Alumni Home > News & Events > What Matters

Recovery and Reuse of Unused Prescription Drugs: Combining New Technologies, Social Policy, and Actual Implementation

By Moshe Alamaro ME '99

Too often we hear about the ongoing crisis in healthcare and rising costs of prescription drugs. The annual value of the world prescription drug market is estimated at $500 billion per year, with as much as 40 percent spent in the U.S. In recent years, a wide range of drugs for a variety of ailments has been introduced to the market, increasing the likelihood of large quantities of the dispensed drugs not being consumed by patients. Patients (and physicians) often will try several drugs until a satisfactory one is found. In addition, patient ambivalence, inability to afford therapies, or intolerance of the side effects of such new products may cause patients to discontinue using a drug, as can a drug working too rapidly or failing to show benefit. It's also been estimated that roughly 40 percent of all prescriptions written in the United States are subject to noncompliance (this includes both filled and unfilled prescriptions), contributing to treatment failure and, importantly in today's health cost climate, unnecessary expense.

Compounding certain of these issues are health care policies that, at present, prohibit a dispensed prescription from being returned to the pharmacy for refund, mainly due to regulations that address safety concerns (reuse, specifically).

The goal of a new program I lead now is to develop a national and eventually international enterprise that will develop and commercialize the necessary technologies, systems, and management models to enable the safe return and reuse of prescription drugs, and to facilitate a credit process for returned medications (from drug manufacturers, insurance companies, tax credits, and other mechanisms). Such reuse of prescription drugs has recently been advocated by members of Congress, consumer groups throughout the U.S., and by state governments. Recently, nine states passed legislation regarding recycling of unused medication within nursing homes (Florida, Nebraska, Nevada, New Jersey, Oklahoma, Texas, Wisconsin, Indiana, and South Dakota) with nine more states considering similar practices.

A market for recycled drugs is already emerging but the technologies, systems, and management for such recycling do not yet exist. What follows is an outline of one recycling solution.

In initial proposals, pharmacies will be equipped with a proprietary and uniform drug dispensing system. Once a prescription is presented, the tablets and capsules will be packaged and wrapped in blister packs. In one approach, a new and efficient ID system will mark the packs with the necessary information such as patient ID, dose, and expiration date.

If the patient does not consume the entire prescription, it is up to the individual to decide whether or not to return the unused portion of the drug. As an incentive, the patient may be refunded part of their co-payment or an amount any third party responsible for the payment of the prescription might otherwise allow. For that, the patient will use a postage paid and pre-addressed mailer to enable fast and convenient return of the drug to a processing center. Alternatively, the patient could drop the unused portion of the prescription in boxes placed in participating pharmacies. The returned drugs will be shipped to a processing center where the blister packs will be inspected to assure that the drug has not been tampered with, a task fully within the capabilities of today's technologies. Returns that are not in good condition will be disassembled for return to the drug manufacturers for credit. Returns in good condition will be disassembled and the drug redistributed for reuse.

Image by Zohar Lazar

The new enterprise will develop the necessary drug packaging and dispensing processes, computerized ID system, inspection of the returned drugs, and shipping of return drugs to manufacturers or to pharmacies, and provide accounting and credit systems for patients, insurance companies, drug manufacturers, and pharmacies. Major organizational clients may include the U.S. military, Veteran's Administration (VA) hospitals, large hospitals, and hospital conglomerates and HMOs.

My team, including faculty from Yale as well as from MIT, hopes to develop a pilot for the new concept and to test public receptivity. Starting with the very people who need drug recycling the most may be problematic since the operation could be stigmatized as being intended only for the poor and uninsured. Therefore, we plan that such a pilot may involve the MIT Medical service as well as the medical providers of universities such as Harvard, Yale, Boston University, and others. The notion is that if the concept is accepted by upscale socioeconomic patients, and if using recycled drugs becomes the right thing to do, it will be easier for the public at large to accept a new concept that is intended to mitigate the endless rise in healthcare costs.

Both Science magazine and the publication of AARP are supportive of this initiative as well as a few state legislative bodies. For more information see "Old Pills Finding New Medicine Cabinets" in The New York Times, May 18, 2005, or contact Moshe Alamaro at alamaro@alum.mit.edu.

Related Articles:
Boston Globe (Oct. 2006): Matching Unused Drugs with Needy of the World
news@nature.com (Nov. 2006): Rising Drug Costs Prompt New Uses for Old Pills

Moshe Alamaro ME '99 About the Author Moshe Alamaro is a research affiliate at the Harvard-MIT Division of Health Sciences & Technology where he collaborates with Professor Robert Langer on a variety of project and program initiatives. Previously he designed, built, and managed the MIT Air-Sea Interaction Lab where he supervised six students. He received the mechanical engineer's degree and master's in atmospheric sciences from MIT. More information on this and his other projects can be found at: http://alamaro.home.comcast.net/Alamaro-bio.htm.

Published August 2005.

What Matters is a guest opinion column written by a different MIT alumnus or alumna each month. The views expressed in What Matters are entirely those of the author and do not necessarily represent the views of the Association or of MIT. For previous columns, please see the archives. Would you like to contribute a What Matters column?
E-mail comments to whatmatters@mit.edu.