America’s Other Drug Problem

by Marshall Allen
ProPublica, April 27, 2017, 5 a.m.

Every week in Des Moines, Iowa, the employees of a small nonprofit collect bins of unexpired prescription drugs tossed out by nursing homes after residents died, moved out or no longer needed them. The drugs are given to patients who couldn’t otherwise afford them.

But travel 1,000 miles east to Long Island, New York, and you’ll find nursing homes flushing similar leftover drugs down the toilet, alarming state environmental regulators worried they’ll further contaminate the water supply.

In Baltimore, Maryland, a massive incinerator burns up tons of the drugs each year — for a fee — from nursing homes across the Eastern seaboard.

If you want to know why the nation’s health care costs are among the highest in the world, a good place to start is with what we throw away. Across the country, nursing homes routinely toss large quantities of perfectly good prescription medication: tablets for diabetes, syringes of blood thinners, pricey pills for psychosis and seizures.

At a time when anger over soaring drug costs has perhaps never been more intense, redistributing discarded drugs seems like a no-brainer. Yet it’s estimated that American taxpayers, through Medicare, spend hundreds of millions of dollars each year on drugs for nursing home patients — much of which literally go down the tubes.

“It would not surprise me if as much as 20 percent of the medications we receive we end up having to destroy,” said Mark Coggins, who oversees the pharmacy services for Diversicare, a chain of more than 70 nursing homes in 10 states. “It’s very discouraging throwing away all those drugs when you know it can benefit somebody.”

No one tracks this waste nationwide, but estimates show it’s substantial. Colorado officials have said the state’s 220 long-term care facilities throw away a whopping 17.5 tons of potentially reusable drugs every year, with a price tag of about $10 million. The Environmental Protection Agency estimated in 2015 that about 740 tons of drugs are wasted by nursing homes each year.

This is, of course, part of a bigger problem. The National Academy of Medicine estimated in 2012 that the United States squanders more than a quarter of what it spends on health care — about $765 billion a year.

ProPublica is investigating the types of waste in health care that academics and politicians typically overlook. Our first installment examined the tens of millions worth of equipment and brand new supplies that hospitals jettison.

Today we look at the wasteful, and potentially harmful, ways nursing homes dispose of leftover meds — and how some states, like Iowa, have found a solution.

On a recent Wednesday in Des Moines, Ami Bradwell, a certified pharmacy technician, popped open the lids of several 31-gallon bins full of prescription drugs. In each were hundreds of what are known as “bingo cards” filled with rows of pills in sealed bubbles.

Experts say incineration is the least environmentally objectionable end-of-life option for unused drugs. But it’s also the most expensive destruction method — from 50 cents to a dollar per pound, paid for by the facilities themselves—which is why many nursing homes resort to flushing.

Nursing homes save the disposal fees in Iowa, because they can donate them to SafeNetRx, where they benefit needy patients like Max Armstrong.

The 82-year-old suffers from multiple chronic conditions — emphysema, congestive heart failure and more. The ailments were manageable until 2015, when he suffered blood clots in his leg and lung. Doctors put him on the generic blood thinner warfarin, but it “almost killed me,” he said, so he switched to Xarelto, a newer brand name drug that costs about $700 a month.

The total tab for the Xarelto and the other 14 medications Armstrong must take each month would cost at least $1,200, according to his daughter. Armstrong, whose savings took a hit during the financial crisis, lives on $1,158 a month in Social Security.

It’s “stupid” to throw away drugs that can keep so many other people healthy, Armstrong said. “There’s a lot of people out there in this world who need help.”