Tomorrow is World Patient Safety Day and this year’s focus is ‘Medication Without Harm’. A number of medication-related pitfalls can put patients at risk of harm, and we urgently need to deal with some of the newer risks, especially after the coronavirus pandemic. As researchers in the Reading School of Pharmacy, my colleagues and I are working to tackle modern medication-related risks to patient safety.

Packets of medication

Most medicines in the West are manufactured by pharmaceutical companies and sent to pharmacies, which dispense them to patients when prescribed. Patients are asked to store and use their medicines as instructed and ideally return the packet or unused portions back to pharmacies for safe disposal. But, as straightforward as this process seems, the medication-use pathway is riddled with risks.

One obvious medication-related risk is not having access to the medicine in the first place. Working on his PhD project with Dr Nilesh Patel and myself, Mohamed Obiedalla asked pharmacists about drug shortages toward the end of 2021. Nine out of ten who replied said that not having medicines in stock or being unable to source them was a real problem, and more than three quarters didn’t have a system to help them manage these shortages. As I write, half of UK pharmacists surveyed felt medicine shortages had put patients at risk over the past six months. Mohamed is hoping to work with national organisations to help develop training for pharmacists to give them confidence to better deal with drug shortages in the future.

Another major medication-related risk is disinformation. When patients can’t access their medicines through their pharmacy, there is a risk that they will turn to the internet to buy these instead. Working on his PhD with myself and Dr Nilesh Patel, Hamzeh Almomani has been interviewing people who have turned to the internet to buy medicines from illegal sources. His findings show that people trust online suppliers based on how the website looks, their experience with the website and whether the medicine they get ‘looks’ genuine. This is worrying because a recent investigation by ITV found the majority of medicines bought from fake online pharmacies were not what they claimed to be. Fake medicines can harm people by poisoning them, not treating their condition, or even fuelling an addiction. Hamzeh hopes his work will identify the top reasons driving people’s online medicine buying, so that we can protect patients from the many risks associated with these sites. Certainly, other people’s approval seems to be a key driver here, for example via website ‘reviews’ and recommendations from well-known people.

You might recall the role that President Trump played in spreading untruths about potential cures at the height of the coronavirus pandemic when he recommended the potent hydroxychloroquine to worldwide audiences. There was, and never has been, any convincing scientific evidence that hydroxychloroquine stops or treats people’s COVID-19 infection. Yet Trump’s endorsement was taken seriously by many and this was dangerous because people who took this and similar medicines were harmed or even lost their lives. The endorsement also used up pharmacy stocks and stopped people who really needed this medicine for their arthritis receiving it. Writing articles aimed at the public, I highlighted the misinformation surrounding President Trump’s unproven claims (some of which was making a mockery of normal regulatory systems in the US even). I also wrote to address other medicine worries during the pandemic. More recently, I took the initiative to write for a public audience again, to show that we have medicines for managing monkeypox infection, before misinformation about this disease spreads.

The coronavirus pandemic also gave us a chance to learn if we can reuse old medicines safely. It’s usually illegal to reuse leftover medicines in the UK for any purpose. But during the coronavirus pandemic, the government released guidance that allowed this to happen in care homes and hospices, under very strict rules. The worry from government was that these settings might not be able to quickly get their urgent medicines, especially for someone’s pain or breathlessness at the end of their life. Working with myself, Professor Simon Sherratt (Biomedical Engineering) and Dr Katherine Finlay (Psychology), Clare Dando, a Psychology Master’s student completing a placement within the Pharmacy School has been interviewing hospice staff to find out how medicines reuse worked and the main barriers to this practice during the pandemic. The idea that medicines might be reused might not seem right from a patient safety perspective. Yet, reusing medicines could help reduce the 25% of NHS’s carbon emissions linked to the manufacture, transport, and usage of medicines. And this can help address the biggest patient safety threat of all, which is the climate health emergency.

Our group has been researching the implementation of medicines reuse for almost 8 years, beginning with the PhD of Dr Hamza Alhamad, now lecturer at Jordan’s Zarqa University. Some of our papers were recently published as a book. We find people are interested in the idea of reusing medicines, especially if their worries about the quality of returned medicines can be eased. The biggest worry is whether medicines returned to pharmacies will have been stored correctly to keep the medicines working. To prove this, we are hoping to receive funding to make sensors for packaging. For now, our focus is on awareness campaigns that will help people return their medicines to pharmacies for safe disposal. We hope this will help contribute to reducing harm from medication, which can take many forms in the modern world.

Parastou Donyai is Professor of Social and Cognitive Pharmacy at the University of Reading.