What a waste!


Rum bin 1

What are the 20 medicines that are most commonly dumped in your pharmacy’s RUM bin?

An article reviewing the findings of the two most recent audits of Return Unwanted Medicines Project bins has revealed a snapshot of exactly which drugs people are not actually using.

In 2016 the Project collected over 704 tonnes of unwanted medicines. An audit undertaken that year found that the most commonly returned medicines were unexpired opened packets of medicines for the treatment of acute conditions. They included paracetamol, salbutamol and glyceryl trinitrate.

The review article, published in Australian Prescriber, found that six of the most commonly returned PBS medicines in 2016 are used for chronic conditions, and three – atorvastatin, simvastatin and metformin – were in the top 20 most prescribed PBS medicines.

The 2016 audit assessed the types and amounts of medicines returned via the RUM Project at the three national incineration sites (Brisbane, Perth and Melbourne). On average, 13,000 RUM bins per month are collected for incineration. The audit aimed to examine the contents of a nationally representative sample of 423 bins.

Among the findings were:

  • 60% of the returned items were PBS medicines: of these – 55% were prescription only (Schedule 4), 1% were controlled drugs (Schedule 8), 4% were pharmacist-only medicines (Schedule 3 – these were assumed to be PBS medicines).
  • 10% of items were over-the-counter medicines (Schedule 2).
  • 14% were dose administration aids.
  • 11% were unscheduled medicines.
  • 4% were complementary medicines.
  • 1% were international, and unknown schedule medicines.

Here’s the 30 most commonly dispensed and returned medicines 

Rank2015–16 PBS prescription counts 102016 audit of returned medicines 2013 audit of returned medicines
1AtorvastatinParacetamolSalbutamol
2RosuvastatinSalbutamol Insulin 
3EsomeprazoleGlyceryl trinitrate Furosemide (frusemide)
4Paracetamol Cefalexin Prednisolone/prednisone 
5PantoprazoleMetoclopramide Glyceryl trinitrate 
6PerindoprilDoxycycline Telmisartan/amlodipine
7MetforminFurosemide (frusemide)Fluticasone/salmeterol
8PregabalinSimvastatinParacetamol
9Fluticasone/salmeterolAtorvastatinMetoclopramide
10Salbutamol AspirinWarfarin
11IrbesartanWarfarinInfluenza vaccine
12Cefalexin Tramadol Perindopril
13AtenololOxycodoneMetoprolol
14SimvastatinPregabalinParacetamol/codeine
15Oxycodone Pantoprazole Atorvastatin
16Amoxicillin Amoxicillin Amoxicillin
17AmlodipineMetforminBetamethasone
18Paracetamol/codeine Prednisolone Oxycodone 
19Amoxicillin/clavulanic acid ValproateCefalexin 
20RamiprilAmoxicillin/clavulanic acidIpratropium

* The 2013 audit was of 377 RUM bins. Although the processes were similar in the 2016 audit, the 2013 audit considered any quantity of a returned medicine as a full pack (i.e. the full dispensed amount). In the 2016 audit, the exact quantity of each medicine returned was counted.

 

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4 Comments

  1. JimT
    04/06/2018

    I find it interesting that Insulin was 2nd in 2013 audit then doesn’t appear at all in the next two audits? was there a change in dosage form or possibly prescribing habits around that time….would have been a huge cost to PBS as it’s not a cheap item. Would be good if those that know about the numbers look at this and learn from the stats and history.

    • (Mary) Kay Dunkley
      05/06/2018

      I also wondered about this. There is an insulin recycling program Insulin for Life https://www.insulinforlife.org.au/ and I wonder if this is the reason for the reduction in insulin being discarded. Looking at their website there is no advice as to whether this meets WHO standards for overseas medication donations and I would be interested in comment from RUM as to whether this program is appropriate or whether it is the thin edge of the wedge for inappropriate donations to overseas countries. I think it is likely that diabetes educators and others are busy collecting unused insulin from patients and donating it to this program hence the drop in that deposited in RUM bins.

      • JimT
        05/06/2018

        as long as cold chain requirements are followed

  2. Vicki Dyson
    04/06/2018

    Waste is not only seen in the RUM bins. Two recent HMRS I’ve conducted are of concern not only for the $ wasted but the health consequences. First was a man with communications difficulties being treated for hepatitis C. Inconsistent collection of Webster packs meant that he had only collected two months’ worth treatment over four months. Second was a patient being treated with a cancer therapy at $3000 per month. Absolute contraindication was taking it with a PPI. She was on 80mg esomeprazole per day!

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