Thérèse Coffey, the health secretary for England, has admitted to giving her leftover antibiotics to friends and family who were feeling unwell. This led to the British Medical Association issuing a statement, describing her actions as “not only potentially dangerous, but also against the law”.
In the UK, medicines fall into three groups that determine how people can access them. “General sales list” medicines, such as small packets of some painkillers or simple cough mixtures, can be bought over the counter in supermarkets and other shops.
“Pharmacy medicines”, such as travel sickness tablets or stronger painkillers, are sold in pharmacies when supervised by a pharmacist. And “prescription-only medicines”, such as antidepressants and antibiotics. These drugs can only be prescribed by a doctor or other health professional with prescribing rights. Antibiotics are prescription-only medicines.
The Medicines and Healthcare Products Regulatory Agency (MHRA) in the UK has previously said that anyone supplying a prescription drug to someone for whom the drug is not intended is breaking the law. However, the agency says that a prosecution is highly unlikely.
In the UK, the Medicines Act 1968 governs the control of medicines, including their supply as they relate to commercial transactions or services. However, it does not include social sharing, which might explain the MHRA’s observation.
Social sharing, though, can sometimes lead to a prosecution. An even stronger type of prescription medicine is a “controlled drug” named in the misuse of drugs legislation. Controlled drugs are particularly addictive and harmful when misused or diverted for illicit use. For this reason, there are stringent rules on how they are prescribed, supplied, stored and even destroyed.
Some controlled drugs even require travellers to have a letter proving the medicine was supplied to them, or a Home Office licence when bringing them into the UK. Under the Misuse of Drugs Act 1971 it is an offence to unlawfully supply a controlled drug or be improperly in possession of it.
But the medicines reportedly discussed by Thérèse Coffey were antibiotics – not controlled drugs. Antibiotics are prescription medicines, and sharing them raises other concerns.
Antibiotics work by killing bacteria or stopping them from spreading. Overuse and misuse of these drugs over the years have led to the creation of “superbugs”, which are strains of bacteria resistant to most common antibiotics.
The World Health Organization (WHO) has called antibiotic resistance one of the biggest threats to global health, food security and development. So to prevent and control the spread of antibiotic resistance, the WHO asks people to only use antibiotics when prescribed by a certified health professional and never share or use leftover antibiotics. This is at odds with the scenario attributed to Coffey and potentially explains the strength of BMA’s response.
In a recent letter to the Times, Professor Claire Anderson, president of the Royal Pharmaceutical Society, wrote:
Patients should always complete their course of antibiotics and never share them with others as this is unsafe and can increase antibiotic resistance. Our members are promoting an “antibiotic amnesty” campaign to remove unwanted antibiotics from circulation, so if the secretary of state does indeed possess any leftover medicines she is welcome to drop them off at her local pharmacy, where they will be disposed of safely.
Aside from the risk of increasing antibiotic resistance, prescription medicines are usually strong drugs that need close oversight. This means a suitably qualified person has to make sure they are the right drugs, given at the right dose for the person intending to use them.
Shared medicines could be unsuitable because of someone’s existing health condition (such as being pregnant, breastfeeding, or having a kidney or liver injury), the potential for the medicine to cause side-effects, an allergic reaction or become habit forming. Shared medicines might also interact with the recipient’s other existing medicines.
Side-effects such as drowsiness become even more important when considering laws that make it an offence to drive after taking certain medicines, especially if these have not been prescribed for the driver.
During the current cost of living crisis, people might be tempted to save on prescription costs by sharing drugs. But no one should be sharing their leftover prescription drugs as the potential harms are likely to far outweigh any immediate benefit.
Parastou Donyai works for the Royal Pharmaceutical Society.