A recent post on Hep Forums was gut-wrenching. A Forum member quit two-thirds of the way through hepatitis C treatment with Harvoni after having three nondetectable viral loads. She wanted to know how she could get rid of the unused Harvoni. So much about this post made me cringe.
First, there was the fact that she stopped before she finished. I couldn’t tell if it was with or without medical advice. Either way, I was shocked to hear that her doctor ordered so many viral loads. This much testing is unnecessary, adds to the cost of treatment, and in this case, likely led to the wrong conclusion. (A viral load should be done at week 4 and week 12 of treatment.) Three negative viral loads during treatment does not mean you stop hep C treatment. At best, she is at risk for a relapse. At worst, she is at risk for a relapse with a resistant strain of HCV for which there isn’t treatment yet. It’s like watching a $92,000 treatment go down the drain.
Click here to read about suggested labs during hepatitis C treatment in the HCV Guidelines written by the American Association for the Study of Liver Diseases and Infectious Diseases Society of America.
Second, and even more painful, is the fact that she had Harvoni, a drug that many others cannot get, and is illegal for her to give her unused medication to someone who needs it. When she asked if the unused, unopened Harvoni could be donated, my heart sank for all those people who were denied treatment. For a moment, I forgot myself, my reputation, my nursing license, my relationship with Hep, and all reason, as I considered the choices. It would not be the first time I questioned the law. However, in the end, there was only one choice, and that was the legal one.
So, what are the legal choices? The FDA provides guidelines about legal and proper disposal of unused medications. Medication disposal programs are cropping up across the country, and have the advantage of being environmentally-conscious and properly enforced. You can also check out www.DisposeMyMeds.org for more information.
However, most of us would feel better knowing that our medications are going to other people, and in some cases, they can. Some medication disposal programs, medical facilities and pharmacies are sending unused drugs to Sirum, which redistributes unused medications to those in need. Individuals cannot donate their medications directly, but in some states, pharmacies can take back medication and donate it to Sirum. An excellent op-ed written by David Bornstein titled, Recycling Unused Medicines to Save Money and Lives appeared in the New York Times (March 20, 2015).
Each state has its own laws governing prescription donation. Visit the National Conference for State Legislatures for more information about this. More states are enacting drug recycling programs in order to deal with the increases in drug costs.
In the meantime, I am learning how to be at peace with the decisions people make. My gut can only stand so much wrenching.
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