Some 20-year-old pain medications still work

I’ve long been aware of studies suggesting that some prescription medications can retain their potency for several years past the expiration date shown on their labels (which is typically one year after they were issued to a customer).  I must admit, though, I’ve recently been pleasantly surprised by one prescription issued to me twenty years ago.

I recently had a bout with severe, immobilizing back pain, which is slowly easing off (the inevitable result of a partially disabling injury back in 2004, which resulted in a spinal fusion and permanent nerve damage).  The doctor (not my usual one) initially prescribed a couple of days’ worth of Tylenol 3, and advised me to get it extended by my primary care practitioner when I got home.

Unfortunately, I couldn’t get in to see her in the short term;  so I looked in my “stash” of previous prescription medications to see what I had that might suit.  I found a prescription for Vicodin issued to me in May 1999.  I wasn’t sure whether the remaining pills would still be any good after 20 years, but I had nothing to lose, so I tried one.  Its potency was probably less than when it was made, two decades before, but it was still more than strong enough to be effective.  It’s providing as much pain relief as Tylenol 3, from a lower daily dose (1 tablet every 4 hours, versus 2 Tylenol 3 pills every 6 hours).  I’ve got enough to last several days.

I note that the US military saves billions in drug costs by extending its “safe use” period for many medications.

The American Medical Association (AMA) concluded in 2001 that the actual shelf life of some products is longer than the labeled expiration date. The AMA stated the best evidence resides in the Shelf Life Extension Program (SLEP) undertaken by the FDA for the Department of Defense.

The original purpose of the SLEP program was twofold: to determine the actual shelf life of stockpiled military medications for future use, and to save government dollars. Over 3000 lots, representing 122 different drug products, were assessed in the SLEP program. Based on stability data, expiration dates on 88% of the lots were extended beyond their original expiration date for an average of 66 months. Of these 2652 lots, only 18% were terminated due to failure.

. . .

These results suggest that many drug products may have extended shelf lives beyond their expiration date. However, it is difficult for any one consumer or health care provider to know which product could have an extended shelf life. The ability for a drug to have an extended shelf life would be dependent upon the actual drug ingredients, presence of preservatives, temperature fluctuations, light, humidity, and other storage conditions. Additionally, the drug lots tested in the SLEP program were kept in their original packaging. Once a drug is repackaged into another container, as often happens in the pharmacy, the shelf-life could decline due to environmental variations.

. . .

Solid dosage forms, such as tablets and capsules, appear to be most stable past their expiration date. Drugs that exist in solution or as a reconstituted suspension, and that require refrigeration (such as amoxicillin suspension), may not have the required potency if used when outdated. Loss of potency can be a major health concern, especially when treating an infection with an antibiotic.

There’s more at the link.

Since reading about that study, soon after its completion, I’ve made a point of keeping old prescription drugs when I had some left over, with particular emphasis on pain medication after my 2004 injury (which has left me in pain 24/7/365).  As the authorities have cracked down more and more on the issue of effective pain medication, I’ve been able to draw on my stash for bad pain days, using current, less effective prescriptions on the days when the pain level is merely routine.  It’s been a blessing.

Provided you can store your old prescriptions in a stable environment, and secure them so that kids and/or potential abusers can’t get at them, I see no reason not to keep them for future use when needed.  In an emergency, if you can’t get to a doctor or pharmacy for some reason, they might be really useful.  (In rural and bush Africa, where it’s frequently very difficult to get hold of some medications, I’ve seen individuals trade them to each other in emergencies, and done so myself on occasion.  “I’ll swap you twenty Doxy and a pack of cigarettes for thirty Cipro” – literally.  Where there’s a need, there’s a way.)

I think the warning above about loss of potency is certainly something to keep in mind, particularly for antibiotics, as a drug that’s too weak may cause your illness or infection to be prolonged, or even get worse.  Other than that, the only difficulty I can think of is drug testing.  If you don’t have a current prescription for the drug(s) concerned, and your employer demands frequent drug tests, you may find questions being asked if they’re detected in your system.  Fortunately, that’s not an issue for me.

Peter

8 comments

  1. Yeah… I have a habit of stashing leftovers in the refrigerator for later – painkillers in particular, since (years ago, last time I had such things prescribed) I’d go home from minor surgery or an injury with a nominal week’s supply, and next morning I’d decide the pain wasn’t as bad as the drowsiness; there are always random occasions for a one-time dose of Vicodin or similar (e.g., really bad cough at night). Muscle relaxants are another thing I like to have on hand. Alas, my supplies of both are long since depleted, and I’ve been fortunate enough not to have medical events justifying resupply.
    On the other hand, I know some people who fervently believe in expiration dates, as if meds became deadly poison on the date stamped on the bottle. (Such people typically don’t trust Big Pharma about anything else, but the expiration date is sacred, as is the trademark.)

  2. My wife jokingly refers to it as the “Apocalypse Pharmacy”. She used to kid me about it, until there was something SHE needed.

    As someone who depends on daily medication, it means the difference between handling a short-term event vs an extended grid-down emergency.

  3. A few points with regard to the shelf life of drugs:

    •The larger the molecule, the more unstable it is. Pancreatic enzymes, insulin, etc. are large molecules, which will break more easily. Small molecules such as potassium chloride will remain intact a few billion years from now when the sun turning red giant incinerates the earth into a cinder. However some small molecules are inherently unstable, such as nitroglycerine, and some large molecules have built-in stability. The molecular structure and properties can be viewed on sites like https://www.rxlist.com/drugs/alpha_a.htm or Wikipedia.

    • Most chemical reactions speed up when warm (that’s how fires work) and water enhances many chemical reactions: reactions will be slowed and their shelf life improved by dry, cool conditions (in most cases).

    •Original packaging, reinforced when necessary, is generally preferable over repackaging.

  4. I keep my house cool because my wife can’t tolerate heat (due to a brain bleed that really messed up some stuff. Eh. It happens. She’s alive and feisty so that’s all that matters.) So Mr. Gun Safe is a good location to store some surplus drugs.

    8 year old Morphine Suphate Immediate Release is almost as, or is as effective as current production lots of the stuff.

    One thing you MUST DO if you are to keep meds is to keep them in their medicine bottle. And never combine two bottles to more than the quantity listed on the bottle. That Morphine IR I talked about? If the coppers catch us with (listed quantity)+1, well, that’s DRUG TRAFFICKING to some agencies. Seriously. So be careful when combining smaller amounts of same type and dosage of drug in bottles.

  5. Peter: I keep a stash of vicodine in the freezer. It’s hard to acquire, doc.s prefer not to prescribe it. When I get the now rare kidney stone attack, I have something to cover the pain until…. My stash is probably 5 years old, and it still works.

  6. Peter,
    in future situations, consider asking the doc to prescribe Motrin(ibuprofen)+codeine instead of the Tylenol version.

    Back in the 70’s, a sister worked for a research physician at Stanford, and some of his work was done using the patients at the VA. What he found was that some of them were exhibiting liver (and possibly kidney?) damage when using Tylenol at standard dosage levels. He warned her to never use the stuff. He suspected that the prior history of the older soldiers made them more susceptible to this sort of damage than perhaps the general population, but thought it best to err on the side of safety.

    For unremembered reasons, hospitals prefer issuing Tylenol for pain, and this seems to have carried over to physicians from working there as interns.

    Tylenol has no anti-inflammatory effects, but inflammation is often a significant problem with pain and joint problems. More and more, inflammation is turning out to be implicated in lots of medical problems.

  7. Tylenol is used for pain because it has the fewest and least severe complications of any pain reliever, when used in proper dosages.
    Not some pavlovian knee-jerk from internship.

    The problem comes when you drink alcohol.
    That, combined with acetaminophen, combines as a hepato-toxic death punch for your liver. Like you were told by the doctor, the pharmacy and the label on the bottle.

    People are idiots, and don’t listen when we tell them not to take alcohol when taking Tylenol, or Tylenol-containing formulations, and then they wonder why they have liver failure. (It’s because they’re idiots, and think rules of physics don’t apply to them, as most idiots do not.)

    Motrin does it’s number on your kidneys, also rather important organs, but it does, in fact, offer anti-inflammatory results not available with acetaminophen products.

    In short, if you have a headache, take Tylenol. And don’t drink.

    If you have a backache, or anything else musculoskeletal, you’re better off with ibuprofen or naproxen.

    And pay attention to the $!*$&^@@&% warning you were given, by people with 15 more years learning medicine than you have.
    Otherwise, you’re an idiot too.

    Suture self.

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