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A supply of personal medications…
…is something all of the emergency preparedness guides tell you to put in your kit. What they usually don’t tell you is how to assemble and preserve that supply. We in Oregon are looking at a worst-case situation (major Cascadia zone earthquake) in which utilities, transport, and communication may be disrupted for weeks to months.
Let’s take a look at the issues – we will focus on prescription drugs, but some of the points also apply to non-prescription drugs and health aids, and to non-drug prescriptions (e.g., eyeglasses, hearing aids/batteries). To do you the most good, you need to be able to:
- Have a good supply on hand;
- Take it with you reliably and conveniently if you have to evacuate; and
- Use it effectively for as long as possible under adverse conditions
Supply: for most people, the basic controls on how much prescription medicine you can have on hand are how your doctor writes the prescription, and what the insurance company will authorize for sale.
- Ask your doctor to write the prescription to cover the longest period the insurance will authorize – which in many cases is 90 days – and/or ask the pharmacist to fill existing prescriptions for 90 days, and request suitable renewals as needed. The larger your average inventory, the higher the probability that you will have a decent supply to take with you when The Big One hits.
- Another thing you can do to build up and maintain a good supply is to have, and stick to, a refill strategy that gets each refill as soon as possible. Plans will refill prescriptions several days before the previous fill is scheduled to be exhausted, so don’t wait until you are almost out of pills to reorder – do so 5-7 days before the scheduled date of the last pill in the previous fill. This way you can build up a 4-5 day “surplus” with each refill – convenient for protracted trips as well as real emergencies. There’s one strategic quandary – if you are organized enough to do the early refill with a 30-day prescription you can build up 2 months of extra supply in a year or less – and then switch over to 90 days (and remember to use the meds in the order received). For most normally fallible mortals, starting with the 90 day strategy is probably preferable.
Other things that may or may not work:
- Ask your provider if he/she has any physician’s sample packs you could have; and/or
- if you are willing and able to pay cash, explain and see if he/she will write a separate one-time paper prescription. If so, fill it at a pharmacy other than your usual one. If it is not a controlled substance and your insurance company isn’t being asked to pay for it, nobody but you and your doctor cares how many pills you possess.
- For medications that are “as needed” rather than specified-dose, accelerate refills to get a reasonable backlog. Purchase a supple of over-the-counter (OTC) drugs you are likely to use, and don’t forget to check to see if any of the prescription meds you use are also sold OTC, perhaps at a lowerspecific dose. Remember the non-chemical things like hearing aid batteries, eyeglasses and contacts, and denture supplies.
- Have your list of medications (which you always should carry on your person and have another copy in your primary emergency pack) with the relevant information – which includes the pharmacy contact information, prescribing MD, and prescription number as well as name of medicine. This may help you restock if you are evacuated to a location where there are functioning pharmacies.
Accessibility: Suppose the earthquake comes, your house is damaged with stuff all over everywhere, it’s dark, and you smell smoke. This is not the time to be scrabbling around on the floor trying to find all of the pill bottles that rolled off the kitchen counter. You need to keep your master supply in a pouch or sturdy plastic bag in or near your bug-out supplies, and extract a day’s or week’s worth at a time.
Effective use: Consult your physician or your pharmacist to make sure you know the following about all of your medications.
If you anticipate running out of medicine (Note that thinking ahead IS required), should you —
- Taper off (alternate doses, partial doses, for how long)?
- Stretch the supply by reducing the dose (half a pill may not be much better than no pill)?
- Substitute something more readily available (such as aspirin for prescription blood thinner)?
Are the medications likely to “go bad,” deteriorate, or become ineffective?
In general, in the case of a major disaster or prolonged emergency, you probably won’t have a large enough supply of most solid or cream/gel medications to risk having them go past their real expiration date (the printed one is almost always very conservative, often by as much as a year). Exceptions: Consumer Reports ON HEALTH (May 2018 p6): “Antibiotic tetracycline…after they’ve expired…can become toxic…” And, “…liquid meds such as nitroglycerine, insulin, and injectable drugs such as epinephrine… lose potency …and may not work well or at all.” However, most ‘over-age’ drugs other than tetracycline are not likely to be toxic, so there’s no real reason not to use it in hopes of benefitting from whatever potency it may still have. One pharmacist told me that insulin pens can be used for at least 1-2 weeks beyond the 28-day limit claimed in the instructions. Ask your pharmacist for specific information.
There is also an issue of storage conditions
Cold: Relatively few medications are susceptible to cold, some are moisture sensitive (keep everything well sealed)
Heat: many may deteriorate in excessive heat (this includes hearing aid batteries). If you are trying to survive a summertime disaster, keep your meds sheltered from direct light, and as cool as possible.
How to do you keep things cool without AC or refrigeration? Dig a hole as small in diameter and as deep as you can in a permanently shaded area, put your well-packaged reserve medicines in the bottom, and fill/cover the hole with good but easily removable insulating material (bubble wrap or loosely wadded paper or cloth will do). If the insulation is absorbent, keep it moist. Or, if adequate water is available, make sure the meds are in watertight containers and put them in water that is in a shallow container out of the sun but where air motion is good – and if you can have it fed by a trickle of water coming in, so much the betpersonal medicationster.
