Recycling Oral Cancer Drugs

Everyone is aware of how expensive many cancer drugs are, and it seems a terrible waste to throw away bottles of pills that we are not going to use. [Note: this post is not about pain medications, such as oxycontin, that are at the heart of so many addiction problems.*] I am referring to oral cancer drugs, such as hormonal therapies like Tamoxifen, aromatase inhibitors used to treat ER-positive breast cancers, and new therapies like immune checkpoint inhibitors that treat melanoma, lung cancer, and other malignancies.

These cancer drugs can cost $10,000 or more for a month's supply, and very few insurances cover the total price. For a number of reasons, any individual's treatment plan can be changed, and it is common to move from one drug to another. What happens then to the thousands of dollars worth of pills now sitting on the counter?

This issue often came up in my office at BIDMC. Women in my groups talked about their treatments, and it was not unusual for someone to begin a new therapy that another woman had stopped a few months earlier. Commonly, an offer would be made: Would you like my pills? and I had to step in and stop the sharing. As practical as this sounded, there was no way that I could encourage it. Honestly, I fully suspect that it often happened at another time and place, but I didn't want to know about it. More often, someone stops taking a particular medication because of side effects or because it is no longer useful, and there is not an obvious beneficiary of the remaining pills.

The American Society of Clinical Oncology (ASCO) has recently released a new position statement:

ASCO is committed to helping patients access the right treatment at the right time. As such, we support drug repository programs solely for oral medications provided they are maintained within a closed system. A closed system is defined as one in which the delivery to and/or return of prescription medicines from a health care or other institutional facility is maintained in a controlled environment under the supervision of a health care practitioner and not the patient.

Although this creates additional work for medical offices or institutions, it makes a great deal of sense. Such a carefully controlled system could help patients who cannot afford expensive treatments as well as ease the consciences of others who just hate to waste them. It likely will take a while for such systems to be developed, but it is a practical and sensible idea. If you find yourself at either end of such a program, needing a new oral drug or having pills that you are not going to use, ask your doctor whether such an initiative exists at your hospital. If it does not, advocate for it to be developed.

*If you have pain medications that you are not going to use, they need to be very carefully disposed of. Many local police departments have locked bins right inside the door. You can toss in the bottles without ever seeing someone. This is much better than flushing them down the toilet, dropping them in the trash, or leaving them in your bathroom cabinet.