Combating medicine waste: expiry dates, storage, and safe use of medicines

Medicine waste is a significant concern for the National Health Service. Sector studies estimate that each Italian discards an average of 1 kg of medicines each year, equating to millions of euros wasted in both public funding and private expenditure. This is a topic of concern for the heads and health institutions across most Western countries, but in Italy the average family spends about €100 annually on unused medicines. To address this primarily cultural issue, the Ministry of Health has been running public awareness campaigns for years, promoting more responsible use of medication.

Key but controversial factors in reducing waste are medication storage and expiry dates. Not only do Italians purchase more medication than needed, but these medicines are often stored incorrectly or forgotten in a cupboard, only to be rediscovered past their expiry date. Legally, all medication packaging must display an expiry date, alongside batch and manufacturing dates. This expiry date applies to unopened and correctly stored packages and varies depending on the medication’s composition. For instance, a vial for intravenous or intramuscular injection usually needs to be used within minutes of opening, while ointments and tablets might last over six months, assuming proper storage. The Italian Medicines Agency (AIFA) clearly advises keeping medicines in a cool, dry place, away from heat sources, and in their original, labelled containers. It’s also crucial to meticulously follow the information provided in each medicine’s leaflet.

Simply paying more attention to these basic rules could prevent 40% of purchased medicines from being discarded due to expiration or unsuitability for use. However, throwing away an expired medication isn’t always the right choice. Reducing waste means not just buying fewer medicines and only when necessary or prescribed by a doctor, but also discarding them only when absolutely unavoidable. Professor Alessia Beccacece, UniCamillus lecturer in Pharmacology, explains: “Many wonder if taking medicines past their expiry date is risky. Pharmaceutical manufacturers guarantee full efficacy and safety up to the stated date, based on specific stability studies conducted under specific conditions. However, this doesn’t necessarily mean they’re ineffective immediately after expiry; rather, there’s no data to prove they can be used beyond that period”.

This statement might seem to conflict with AIFA’s guidelines but is supported by numerous studies. Professor Beccacece highlights: “Several studies have tested expired medicine batches for efficacy and found many to be stable months or even years after their expiry dates. For example, a 2006 Journal of Pharmaceutical Sciences study found that two thirds of the 122 expired pharmaceutical products tested were still stable and safe for use. It’s simply incorrect to say that expired medicines are always dangerous. If stored and handled correctly, many maintain high efficacy long after their expiry date”. This distinction underlines once again the importance of proper medication storage. The AIFA confirms that medicine expiry dates are not arbitrary but result from standardized tests and specific protocols. It is inappropriate to resort to DIY, deciding autonomously whether or not to take an expired medicine. As Professor Beccacece states: “efficacy maintenance isn’t systematic across all products. Chemical, physical, and microbiological instabilities can occur especially in sterile pharmaceutical solutions, potentially compromising medicine safety and efficacy”. In light of this, it seems more appropriate for healthcare facilities in general, where the cost of waste is still too high, to avoid immediately discarding expired medicines without confirming their unusability. Also, “conducting periodic tests to evaluate possible expiry date extensions”, as suggested by the UniCamillus lecturer, “could be a good solution for various situations, like preventing medicine shortages, particularly relevant in low-income countries where short expiry dates pose a costly challenge for hospitals”.