Any survivalist worth her salt is bound to notice, sooner or later, that all the antibiotics she’s been secretly stockpiling have pretty short expiration dates. For common household medicines, the use-by-date is often only 2-5 years after production. If you were hoping for a set-and-forget style bug-out or bug-in-bag, that fact is a serious spanner in your spokes.
But how reliable are drug expiration dates? Are your medicines still safe to take?
Luckily, these questions come up outside of survival situations too. The average citizen wants to know the best way to store medicines to keep them long term, which drugs are safe to use after the expiration date has passed, and if there are any drugs that should never be used after they’ve expired. For many people, these questions come up not because of the need to keep medicines supplied long term, but because medications can be quite expensive, and it costs too much money to replace unused but ‘expired’ drugs on a regular basis.
What is an expiration date anyway?
An expiration date indicates the last day that a manufacturer can guarantee 100 percent effectiveness and safety for that packet of medication. You’ll find expiration dates, use-by dates or best-before dates on the packaging of most medications, including herbal supplements, over-the-counter (OTC), and prescription medications. Pharmaceutical companies in the US (and most everywhere else) are required by strict laws to estimate dates on prescription medications before they can start marketing them. Due to legal reasons and liability fears, this date is chosen to be well within the timeframe in which the manufacturer is confident they can guarantee the stability of that drug.
The stability testing which informs expiry dates in the US is set out by the Food and Drug Administration (FDA). If the drug is stored in conditions other than those recommended on the label, or if the original packaging is opened, then the expiry date stops being reliable. The drug may last (i.e. remain effective and safe to use) just as long, but the manufacturer is no longer liable if it doesn’t.
Waste-prevention advocacy groups have recently been waging campaigns in the UK and elsewhere to highlight the huge amounts of perfectly edible food that are wasted because of confusion surrounding expiry dates. Until recently, it turns out, most people haven’t been clear on the difference between ‘use-by’, ‘best-before’ and ‘display until’ dates concerning food. Only ‘use-by’ dates are meant to indicate a date by which food may be unsafe to be consumed. Best-before and display-until only indicate the dates within which food will look it’s best and can reasonably command full price from a grocery store. At home, consumers should use their own good sense to decide whether or not food is edible, and in most cases it is edible for a good while after that best-before date.
So with all the pressure on consumers to re-think throwing out food unnecessarily, has there been any efforts to increase transparency about real drug expiries and safety margins? The answer is yes.
Are old medications still effective?
Back in 2001, the American Medical Association (AMA) reported that the real shelf life for many products is considerably longer than indicated by the expiration date on the label. The AMA drew their results from a one-of-a-kind opportunity to do testing on a huge volume of medications that had been stockpiled long-term. Where did they find all this medication, and who funded the study? The Department of Defense, of course!
The Shelf Life Extension Program (SLEP) was designed to do two things: figure out the actual useful life of stockpiled medications for future reference, and so that the government could save money by keeping quantities of the stockpiled drugs for use if they were deemed safe and effective. The research assessed more than 3000 separate stockpiles, covering 122 unique products. 88% of the stockpiles were extended, by 66 months on average. The study provided examples of several drugs that were tested after 66 months with no loss of stability: morphine sulfate; ciprofloxacin; diphenhydramine; and amoxicillin, a common antibiotic.
The actual potency of different drugs is however difficult to know. The longer you keep drugs (in general, but particularly past their official expiration date), the more possible environment fluctuations they are exposed to, and the higher the likelihood that they’re chemistry has changed.
Are old medications safe to take?
There are actually no studies or individual reports to show that out-of-date medications have been toxic to humans. There was one such case back in 1963, but the drug in question, a form of tetracycline, is not on the US market anymore.
As a rule, drugs is suspension or solution, or any that require refrigeration, are the most likely to lose potency after their original expiry date. It’s important to note that ‘loss of potency’ means something very different for antibiotics than for paracetamol – a pain relief tablet that has lost 20 percent of its potency will still relieve 80% of your pain, but an antibiotic that has lost 20 percent potency may no longer be powerful enough to beat an infection, leading to ongoing illness and a resistance in that bacteria to that strain of antibiotic. Antibiotic resistance is a serious issue.
EpiPen autoinjectors are one medication that we know for sure loses potency, and considering the stakes that are usually involved for anyone who needs an EpiPen, relying on an out of date one should never be your first choice. Insulin, vaccines, and blood products all degrade quickly after their expiration date is reached.
If you are in a survival scenario and an expired medication is the only medication around to treat a particular condition, it is probably safe in most cases.
Pain relievers and antihistamines may lose effectiveness but cannot become dangerous, but anything with a liquid component could potentially begin to harbor bacteria after the preservatives lose effectiveness, which could cause serious unforeseen complications in a patient you are trying to treat.
Drugs in tablet and capsule form appear to be the best at maintaining their safety and effectiveness. If you every find that a drug is crumbling, has gone soggy or dried out (if it was a cream or ointment), or if it gives off a strong smell, then you’d be wise to discard it.