Can aid workers hand out expired medication? Doctors say it’s ‘not entirely unusual’

Questions surrounding expired medicine have cropped up after news that a group of Canadian humanitarians were detained in Ethiopia for using it.

In Ethiopia, 13 Canadian citizens working with Alberta-based NGO Canadian Humanitarian are being detained after allegations surfaced that the group was handing out expired medication.

In a statement to Global News, Foreign Affairs Minister Francois-Philippe Champagne said he spoke with his Ethiopian counterpart about the Canadian detainees and said he would provide consular assistance, but was unable to discuss specifics of the situation.

In an online statement, Canadian Humanitarian said while they could not comment on the medicine’s expiry, they insisted the medication was still safe.

For the most part, Jillian Kohler, director of the World Health Organization’s Collaborating Centre for Governance, Accountability, and Transparency in the Pharmaceutical Sector, said doctors are not supposed to hand out expired medicine.

When she first heard about the Canadians being detained in Ethiopia, she said it struck her as “very unusual.”

“It’s not entirely unusual, but it really is case-specific,” she said.

1:21 Charges against Canadian humanitarian group detained in Ethiopia ‘highly unusual:’ pharmacology expert

Ideally, medicine should have around a year-long shelf life after they’ve been distributed. But when dealing with countries where supply systems often are not perfect, like Ethiopia, Kohler said there can be delays.

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“We don’t actually know what drugs were being distributed and how far off they were from their expiration date. Was it one day? Was it two years? And it really depends on what type of medicine that they were distributing,” she said.

“If we’re talking about a day or two, it shouldn’t be significant. If was it was longer, it possibly could be.”

4:17 Detention of humanitarian group members in Ethiopia is unusual, one expert says

Kohler also raised the issue of what standards each country holds their medication to.

“It’s important that we maintain the same types of standards of care everywhere, whether we’re in Canada or whether we are in Ethiopia or whether in another country,” she said.

“Part of that could be respecting the dates that the manufacturers have marked as expiration dates on drug products.”

But when it comes to expiration dates, Barbara Gobis, director of the University of British Columbia Pharmacists Clinic, said, “it’s not just a number or a stamp on a label. There’s a lot more that goes into it.”

Every manufacturer is required to put an expiry date on their medications, which is the date that will guarantee potency and accuracy of label claim, but after which anything isn’t necessarily guaranteed. After that date, she said, the manufacturer is not required to be able to ensure that the product is still working as advertised on its label.

“It’s more of an administrative time stamp for the manufacturer’s protection,” she said, “but it does not mean that the day after the expiry date is passed that the drug becomes toxic or problematic.”

When it comes to determining which medication may still be viable past its expiration date, Gobis said certain drugs have been found to be more problematic than others. Liquids like insulin, for example, have a tendency to lose their potency after they’ve expired, as do nitroglycerine tablets, sprays and aspirin.

Expiration dates can also be influenced by how a drug is stored once it leaves the controlled environment of a manufacturer’s laboratory. If a drug is stored in a cool or dry place, it is likely to last longer than medication left out in the sun or damp space.

2:48 Canadian Humanitarian charity workers detained in Ethiopia

Numerous studies have also been done into the viability of drug therapies beyond their expiration date due to waste caused by discarding unused drugs. A medical journal called Cancer published a study in 2017 that said Canada wasted over $102 million in taxpayer dollars over a three-year period by tossing injection cancer medication.

“There’s certain things that we do know that will degrade over time, but the vast majority of drug therapies don’t,” said Gobis. “If you can use a drug therapy beyond its expiry date and it’s still viable to do that, then you’re better off using it to care for people than to throw it away for an administrative reason.”

“Is it legal?” she asked. “Well, is it morally and ethically appropriate to deny somebody treatment when the drug is likely still good and the condition that is being treated is something that warrants therapy?

“If I am in an environment where I can access a replenished supply of drug therapy I would use to replenished supply and not the expired supply. If I’m somewhere where I can’t access in the supply and I have expired supply, that is maybe weeks or a couple of months expired, I wouldn’t hesitate generally to use it because I want to care for the people that I’m with and the alternative is no care.”