The heat of a humid, sweltering summer afternoon is loved by many and detested by others, me included. Although a vacation lying on a beach (smothered in sunscreen) in the summer sun may be just what the doctor ordered, high heat can be deadly in more ways than one. Intense heat and humidity can cause harmful chemical reactions and decrease potency of medications in shipping.
Shockingly, temperature of medications during shipping is not regulated by the Food and Drug Administration or state boards of pharmacy. These agencies closely regulate safe storage of pharmaceuticals in warehouses, pharmacies, drug manufacturers, hospitals and medical offices, punishable by fines if stored at the wrong temperature. Hospitals, offices and clinics are required to document temperatures daily.
Massachusetts state guidelines vaguely read as, “A pharmacy shall ensure packing, shipping and transportation processes do not adversely affect the integrity or stability of medication dispersed by mail.” Mail-order pharmacies use the U.S. Postal Service or FedEx. The pharmacy is ultimately responsible for ensuring safe packaging for transport.
Most pharmacy warehouses are in the hottest states. Mail-order pharmacies state they use weather-resistant packaging. Research shows medication packages spend approximately 70% of travel time outside the appropriate temperatures.
It is recommended to store medications in a dry place, with temperature ranging from 68 degrees Fahrenheit to 77 degrees, with short-term exceptions from 59 to 86 degrees. Temperatures in a car at 80 degrees Fahrenheit can reach 109 degrees in 20 minutes, and 170 degrees in 60 minutes. The average temperature in trucks and mailboxes is 150-170 degrees.
Oppressive heat and humidity can decrease the effectiveness of medications. An organ transplant patient who received his medication via shipping, which was altered by high temperatures, suffered organ rejection because the medication was no longer effective. Some medications actually have ingredients that contain minute amounts of carcinogens that are considered safe. When heated, they increase to unsafe levels. There are also thousands of chemical reactions that can occur in medications exposed to high temperatures.
Liquid and aerosolized medications are most at risk with high heat. Some important medications affected include insulin, epipen, pancreatic enzymes, levothyroxine, albuterol and other life-saving inhalers. At home or in transit, all medications should be stored in a cool, dry environment. Never store any prescription or over-the-counter medications in your bathroom.
Some insurances dictate what pharmacy one must use. Many are mandated to use unsafe conditions to obtain their medications. There are a few obvious signs that medication has been harmed by heat, such as melted capsules and discoloration or disintegration of tablets. Often, one is alerted by a change in their medical condition.
What can you do? Store your medications properly at home. Don’t leave them in a parked car. Talk to your provider if you suspect a change in your health is due to overheated medications. If enrolled in an insurance program that requires mail-order, ask for an exception during the summer months, ask about shipping practices and ask for temperature-controlled packages. If traveling, take your medications in your carry-on bag.
What can mail-order pharmacies do? Express shipping, temperature monitoring devices, requiring signatures and other policies that demonstrate integrity in maintaining the quality of their product.
What can the government do? Seems like a simple and logical solution to apply the same regulations for facilities storing medications as for the shipping of medications. Unite for Safe Medications (uniteforsafemedications.com) is a grassroots non-profit advocacy organization fighting for regulations.
May you have many days to relax on the beach with the perfect combination of a slight breeze and warm temperatures. May your medications maintain their integrity at appropriate temperatures. Most importantly, may the government and pharmaceutical companies quickly address this glitch in keeping medications effective and safe.
Take care of yourself and someone else.
Juanita Carnes is a Westfield resident and a nurse practitioner with 38 years of experience in a hospital emergency department and urgent care facilities. She served 30 years on the Westfield Board of Health.
