Can't give them away

Members of the Faith Presbyterian Church in Paris, Texas, a rural town about 105 miles northeast of Dallas, have discovered a unique way to love their neighbors, but the government is making it plenty costly.

Once a month, the church converts its sanctuary into a free medical clinic for the town's underprivileged. Instead of waiting room chairs, patients sit in wooden pews and listen to the doctor's daughter play hymns on the piano. As the notes of "I Surrender All" waft down the hallway, volunteers assist patients with medical forms and then escort them into Sunday school rooms where doctors wait with stethoscopes.

The clinic is the brainchild of pharmacist Imeine Ukhun, who joined forces with his pastor, John Kelley, to form Agape House WorldWide Ministries, Inc., a nonprofit organization that operates faith-based medical clinics for indigent people in Texas and Oklahoma.

Lacking its own clinic, Agape House set up shop in Pastor Kelley's church, where each month people line up by 5 a.m. to receive help from volunteer pharmacists, nurses, and physicians. "If it wasn't for the Agape House, they would not have the medicine because they simply cannot afford it," said 80-year-old Lola Simpson, who brings elderly friends to the clinic.

With newfound popularity came an urgent but costly need-more prescription drugs. Though local doctors' offices and pharmaceutical companies provide free drug samples, those donations aren't enough. Rather than send low-income patients away, Agape House dips into overhead funds to purchase prescription-drug vouchers that patients can redeem at local pharmacies.

But Pastor Kelly has discovered a disconcerting fact: Each year state and federal regulations require nursing homes and assisted-living facilities to destroy millions of dollars worth of unused prescription drugs-the same drugs that Agape House must buy at a premium.

The director of Paris Oaks Assisted Living Home, Jina Nance, told WORLD that her facility destroys roughly $2,000 worth of medication a month. "I was almost ashamed at our last disposal," she said. "It's a big waste and a lot of it is taxpayer dollars. Medicaid pays for these prescriptions for about half the people who live here."

Most prescriptions for her 54 nursing home tenants come in two-week supplies, she said. Single doses come individually packaged, but if the patient dies or switches medication, the nursing home must destroy the entire supply. And that translates into thousands of flushed dollars. "When you see a huge trashbag full of it, it's enough to get your attention," she said.

Though exact dollar amounts were unavailable, a recent study by the Texas Medicaid Office estimated that nursing homes destroy between $6 million and $20 million worth of drugs each year. Estimates for nursing homes in Oklahoma fell between $3 million and $10 million.

That frustrates Pastor Kelly, who would rather use those drugs to treat the impoverished patients visiting his clinic every month. He and Dr. Ukhun have launched a campaign to change laws prohibiting the recycling of unused drugs. They face formidable resistance from pharmaceutical companies and state bureaucracies.

Drug recycling would cut into the profits of pharmaceutical companies, but the industry insists the real issue is public safety. "It doesn't matter what kind of packaging it's in," said Mark Grayson of the Pharmaceutical Research and Manufacturers of America. "How do you know the chain of custody, how it was stored?" He also cited concerns about expiration dates.

At the Paris Health Care nursing home, head nurse Kathleen Haley doesn't understand all the fuss about safety. She notes that the state licenses nursing homes and they are subject to inspection in order to receive Medicaid and Medicare funding. And only state-licensed nurses and medical aides can dispense prescription drugs. Furthermore, since most of the drugs come individually packaged, only one dose at a time comes in contact with the patient. The remainder stays locked in a medication room. As for expiration dates: "The expiration date is on the [blister pack] card," she said. "So if it was expired, you would destroy them, you wouldn't recycle those."

But Texas health officials say federal law ties their hands. At issue is a U.S. Food and Drug Administration (FDA) guideline stating that "only medication that has been dispensed in the original manufacturer's packaging may be returned." That makes drug recycling impractical since local pharmacies repackage most nursing home prescription drugs, said Gay Dodson, executive director of the Texas State Board of Pharmacy. "I don't have a problem with that [drug recycling] happening. It's just that we have a letter from the FDA saying this is the only way it could happen," Ms. Dodson told WORLD.

Other states, however, say the FDA letter is merely a guideline, not a law. At least 36 allow some form of drug recycling. In Louisiana, for instance, some 300 nursing homes voluntarily donate unused prescription drugs to indigent clinics. Asked if FDA regulations posed a problem there, Louisiana health department spokesman Bob Johannessen said, "I don't recall that having been a concern here."

State bureaucrats have another beef with drug recycling: They say it would cost more than it would save. State task forces assigned to study the issue in Texas and Oklahoma cited the extra cost and labor needed to collect, monitor, label, and redistribute unused drugs. The Texas task force told state legislators that such a program would not be "cost effective."

At least one member of the task force disagreed. "The millions of dollars being destroyed annually is increasing every year," said pharmacist Neil Libby, who served on the task force and, as a state surveyor, oversees 160 nursing homes. "At some point it will obviously be cost effective to recycle the medications," he said.

Meanwhile, drug-recycling proposals in Texas and Oklahoma remain stonewalled. Tulsa County Medical Society's Paul Patton compared the current debate to the price wars fought over milk several years ago. "I still remember the barrels of milk being poured out on the ground because milk producers couldn't get enough money for their milk," he said. "There were people in this country who needed that milk.... To me this is exactly the same situation."