserved its own post. Why are mail order drugs even allowed by law?
Stephen Logsdon, Pharm.D. wrote:
“With regard to mandatory mail, here in Florida it gets HOT…and as we all know, prescription meds (of all kinds) are simply NOT meant to ‘stored’ in a 110+ degree mailboxes for up to 6-8 hours at a time, and I refuse to accept/return to sender any medication that has been subjected to such ‘excursions.’
I’ve had many successes succinctly explaining to patients whose insurance is trying to enforce a ‘no-refill at retail’ policy that the lack of climate control during the shipping progress may very well effect the efficacy their medication has against the illness they’re taking them for…just something to think about…”
This is an excellent point. The package directions on most medications specify that they should be stored at controlled room temperature, defined at approximately 68° to 77° F. Some, like Synthroid and Torpol, list exceptions for short-term excursions, usually 59° to 86° F. Trouble is, not every state is temperate. Summer temperatures in Florida often soar into the hundreds. Add a metal box to the equation, for example a UPS truck or a mailbox, and the temps can reach almost 200°, which is why you should never leave your dog – or your child – locked in the car.
So what happens to meds when exposed to high temperatures?
High temps degrade the potency and stability of many drugs, which could drastically affect the efficacy of the medicine, posing a potential hazard to patients.
A 2004 study by the American College of Chest Physicians (ACCP) found that when exposed to temperatures of 150 F for a period of four hours, formoterol, a common inhaled asthma medication, showed significant chemical composition changes and was found to deliver less than half the prescribed dosage.
The Abbot Lab hotline recommends that patients replace their Synthroid pills if the pills are exposed to temperatures higher than 86° for an extended length of time – say a couple of days in transit.
This research is not new, and it’s not startling that medications are properly labeled…and that delivery companies can’t meet the temperature standards set by the manufacturers. So how dangerous is this situation? And what can we do about it?