Westfield Health Bulletin: Prescription drugs can be ruined by heat during shipping and storage

The sweltering heat of a muggy summer afternoon is loved by many and hated by others, including me. While a beach getaway lazing around in the summer sun (slathered in sunscreen) may sound ideal, a high fever can be deadly in more ways than one. Extreme heat and humidity can cause harmful chemical reactions and reduce the effectiveness of medications during transport.

Surprisingly, the temperature of drugs during transport is not regulated by the Food and Drug Administration or state boards of pharmacy. These agencies strictly regulate the safe storage of drugs in warehouses, pharmacies, pharmaceutical companies, hospitals, and clinics, and can impose fines if they are stored at improper temperatures. Hospitals, clinics, and doctors' offices are required to record temperatures daily.

Massachusetts guidelines state vaguely that “pharmacy must ensure that packaging, shipping, and transportation processes do not adversely affect the integrity or stability of drugs delivered by mail.” Mail-order pharmacies use the U.S. Postal Service or FedEx. The ultimate responsibility for ensuring safe packaging for shipment rests with the pharmacy.

Most of the pharmacy warehouses are located in the hottest states. Mail order pharmacies say they use weather-resistant packaging. Studies show that drug packaging spends about 70% of the time in transit outside of the right temperature.

It is recommended that you store your medication in a dry place, between 68 and 77 degrees Fahrenheit, although 59 to 86 degrees Fahrenheit are okay for short periods of time. The temperature inside a car that is 80 degrees Fahrenheit can reach 109 degrees Fahrenheit in 20 minutes and 170 degrees Fahrenheit in 60 minutes. The average temperature inside a truck or mailbox is 150 to 170 degrees Fahrenheit.

Extreme heat and humidity can make drugs less effective. High temperatures have altered drugs during transport, causing organ transplant patients to reject their organs because the drugs no longer worked. Some drugs contain ingredients that contain traces of carcinogens that are considered safe. When heated, the carcinogens increase to dangerous levels. Thousands of chemical reactions can also occur in drugs exposed to high temperatures.

Liquid and aerosol medications are most at risk in high temperatures. Important medications affected include insulin, EpiPen, pancreatic enzymes, levothyroxine, albuterol, and other life-saving inhalers. Store all medications in a cool, dry environment at home and while traveling. Do not store prescription or over-the-counter medications in the bathroom.

Some insurance policies dictate which pharmacies you must use. Many policies require you to obtain your medications in unsafe conditions. There are some telltale signs that your medication has been damaged by heat, like capsules melting or tablets discoloring or disintegrating. Often, you'll be alerted by a change in your health condition.

What can you do? Store your medications properly at home. Don't leave them in a parked car. Talk to your health care provider if you think any changes in your health may be due to overheated medication. If you have an insurance program that requires mail-in orders, apply for a summer exception, ask about shipping methods, and request temperature-controlled packaging. If you travel, pack your medications in your carry-on luggage.

What can a mail order pharmacy do? Things like expedited shipping, temperature monitoring devices, signature requirements, and other policies that show integrity in maintaining the quality of their products.

What can governments do? Applying the same regulations to the facilities that store medicines as to their transportation seems like a simple and logical solution.Health and Safety Policy) is a grassroots nonprofit advocacy group that fights for regulation.

May the perfect combination of light breezes and warm temperatures keep us relaxing on the beach, may the right temperatures keep our medicines potent, and above all, may governments and pharmaceutical companies swiftly address this flaw in keeping our medicines effective and safe.

Take care of yourself and others.

Juanita Karns is a nurse who lives in Westfield and has worked in the hospital emergency department and urgent care facility for 38 years. She served on the Westfield Board of Health for 30 years.