Calls to allow re-purposing of unused end of life medicines

 

The Royal College of General Practitioners (RCGP) is calling on the Government to allow the ‘more effective’ use of medicines commonly used in end of life care during this pandemic.

 

The College has asked that these measures temporarily include the re-purposing of unused medicines for end of life care.

 

Professor Martin Marshall, Chair of the RCGPs, said:

 

“Patients rely on medication at all stages of their lives, but when they are at or near the end of their lives, the medication patients receive is vital to ensure they remain comfortable at what is often a very distressing time.

 

“During the COVID-19 pandemic, an increasing number of patients are needing medication to help control pain or symptoms such as breathlessness at the end of their lives.

 

“To maximise the availability of such medication, we have raised this issue with Government urging temporary measures to allow more effective use of existing stocks of medicine. For example, being able to re-purpose unused medication so that it can be used for other patients who need them when they need them.”

 

The Royal Pharmaceutical Society (RPS) has said that under no circumstances patient-returned or date-expired medicines be used, even in end of life situations. They published this view in a recently published document aimed at supporting pharmacists and pharmacy technicians when making ethical professional decisions during the pandemic.

 

On page 11 of this guidance document the RPS set out the current legal position by saying the following:

 

“Under no circumstances is it currently acceptable to supply patient-returned or date-expired medicines without further regulatory advice as this would be in contravention of section 64(1) of the Medicines Act 1968 if a patient is harmed by taking a medicine that is not of the nature or quality demanded.”

 

After the legal statement the RPS go on to explore some of the situations that may arise:

 

“Should the situation arise that key medicines become unavailable, it may be necessary to give consideration to the use of some patient returned medication, for example from end of life packs, or that which is recently expired.

 

“Subject to the availability of space and segregation from in-date stock, pharmacists and pharmacy technicians should retain patient-returned medicines that are likely to be in short supply (taking account of the latest COVID-19 infection control guidance) as well as recently expired medicines that appear of suitable quality for triage and potential reuse in case they are needed for future supply should in-date stocks be declared exhausted.”

 

Chair of the Scottish Pharmacy board Jonathan Burton MBE commented:

 

“The new guidance on ethical and professional decision making recently launched by RPS makes specific reference to the potential need for re-purposing of medicines.

 

“This is a very difficult and challenging area of practice as current legal and professional guidance very much guards against this practice, but we are entering uncharted situations, especially with regards to demand for medicines in intensive care units and end of life situations.

 

“The new RPS guidance makes reference to the fact that the re-issuing of recently expired medicines, or those returned from unused end of life or just in case packs, may have to be considered going forward.

 

“The guidance goes further and encourages pharmacists and pharmacy technicians to now retain such medicines that are likely to be in short supply, so they can potentially be triaged and reused should the worst-case scenarios develop where in-date stocks are declared exhausted.”