Emergency responders in “various jurisdictions” are turning to expired medications because of drug shortages across the nation.

States are responding to the shortages [1] by loosening rules, allowing emergency medical personnel to keep old drugs around in the absence of unexpired meds. In Oregon, ambulances were authorized to carry expired medications. Parts of Nevada have extended expiration dates on drugs in short supply for up to a year. Arizona no longer penalizes ambulances for running out of mandated medications.

The U.S. Food and Drug Administration warns that using expired medical products “is risky and possibly harmful to your health.” Medications, after their expiration date, can change in chemical composition or decrease in effectiveness [2], but the agency occasionally allows use of specific batches after they are tested for safety.

Many emergency responders feel they have no choice. The Bend Fire Department in Oregon says it had 11 expired medications in its drug kits at one point.

“We've never (before) had to go diving back into the bin to try to retrieve expired boxes of drugs,” Tom Wright, emergency medical services coordinator for the Bend Fire Department told the Associated Press. "We had the backing of our insurance company that giving expired drugs is better than giving no drugs at all. The department still carries expired doses of two drugs.

FDA officials say it could take years before supplies get back to normal levels.

“Manufacturing quality lapses, production shutdowns for contamination and other serious problems are behind many of the shortages…Other reasons include increased demand for some drugs, companies ending production of some drugs with small profit margins, consolidation in the generic drug industry and limited supplies of some ingredients,” the AP reports.

FDA spokeswoman Sarah Clark-Lynn says the FDA is looking for solutions that would help responders and hospitals use expired medications during a shortage.

One way the FDA is attacking the problem of shortages is through drug manufacturers.

Last November, the FDA sent letters to drug manufacturers “reminding them of their legal responsibility to report the discontinuation of certain drugs” and asking them to voluntarily report if they saw potential for a drug shortage [3]. The FDA says there has been a six-fold increase in notifications and 128 drug shortages have been prevented since the letters went out.

“We’re seeing fewer numbers of shortages [4] occur--42 new drugs in shortage reported in 2012, compared to 90 new shortages at this time last year,” wrote Commissioner Margaret Hamburg on the FDA blog in May.

An interesting post by the Harvard Medical School [5] from 2003 says drug expiration dates stand for something, but not what most people think:

Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs [6], the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date.

So the expiration date doesn't really indicate a point at which the medication is no longer effective or has become unsafe to use. Medical authorities state expired drugs are safe to take, even those that expired years ago.
 

thumbnail by Arenamontanus/flickr [7]

Thumbnail: