Why you should care

Because this is about affordable medication and has nothing to do with the Affordable Care Act, for once.

When Cynthia Anderson lost her job after 23 years, she didn’t know how she’d afford her husband’s stroke medication. Paying cash was out of the question, she says as she rests her hand gently on his shoulder. Skyrocketing Bay Area rents had already forced the Andersons to move in with Cynthia’s sister. Never mind the cost of her own medication for an old injury. Or the fact she suffers from major depression. Things were dire, and she was completely lost.

Then, a few months ago, she heard about SIRUM (Supporting Initiatives to Redistribute Unused Medicine), a nonprofit that matches unused prescription drugs with pharmacies and clinics that serve low-income patients. She showed up at Better Health Pharmacy in San Jose expecting to pay at least a small fee for her husband’s medication. When she found out it was free, tears welled up in her eyes. “It was surreal,” Anderson says. “I could finally sleep.”

Some 35 million Americans don’t take their medicine because they can’t afford it, according to a 2015 study by the Commonwealth Fund, a New York–based foundation that works on the U.S. health system. For people with mental health issues, medication is often a fragile barrier between themselves and the ER or psych ward or county jail. Meanwhile, an estimated $5 billion in unused prescription drugs are dumped into incinerators or trash dumps each year, or just down the drain — and into our soil and groundwater.

The solution may seem glaringly obvious in the era of Tinder, Etsy and other online brokers: Match surplus meds with needy patients. Yet until recently, only a handful of regional organizations did anything like it — the Iowa Prescription Drug Corporation, for instance, as well as programs in Tulsa, Ohio and New Hampshire solicit excess drugs from manufacturers and then distribute them to local patients in need. SIRUM takes a different tack, one focused on setting up a platform for exchange. Its web-based service connects the hospitals, pharma distributors and other donors to recipient clinics and pharmacies, letting the organization play Yente, in essence, to almost 150,000 “medical marriages” since 2011. So far, it’s connected about 220 facilities in 80 cities in California, Ohio, Oregon and Colorado, and it’s tripled in size over the past year. “It was almost horrifying,” says Kiah Williams, one of SIRUM’s founders, describing simultaneous medical waste and need. If we can recycle a soda can, she thought, why can’t we recycle a medication?

It’s all very Silicon Valley: Take something that’s not working, add software and presto! You’ve got a solution. The SIRUM founders did it the very Silicon Valley way too, bootstrapping nights and weekends before quitting their day jobs or dropping out of school. Williams was at the Clinton Foundation in New York, Adam Kircher was in his first semester at Harvard Business School and George Wang was a postdoc biologist at Stanford. Throw in a stint at Y Combinator, the prestigious startup accelerator and a social entrepreneur residency at Stanford’s Haas Center for Public Service, and you’ve got the secret sauce.

But that simple tale belies the fight for the right to recycle. Getting states to pass laws supporting reusing medication hasn’t been easy, like the seemingly commonsense campaign to allow restaurants to give leftover food to the homeless. As parts of the country struggle with an epidemic of opioid addiction, some worry that the drugs will get into the wrong hands. But in 2012, when California debated a law designed to expand donation and distribution legislation enacted in 2005, it wasn’t politicians on one side of the aisle that objected: Rs and Ds alike voted in favor of the bill. Instead, the California Board of Pharmacy “lobbied against the bill right up until the 12th hour,” says former State Senator Joe Simitian, who has worked on drug-recycling legislation for years. It wasn’t until SIRUM stepped up, he says, and went “gangbusters” that the bill went from a piece of paper to law. (The California Board of Pharmacy did not comment.)

Today, thanks in part to SIRUM’s efforts, some 40-plus states have laws that permit the creation of drug collection and redistribution programs. However, in most cases programs are notional; few have been created. Some allow only the recycling of cancer drugs; adding more prescription drugs to the roster is slow going. Painkillers and other opiates are still banned from the list, something Williams says remains an issue for those chronic-pain patients who can’t afford costly, daily medication. Critics say that the barrier to access cheap recycled meds is too low, since patients need only a prescription and an ID, and no income statement, to obtain recycled meds. The objection is often lobbed at socially minded services: Are well-off people gaming the system? Are they really in need? “That’s a risk we take for the better good,” says Jennifer Youn, assistant director of pharmacy services for Santa Clara county, which includes Silicon Valley.

For Cynthia and her husband, that need was clear: Recycled meds made the difference between life and death. With such high demand and so many unused meds headed for medical incinerators, or worse, down toilets, one might hope that SIRUM and their counterparts launch the next big chain of pharmacies. But this time the customers would be low-income Americans.

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