Hot Summer Threatens Efficacy of Mail-Order Medications (nytimes.com) 76
An anonymous reader quotes a report from the New York Times: Melted capsules. Cloudy insulin. Pills that may no longer work. Doctors and pharmacists say the scorching temperatures enveloping the country could be endangering people's health in an unexpected way: by overheating their medications. Millions of Americans now receive their prescription medications through mail-order shipments, either for convenience or because their health plans require it. But the temperatures inside the cargo areas of delivery trucks can reach 150 degrees Fahrenheit in the summer, according to drivers -- far exceeding the range of 68 to 77 degrees recommended by the national organization that sets standards for drug handling.
Mail-order pharmacies say that their packaging is weather resistant and that they take special precautions when medication "requires specific temperature control." But in a study published last year, independent pharmaceutical researchers who embedded data-logging thermometers inside simulated shipments found that the packages had spent more than two-thirds of their transit time outside the appropriate temperature range, "regardless of the shipping method, carrier, or season." Extreme temperatures can alter the components in many medications, from pancreatic enzymes to the thyroid replacement drug levothyroxine to oral contraceptives, medical experts say.
Dr. Mike Ren, a primary care physician and an assistant professor in the department of family and community medicine at the Baylor College of Medicine, said that liquid medications like insulin or AUVI-Q, the epinephrine injection for allergic reactions, are often at heightened risk of degradation because excessive heat exposure can cause the evaporation of liquid components that were compounded at precise ratios. Aerosolized medications, too, are uniquely vulnerable because of the risk of pressure changes in the canister. "Doctors recommend picking up your prescriptions at a local pharmacy whenever possible during hot summer months, particularly if your medication is liquid or aerosolized," notes the report. "If you are enrolled in an insurance program that requires using a mail-order pharmacy, ask for an exception during the summer or, at the very least, contact the on-call pharmacist at the mail-order company to get more information about shipping practices and to ask for temperature-controlled packaging. You should do this even if the drug does not require refrigeration."
Once you do get your medication, you should make sure to preserve it in a cool, dry environment, away from direct sunlight. If you're flying, your prescriptions should be stored in your carry-on bag. They should never be left in a parked car.
Mail-order pharmacies say that their packaging is weather resistant and that they take special precautions when medication "requires specific temperature control." But in a study published last year, independent pharmaceutical researchers who embedded data-logging thermometers inside simulated shipments found that the packages had spent more than two-thirds of their transit time outside the appropriate temperature range, "regardless of the shipping method, carrier, or season." Extreme temperatures can alter the components in many medications, from pancreatic enzymes to the thyroid replacement drug levothyroxine to oral contraceptives, medical experts say.
Dr. Mike Ren, a primary care physician and an assistant professor in the department of family and community medicine at the Baylor College of Medicine, said that liquid medications like insulin or AUVI-Q, the epinephrine injection for allergic reactions, are often at heightened risk of degradation because excessive heat exposure can cause the evaporation of liquid components that were compounded at precise ratios. Aerosolized medications, too, are uniquely vulnerable because of the risk of pressure changes in the canister. "Doctors recommend picking up your prescriptions at a local pharmacy whenever possible during hot summer months, particularly if your medication is liquid or aerosolized," notes the report. "If you are enrolled in an insurance program that requires using a mail-order pharmacy, ask for an exception during the summer or, at the very least, contact the on-call pharmacist at the mail-order company to get more information about shipping practices and to ask for temperature-controlled packaging. You should do this even if the drug does not require refrigeration."
Once you do get your medication, you should make sure to preserve it in a cool, dry environment, away from direct sunlight. If you're flying, your prescriptions should be stored in your carry-on bag. They should never be left in a parked car.
Re:Yep (Score:5, Insightful)
The frustrating thing about this is that air conditioning exists and it's really not all that expensive, but the package delivery companies and warehouses like Amazon don't care about the comfort or safety of their workers. Why should we expect them to worry about the integrity of our packages?
Re: Yep (Score:2)
Air conditioning in the car didn't stop my husband's Norvir capsules from melting into an unrecognizable mess during a 600 mile summer trip from San Jose to San Diego. And that was nearly 2 decades ago. We were able to convince Kaiser to cover the refill. It would have cost thousands without coverage.
Needless to say, his regimen no longer includes Norvir.
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The more relevant change is that we are now mailing things like prescription drugs a lot more often than before. The exposure to the elements has increased much more than has the severity of those elements.
Count how many packages get left in your mailbox or at your doorstep in a month, and compare that to 20 or 30 years ago. It's a huge increase. https://www.pitneybowes.com/us... [pitneybowes.com] says we (the US) received a third more packages in 2023 than in 2019, and 2028 is expected to almost double 2019's number.
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If medication spoilage becomes a widespread issue with the rise of home deliveries, there needs to be a regulatory move. Thermosensitive products need to be shipped in ice packs, or refrigerated transport. Like it is the case for deliveries in bulk to pharmacies. It's not gong to happen unless they are required to do so.
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Yep. I get frozen fish and meat delivered monthly to my home. I get refrigerated food delivered weekly to my home. This issue is completely solvable with minimal effort.
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Hardly news (Score:5, Insightful)
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How the hell do I store them below ambient temperature without refrigerating?
I know you're trying to be a smartass, but those novelty Peltier soda can coolers [walmart.com] do a great job of keeping medicines slightly chilled.
They've actually been around for quite awhile. I owned something similar as a teenager and didn't realize the limited delta-T that Peltier based cooling could achieve, so some Lunchables that I'd stashed in the thing quickly turned into a science project.
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The main reason to not refrigerate is to avoid condensation. For liquids, to avoid separation or precipitation. In most cases, it's just fine to put them in the freezer, or even to refrigerate. In olden days, it was recommended to refrigerate antibiotics.
Everyone uses the same shippers (Score:5, Insightful)
Doctors recommend picking up your prescriptions at a local pharmacy whenever possible during hot summer months
There's a 98% chance that the meds at the local pharmacy spent a good portion of their journey stacked in boxes on the same FedEx/UPS/DHL/USPS trucks that do the home deliveries. It's not like they magically appear at the pharmacy 4 blocks from my house.
Re: Everyone uses the same shippers (Score:2)
Perhaps for prescriptions that are heat stable, but not for those that require generation. It's very noticeable when all your Norvir capsules melt into one, as happened on one of our long trips. And that was with the AC on in the car.
Re:Everyone uses the same shippers (Score:5, Interesting)
In the UK medication that has thermal requirements gets shipped in thermally controlled containers. They can be as simple as being insulated plastic crates, maybe with some ice packs. Maybe throw in a temperature logger or a chemical heat detector so that the recipient can verify that nothing was cooked.
The medication I sometimes take arrives at my house wrapped in recycled insulation with ice packs. Just plastic bags with recycled wool fibre or something similar, and plastic bags of ice.
Re:Everyone uses the same shippers (Score:4, Interesting)
In the UK medication that has thermal requirements gets shipped in thermally controlled containers. They can be as simple as being insulated plastic crates, maybe with some ice packs. Maybe throw in a temperature logger or a chemical heat detector so that the recipient can verify that nothing was cooked.
The medication I sometimes take arrives at my house wrapped in recycled insulation with ice packs. Just plastic bags with recycled wool fibre or something similar, and plastic bags of ice.
To be fair, I think a lot of Brits don't get the sheer distances involved or the high temps of many parts of the US.
I'm an Australian who moved to the UK. Insulated containers and ice packs are fine for a 10 mile journey in the English summer where temperatures might reach 30 degrees C. Phoenix Arizona will regularly get over 30 degrees C for weeks on end. If you're living out away from the major cities like Phoenix and Tucson, a delivery might be several hours in a van with limited climate control. Now I'm sure Arizonans are equipped to deal with high temps as they've always had them but the issue for many states is that they're starting to experience higher temps so things like this are starting to become an issue.
The distances cant be overstated, even here in the leafy towns of the home counties, my Amazon package still spends several hours in the back of a van and I live in the same town as a distribution centre.
Think about the kind of precautions you'd need to think about if you had to take refrigerated medicine on a flight to Australia. That's 24 hours if you're going to Melbourne or Sydney, longer if you've got a long layover. It's a serious concern if you've medication that needs to be kept under 15 C an insulated cooler isn't going to cut it (in case anyone is interested, I believe most airlines have refrigeration available, call your airline in advance and ask).
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The stuff I use is manufactured in the US, and I would presume it was properly temperature controlled before getting on the airplane/boat to the UK.
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The stuff I use is manufactured in the US, and I would presume it was properly temperature controlled before getting on the airplane/boat to the UK.
Which would be sent using a climate controlled container, such as these [vrr.aero]. There's an entire industry that can handle temperature sensitive goods. That's fine for bulk logistics, doesn't scale well for the last mile (or last 50 miles in many cases).
With the flight to Australia example, that's more for a single person with a small supply, as mentioned the airline will have encountered this before and can advise and assist.
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They seriously overpack my insulin with icepacks. It's always in good shape when I get it. I have too many ice packs, is the main problem. Maryland, and don't underestimate how hot it can get near Baltimore. It's often warmer than all points south during the summer.
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Over 30C in Phoenix? Over 40C for weeks is not unusual.
"Phoenix broke 19 daily heat records in 2023, with 185 days of hitting at least 90 degrees, 133 days of at least 100 degrees and 55 days of at least 110 degrees."
(Note to those who suffer from metricalosis: 90F = 32C, 100F = 38C, 110F = 43C.)
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Not to mention the fact that, often the "last mile" of the delivery means the item sits in a USPS/UPS/FedEx truck for 6-8 hours before it is delivered to the customer.
I use the UHC web pharmacy and they ship the bottles in a white plastic bag, no coolpaks, no nothing. In fact, I'm expecting an order from the pharmacy today, according to the tracking, and pretty much ANY delivery I get of ANYTHING, will show on USPS/UPS/FedEx tracking as "out for delivery" VERY early in the morning and its not delivered to m
Re:Everyone uses the same shippers (Score:5, Informative)
Doctors recommend picking up your prescriptions at a local pharmacy whenever possible during hot summer months
There's a 98% chance that the meds at the local pharmacy spent a good portion of their journey stacked in boxes on the same FedEx/UPS/DHL/USPS trucks that do the home deliveries. It's not like they magically appear at the pharmacy 4 blocks from my house.
I'm not so sure about that. I did some work a while back with the pharmaceutical supply chain and a lot of effeort went into ensuring medicine that had temeprature requirements met them during transit.
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I did some work a while back with the pharmaceutical supply chain and a lot of effeort went into ensuring medicine that had temeprature requirements met them during transit.
I have personally received meds that had melted and resolidified into a single solid blob in the pill bottle. More than once.
Presumably, these were not considered temperature sensitive in normal circumstances..
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Re: Sure, that'll fix everything (Score:2)
Yet, medications sent to a pharmacy might be shipped in larger packages than these sent to individuals. And these larger packages might have better insulation from the weather.
Re: Sure, that'll fix everything (Score:4, Insightful)
Yes. Especially for meds requiring refrigeration . It's not like we don't already have shippers that can transport foods that shouldn't be exposed to high temperatures, like frozen foods .
Re: Sure, that'll fix everything (Score:5, Interesting)
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How is it scaremongering to point out that refrigeration is not being used in transporting medication or that it sitting in your (probably metal) mailbox or on the front stoop (maybe in the sun) is a bad idea. Let me guess, you have never had your medication deteriorate because of temperature.
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Because fricking title is obviously an attempt to subtlety link climate change to losing your meds?
As others have stated, nothing to see here, it's been like this for ever with regards to meds and no, the "hot summer" didn't change anything.
Also, look at self refrigerated packages which were mentioned in the post I replied to.
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That does not follow, when the problem in TFA is excess temperatures.
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The problem was overheating during transport. There is enough transport that can keep things cool, from large trucks with refrigerators to pizza mopeds. The pharmacist would not deliver anything from its store that is already beyond use, I hope.
So the pharmacist that receives overheated medicines has a problem, but that medicine would not be delivered to the customer. My conclusion is that the problem lies between the pharmacist and the client. Or at the client, but that is another problem.
Never left in a parked car? (Score:5, Insightful)
Actually, one of the useful features of an EV is the ability to run the air conditioning when you're not in the car. It helps a lot here in Florida when you've got multiple shopping trips to run and don't want your chocolate turning into a puddle while you're inside the next store. Tesla calls it "dog mode", but most other EVs are able to do the same thing.
Of course, the low-tech way is just to bring a cooler with some ice. That works too, provided you remember to pack the cooler.
Re: Never left in a parked car? (Score:2)
I don't believe we can do this in our 2015 Volt PHEV and 2017 Bolt EV. Maybe with a paid Onstar membership. But we don't pay.
Re: Never left in a parked car? (Score:4, Interesting)
I don't believe we can do this in our 2015 Volt PHEV and 2017 Bolt EV. Maybe with a paid Onstar membership. But we don't pay.
The Bolt's A/C will stay on for 20 minutes if activated by the keyfob, and an hour if you power up the car with it in park and lock the doors. Mine will actually get uncomfortably cold at the lowest setting on the thermostat, even in the blazing hot midday Florida sun. My partner has a bit of a fondness for Reese's candy and anytime I've picked some up and then had other errands to run, they've survived completely unscathed. Not having to rush right home with some chocolate certainly falls under the umbrella of "solutions to first world problems", but it's just one of the small niceties I've grown accustomed to since making the switch from a gas car.
Re: Never left in a parked car? (Score:3)
I did not know that about the Bolt. It is my husband's car. I don't think either of us ever RTFM.
For us the heat issue hasn't been about chocolates as much as prescription drugs. The Norvir he was taking wasn't heat stable and completely melted during a trip. I think it was in a bag in the trunk of our Prius. Probably sun was shining on it, and despite AC, it still melted. I just Googled and found that there has been a heat stable version of Norvir for 14 years. It was a while ago.
Re: Never left in a parked car? (Score:2)
Also, AC in our previous Prius wasn't enough to stop all Norvir capsules to turn into one puddle.
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Actually, one of the useful features of an EV is the ability to run the air conditioning when you're not in the car...Of course, the low-tech way is just to bring a cooler with some ice.
Or just leave your regular car idling with the doors locked.
Fun fact your medication is probably made in India (Score:5, Insightful)
And there's virtually no oversight. There's supposed to be, but having Americans force their way into a foreign owned factory would cause a minor international incident, so they just don't do it.
Earlier this year a bunch of people lose their eyesight because of tainted eyedrops out of a factory in India.
Regulations are written in blood. We should write one that requires medicine to be made in the USA.
Re:Fun fact your medication is probably made in In (Score:4, Informative)
India is still better than China. One of the wonderful perks of being middle aged is that nearly everything gives me heartburn, so I've resorted to having to treat it with generic Pepcid AC (famotidine). Turns out that Walmart sells big ass packs of the stuff which are manufactured somewhere other than India (the package does not list a country of origin), and those don't work at all. Perhaps the route they're being shipped takes them through the center of the Earth, or perhaps they're just not being manufactured with to the proper standards required to produce a functional drug. At any rate, the other medicine from smaller quantity package labeled "Made in India" does actually resolve my heartburn when I take it.
I've actually noticed a similar issue with Walmart's generic ibuprofen, too. They sell ginormous bottle of liquid capsules from China, and you may as well just be popping jelly beans instead for all the good it will do. The generic ibuprofen that actually works? Again, reach for "made in India".
Yeah, before someone says it, I realize ibuprofen isn't the best thing to be taking when you suffer from heartburn. Try telling that to my migraines.
Re: Fun fact your medication is probably made in I (Score:3)
I believe the word you needed to use here is "fake" instead of "generic". I regularly take some generic medicines too: they come with the brand of a genuine pharma company, country of origin and all, and guess what, they work, as they're supposed to.
Sounds like a profitable lawsuit (Score:2)
You know, if you are actually experiencing this, paying to have the medication actually tested might be a very profitable endeavor.
I mean, Subway got sued for their subs occasionally only being 11.5 inches long.
If the generic doesn't actually contain famotidine, ibuprofen, or whatever is advertised on the package, I see that being a very big deal that would make for quite the class action lawsuit against Walmart, a big payout.
Re: (Score:2, Flamebait)
I just tossed the drugs that didn't work into the trash. It would probably be quite an uphill battle to make a legal stink out of this, since I'm neither wealthy nor influential enough to get noticed.
Also, unless you get a lawyer who really wants to punish the company and can build a successful case around that angle, you're generally limited to compensation based upon how much loss was ultimately suffered. That's the reason why cases like the Subway one are so unusual. Typically, you'd just get your mea
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1. There are always lawyers up for going after Walmart.
2. Remember, drug being sold without their active ingredient, different ingredients, or improper amounts, would make the FDA sit up and take notice. It's kind of the whole reason for their existence.
Here's my thoughts:
1. If you have a bottle that doesn't meet standards, that means that the entire lot probably doesn't meet standards. This meets the requirements for a recall and all that.
2. If you can show that this persists across multiple lots, or
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I've got some experience with attempting to pursue lawsuits against big companies. Many years ago, my family was on the Disney Magic cruise line and all of us got food poisoning. It even made the news. [upi.com] Lawyers said we had no case, because the illness was mild and we didn't incur any medial expenses.
More recently, I bought mattresses from Zinus that began leaking fiberglass. There's actually an ongoing class action suit against them that someone else started, which would make it difficult to file an indi
Getting beaten to death (Score:2)
Re: Fun fact your medication is probably made in I (Score:2)
The FDA does have an oversight program of foreign drug manufacturers. It's very limited.
Sadly, manufacturing is not the only problem. I'm losing my sight, slowly, due to a recently discovered side effect of a western-designed and western-manufactured drug, that had been on the markets for two decades.
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Requiring medicine be made in the U.S. is a nice jingoistic ring to it, but totally impracticable. Given the amount of meds Americans consume, the U.S. does not and never will have the capacity. And if they did have the capacity, those meds would easily increase in price beyond your imagination.
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Pick up? (Score:5, Interesting)
"Doctors recommend picking up your prescriptions at a local pharmacy whenever possible during hot summer months"
Many people who are on medications can't drive (the elderly, those with poor vision, epilepsy etc) and of course some medications recommend dot not drive or operate machinery...
And walking long distances during hot summer months isn't a good idea either.
This is the insurance companies fault (Score:2, Troll)
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Also in the US at least for my insurance in the past 10 years (Aetna and UHC) if you have a persistent prescription they often require you to use their mail order pharmacy for the best price or at least heavily encourage it.
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Yup.. Also have UHC and I CAN get persistant prescriptions locally at a drugstore, BUT, that will be a 30 day supply AND a somewhat hefty copay. Whereas, if I use the web pharmacy, I get 90 day supply AND NO copay. I'm fortuanate that the only drugs I take are the cheap end of the formulary.
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You first.
The sky is falling! (Score:5, Interesting)
Seriously? (Score:2)
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If you want temperature controlled shipping you contract for it. It's not UPS's fault if these online pharmacies are just using standard shipping. At the very least, there are cold chain stickers you can put on sensitive items that will change color if an item has spent more than X minutes above temperature Y. The pharmacies should be using these to tell the patient if their medication has been potentially compromised.
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I just don't see how medications could be legally transported unsafely.
I have no idea if that's true or not. However if it is, that's not a carrier issue. That's on the pharmacy to choose the appropriate shipping method. Cold shipping is much more expensive. A carrier isn't going to ship something cold unless they are paid to do so. Most of the time, they don't even know what is in the box unless it is a hazardous material that has to be declared.
So if anyone is breaking the law, it would be the online pharmacy, not the package carrier.
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This is an issue even for OTC. (Score:4, Interesting)
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I had a recent order of CoQ10 gummies from Amazon, which when they arrived, and I grabbed them off the porch within 10 minutes of them being delivered, they were still melted into one giant gummy in the bottom of the bottle. The problem was that the tracking showed the package went on the truck for delivery around 8am and wasn't delivered to me until around 4pm, so even though there was a cooling pack in the package, the package still rode around Las Vegas for 8 hours.
I raised hell with Amazon customer serv
Hot trucks (Score:2)
On Aug. 17, 1974 I was standing outdoors in coastal Los Angeles when I heard and felt an explosion. There was immediate concern that this could have been related to a terrorist bombing at LAX a few days earlier. The actual cause was a truck containing organic peroxides, normally refrigerated for safe delivery, parked on a hot evening. Star Trucking explosion [calisphere.org]. I doubt that 5% benzoyl peroxide acne cream would do this at the local Walgreen's, but...
This was my second encounter: organic peroxide exploded at
Live from the Blast Furnace... (Score:2)
I ordered a bottle of the CoQ10 suppliment from Amazon recently The product was in "gummy" form. The tracking said the product was on a truck at around 9am, and I was notified of delivery at about 4pm, and immediately went outside to collect it. Even though Amazon put a cooling pack in the package, it was defrosted to liquid, and the product was so hot I couldn't hold on to it for any length of time. Of course the gummies were turned into ONE giant gummy in the bottom of the bottle. Being I live in the "Bla