Expired Medication

[DiverMedic]

I did a search but found little results in the forums and from the web.

Common sense and practice dictates not to give an expired medication to a patient. Does anyone know of a law or regulation that this would fall under? Previous companies I have worked for had no problem removing and replacing expired items from inventory. My current employer is small with 10-20 medics whom often work remote areas including offshore (i.e. ships, barges, and platforms). Our budget is also small so they have been a little resistant in replacing expired meds. I am trying to gather some more information before I go back into the office.

An additional problem is that our medical director does not work directly for our company, but we do have an agreement to work under his direction. I don’t want to be the guy to have to ask my medical director to give this expired medication to a patient when we are 6 hours out from the hospital. Any help would be greatly appreciated.

 

[Devilz311]

Not sure about the law, but in NJ if a spot inspection is done by NJ OEMS at a hospital (pretty common) your truck can fail for having expired meds.

 

[EMT11KDL]

same in idaho

 

[Handsome Robb]

I'm guessing this would fall under negligence? Knowingly administering an expired medication to a patient is pretty negligent...

 

[dstevens58]

I seem to remember from working in a military supply (medical) warehouse, we used to get publications now and then that would extend expiration dates on medicines. We would have to pull all the vials we had in stock between four field hospitals, write the extension/extended date on the meds, then on our inventory cards, but we retained the publications to prove the expiration dates had been extended.

Also, we shuffled a lot of stuff between the warehouse and traded it with the hospital, because they used it a lot quicker than we did when stored in the warehouse. We would exchange it with items that had a longer shelf life.

Not sure if those "publications" exist any more and I can't remember the name of them. This was back in the mid-70's when I worked in this warehouse.

But as to the original post, I would consider myself to be negligent if I pushed an expired med.....would have to be a life/death decision.

 

[mycrofft]

An example of profession versus technicians

A professional says "These are expired, replace them". And when you get their replacements, check to make sure they aren't dumping stuff on you with short time to expiration.
That being said, if meds are kept in the dark (especially away from sunlight or fluorescent lights) and under 80 deg F, NATO found many meds are actually quite potent after their expiration dates (according to the logistics staff at RAF Little Risington Ech II hospital in 1988)..

 

[RocketMedic]

We rotate our stock, but a company my dad worked for used to gift expired or near-expired meds and replaced, serviceable equipment to an ambulance service in Mexico. They reported favorable results, iirc.

 

[BF2BC EMT]

Be ready for a hefty lawsuit when you have to intervene on someone who is critical and the drugs don't work making your job that much more difficult. Let's say you want to tube someone who is destating and scared and they need RSI now, you push drugs that aren't working correctly or work half the amount of time they normally would. Only bad things can happen and by using those drugs you(the one responsible for maintaining them on your shift) can and should be held liable

Edit-our local ems, who regularly cruise around found out you would be OOS(other punishments,not sure). If you used the drugs you're probably looking at a harsh reality lesson.

 

[DiverMedic]

I whole heartedly agree with all the above. I don’t want to be put in the position having to push expired meds due to a critical patient. Additionally I would not want to defend myself in front of a judge and jury either. I am going to approach a friend of mine that who works in a law office and see what he can find. I will update with what I find out. Thanks for everyone’s thoughts.

 

[akflightmedic]

Not that I am encouraging the behavior but there is a huge difference between a medication that expired Sept of 2011 and one that expired Sept of 2008.

As recently as 2007, I was issued guidelines from the US military advising us to continue using drugs 6 months past their expiration date.

Manufacturers always factor in a safety on most medications. They do not magically stop working on May 1st simply because the expiry date is April. The posted dates are when the medications are at known maximum efficacy.

Again light and temperature greatly affects these dates as well.

As a tangent, stretchers are the same way...your 450lb rated stretcher is typically capable of toting 600 lbs. The manufacturer puts in that safety knowing the majority of the time you will not exceed the posted weight limit and the times you actually do will be few and far between.

 

[medicdan]

ak, are there studies of a wide base of medications and their potency over time that can be cited and used to justify extensions on expiration dates?

 

[akflightmedic]

Every drug created has these studies...are they published or releasable? Therein lies the question.

If you have the sole patent for a brand drug which most companies do for 5-7 years before generic can be sold (in USA), would it not behoove you to also keep expiration dates as short as possible or even shorten it (on paper)?

 

[mycrofft]

During the Cold War

NATO/US set up and "mothballed" a number of "Third Echelon Hospitals" for opening and use in the event the Soviets came pouring through the Fulda Gap. In fact, some of these were opened for DESERT STORM especially in the event Sadam's folks used chemical weapons in-theater. You might be able to winkle out studies from that period, these "turn key hospitals" were scantily staffed and yet able to go from nothing to ready in a day or so. RAF Little Risington was one, and there was another in Lincolnshire, "Nocton Hall " or some such? All gone now.
Nonetheless, the standard is that if it is outdates, it has to go. Try donating ton your local animal shelter's vet?

The opposite issue is, what about meds that SAY they are unexpired, but have been stored in continuous fluorescent light (Epi ampules are notorious for that), or sunlight, or temps over 80F? Are they really still potent?

 

[Brandon O]

The law you're looking for would be negligence. Administering expired drugs is a violation of the standard of care no matter how you squint at it. And I can't imagine any state or regional licensing authority that wouldn't take their own measures if it came to light.

Whether it actually causes harm is another question. Typically drugs don't turn into poison after expiration, they just become less potent over time and that's the date they've chosen as the cut-off. Within reason I suspect true harm would be rare, but if someone's looking for a reason to pin you to the wall after a bad outcome, this would be a great way.

 

[AlphaButch]

Texas Admin Code requires services to have a written policy regarding expired medications and medication storage; basically you have to follow manufacturer recommendations.

We only have a couple of medications which get replaced on a set schedule regardless of expiration, this is due to storage and temps here in Houston. If we find something is expiring but we are unable to replace it (due to nationwide shortages), we'll contact the manufacturer to inquire about a recommendation differing from what's on the packaging, and that gets filed (alot of times, it's a 1-3 month extension on the expiration).

Expired non-controlled substances and expired supplies are sometimes sent to outreach programs in Africa with our MD when he's off volunteering.

 

[mycrofft]

I remember crystalized sedative...

I was rummaging in a cupboard in my old ambulance employer's garage (they're all old now) and found a big, five-year expired Bristoject with a clear liquid and a beautiful crystal just lying in it. Had been stored at temps varying between near-freezing and over 100 F in the dark for the whole time.

EDIT: TALWIN! Knew I'd think of it. Not a sedative but a narcotic.