E-drug: Request for research assistance - expired drugs
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Dear e-druggers,
I am a student at the University of Maryland and am doing a paper on the
use of expired drugs in relief settings. The direction of my research
changed somewhat when I found Naomi Adams Dissertation, as she was asking
the same questions, had found the same core documents and was coming to the
same conclusions, for the most part, that I was. I'm now focusing on those
areas where our direction was different, or where I could expand and
complement her work. I was hoping people here might be helpful in that
regard.
I'm not that interested in the ethical or practical arguments as to why one
should or should not use expired drugs. Those issues have been well covered
in past discussions on the e-drug list as well as in the journals and
through interviews I've done. What I am interested in, is the core,
underlying question - how safe is it to use expired drugs in those
situations when there is nothing else?, as well as several other related
issues, specifically:
1) I am including a bibliography below, that while not all inclusive, (or
uniform in style, for that matter), represents the most relative papers I
have found on the topic of drug stability, and use after expiration as well
as on "basic tests" to determine degradation. I keep running across elusive
mentions that many relief organizations have their own lists of how long
drugs are good for, post expiration, and guidelines on what to look for to
make sure they are still good and degradation tests. Likewise, articles in
specialist journals, newsletters and the like. There have also been a
number of mentions of non-US governments and militaries running testing
programs and doing research into this area. It's mostly gray literature,
so - what am I missing?
2) On the subject of "basic tests", how reliable are these for detecting
"gross degradation" , that being where a substance has fallen below 90%
potent, or has otherwise degraded (emetic coating, excipient, etc) to the
point that it is unusable. Likewise, are the identity tests of any use in
this way, particularly the melting point? I.e.: Are degradation products
likely to alter the melting point of a known substance significantly enough
to be noticeable, and thus be a useful indicator? If so, how much is it
likely to alter it?
3) I have heard a number of accounts of "mom and pop" relief organizations
and religious missionary groups using veterinary drugs on people, but have
found nothing in print. How common is this practice? How safe is it? My
understanding is that some of the drugs are identical, particularly many of
the antibiotics, I also understand that some excipients used in veterinary
drugs are unsuitable for humans. Any opinions?
4) I would welcome anecdotes from those that have been and done, what drugs
were good past expiration and how long past?, what do you look for or try to
test when deciding if to use a expired drug? What drugs have you not even
trusted to reach their expiration, and why?
5) Lacking an expired or un-expired drug that you trust enough to give to
someone (or take yourself), can anyone offer anecdotes about "dual use"
drugs or using drugs for their side effects? Are there any lists of drugs
that work well this way or guidelines for doing that sort of thing? How
often is this sort of thing resorted to?
6) Has the Media blitz over "drug dumping" and the resultant stricter
guidelines on donations resulted in fewer drugs being donated? Likewise,
has the drug company reaction to this of keeping "short lists" of NGO's that
they will deal with resulted in more use of "creative options" by the mom
and pops?
7) Can anyone offer any social or cultural insights into how the different
types of NGO's function, and their relationships with the drug companies,
their competition and cooperation with other NGO's? to get and to distribute
essential medicines.
8) Can anyone offer any insights into the interactions and different
interests of the managers of relief organizations vs the relief workers in
the field as it applies to providing or blocking access to needed drugs,
expired or not.
Thank you,
Nathan Estey
Nfe2@comcast.net <= best
Nestey1@umbc.edu <= ok, but above address is better.
Student, University of Maryland, Baltimore County
[Nathan supplied his bibliography which I can send to anyone
individually. Also I have provided him directly with some more
information. BS]
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