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As a medic, you might one day have to decide whether to administer an expired medication. What’s your plan?

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In a disaster, especially a long-term collapse, the family medic must be able to handle many emergencies. Some of these are clearly survivable, such as a broken finger, and some are clearly not, such as a bullet to the brain. A realistic attitude toward these hard facts won’t make decision-making easier, but it might make it less complicated.

Your goal as the sole medical asset in an austere setting is to prevent the avoidable deaths.

One significant way to accomplish this is to pay strict attention to prevention. The medic’s responsibilities include making sure water is properly sterilized, food is prepared safely, and activities of daily survival are performed with appropriate clothing and protective gear. This will avoid a lot of headaches and greatly increase your chance of success when everything else fails.

Another way to keep your people healthy is to have medications and supplies to deal with the issues you’ll encounter as a medic. Bandages, antibiotics, pain relievers and numerous other items will be important in your mission to keep people healthy. But what happens when these items expire?

Before I begin, I want to tell you that my focus is medical preparedness for major disasters and long-term survival. This means a strategy of putting together stockpiles of supplies that might save a life in times of trouble. In normal times, when you can just call your doctor for a fresh prescription, you should seek out modern care by qualified professionals.

WHAT’S AN EXPIRATION DATE?

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Let’s start by examining what an “expiration date” really means. It is defined as the last day a pharmaceutical company will guarantee a drug’s full potency. These dates weren’t mandatory until 1979 in the United States, and printing them on labels brought up a lot of questions: Do you throw them away when they expire? What happens if you take them after the date on the label? What if a disaster takes away the ability to manufacture fresh supplies?

According to one survey, about 70 percent of people wouldn’t take an expired pill.

According to one survey, about 70 percent of people wouldn’t take an expired pill.

These very questions were asked by the U.S. Department of Defense. With a billion dollars’ worth of drugs stored away in warehouses for military and civilian use, the DOD faced the physical and financial challenge of destroying and replacing millions of doses on a regular basis. As you might imagine, this gets pretty expensive.

The drug companies’ data didn’t help. There was no requirement to test for effectiveness any longer than the expiration date. This led the military to begin studies that could determine if it could extend the shelf life of its massive inventory.

THE SHELF LIFE EXTENSION PROGRAM

Massive drug inventories reaching expiration dates.

Massive drug inventories reaching expiration dates.

This evaluation, done in conjunction with the Food and Drug Administration, eventually became known as the Shelf Life Extension Program. It tested more than 100 drugs that had been expired for one to 15 years and found that 90 percent of them were still fully potent and considered safe. These medications were mostly the ones in pill or capsule form. Notable exceptions were nitroglycerin, insulin, epinephrine and antibiotics in liquid form.

This wasn’t a lone study but a series of tests that spanned decades. Unrelated studies showed similar results. A report in the medical journal, Archives of Internal Medicine, evaluated some drugs that were 28 to 40 years expired. Twelve out of 14 active ingredients were still found to be fully potent.

Despite these findings being made public from time to time, most people still believe that a drug shouldn’t be taken after the expiration date, and a number of civic programs, often sponsored by pharmaceutical companies, actively encourage the disposal of meds as soon as they expire.

As if the Shelf Life Extension Program does not exist, even the FDA offers instructions on trashing expired medications. Indeed, when interviewed in 2000, a former FDA expiration date compliance chief believed that many at the agency didn’t know about the program at all.

This is despite a number of emergency use authorizations for expired drugs being quietly issued over the years. During the swine flu epidemic of 2009, a five-year emergency use authorization (EUA) was given for the anti-viral drug Tamiflu. This meant that the government authorized the use of the medication for five years after the date on the label. A number of other drugs have been extended over the years for similar reasons.

Why does shelf life extension data sit silently on the, um, shelf? There is a small savings for the individual consumer—but a lot to lose for drug companies.

Imagine a politician running on a platform of saving the consumers money by not throwing out expired drugs. The opposition would say, “My opponent is trying to make you take stale drugs.” The public has been conditioned to think that they somehow become dangerous when they expire.

This isn’t the case in the grand majority of cases. The classic example given for a “dangerous” expired drug is Tetracycline. In 1963, the Journal of the American Medical Association linked a case of kidney damage to the antibiotic. This case, however, involved a form of the drug that is no longer in use.

Although few instances of complications have been reported, some university professors and even Tetracycline’s Wikipedia entry still consider it dangerous when expired. Doxycycline, a member of the same antibiotic family, was given an emergency use authorization in 2010 for several years after its expiration date.

With all the scary press over the years, about 70 percent of people surveyed would not take a prescription or over-the-counter drug after the expiration date. The military throws out intravenous bags of normal saline because of the response when a serviceman sees that that it’s beyond the expiration date. Even charities that send medical supplies to disaster areas in underdeveloped countries will often refuse expired drugs.

That’s the public’s opinion, but does it make sense from a survival standpoint?

STORING MEDICATIONS

This brings us back to you—the medic. It’s been awhile since the collapse happened, and the medications left in your storage have all expired. They are not being made anymore, so no fresh supplies are coming. There aren’t any rescue helicopters or ambulances heading in your direction. You might one day have to decide whether or not to use an expired medication. What’s your plan? It would be wise to first know how to extend shelf life with good storage practices.

THE CONDITIONS SHOULD BE:

DRY: Medications are commonly stored in the worst place possible: the bathroom. Bathrooms are the most humid areas of the house, and drugs should always be kept in dry conditions. Many medicines have little packages called “desiccants” in the bottle. Don’t remove them; they are there to absorb moisture.

Pills last longer in dark bottles that protect their contents from the light.

Pills last longer in dark bottles that protect their contents from the light.

DARK: Light has a tendency to speed the loss of a drug’s potency. This is why many medicines are stored in brown or amber bottles. Keep all meds in a dark place and, preferably, in their original containers.

COOL: Although drugs usually don’t benefit—and might even be damaged—from freezing temperatures, they retain potency twice as long at 50 degrees (F) than at 90 degrees (F). Keep them in the refrigerator or other places where they won’t be exposed to heat.

Here’s another way to extend the longevity of your medicines: Grow your own. The hard facts are that if a disaster situation lasts long enough, you’ll run out of pharmaceuticals. There are, however, other options—the plants in your own backyard.

Many plants have medicinal benefits that have made them invaluable in off-grid settings. The underbark of willow trees, for example, contains salicin, the ingredient used in the first aspirins. Natural herbs and other remedies act as drug “extenders,” will work for minor ailments and decrease the rate at which you deplete the meds you have. At the very least, they will give you a shot at reaching expiration dates with some medicine still in your storage. The effective medic knows what herbs treat illnesses and injuries. Your ancestors used them for many different medical problems. Somewhere along the line, the knowledge was lost; but it can be found again with a little time, effort and education.

THE MEDIC’S DILEMMA

All this, however, doesn’t prepare you for the decision you might one day have to make as family medic in a disaster. Someone is sick or hurt, your medicines are expired, and you have to choose whether or not to use an old drug.

In a disaster, the decision-making process might come down to asking yourself some basic questions. Of course, the first is, “What’s the problem?” The second is, “Do I have medicine that will treat it?” If you’ve been off the grid long enough, the third question might be, “Could this medicine, even if it has expired, possibly save a life?”

Let’s be even more specific. A loved one is fading from an infection. Something bad has happened, and you’re off the grid—with no hope of getting to modern medical care. You have an expired bottle of antibiotics. What are you going to do? Someone you love is dying. Are you going to use the expired drug or not?

Exactly. When it comes down to the nitty-gritty, you have to do what you can with what you have. In this situation, you really can’t withhold a drug that might save a life because some professor said it wasn’t a good idea to use it. He or she wasn’t seriously considering a time when an expired medication might be the only option you have left.

Joe Alton, M.D., is a physician and co-author of the Survival Medicine Handbook, as well as the founder of www.doomandbloom.net. A version of this article first appeared in the March 2016 print issue of American Survival Guide.