I think it's a great idea. It poses some challenges, especially for the “as required” medication. As an example, my father has a chronic back condition that flares up every now and then. He's given a narcotic at times that he can use for travel or what not.
So I think from a return standpoint for medication that's prescribed, it can certainly be problematic in that light; for expiry dates, absolutely, or even after one year.
As I think Dr. Emberley alluded to earlier, on the medication review we could say, “Hey, listen, you're not using this medication anymore. Do you have any left? Can you return it to the pharmacy?” We could have that dialogue and documentation. I think the medication review is probably your best avenue for that.
With regard to how much goes out the door, I think there's a lot we can do with regard to restricting quantity. I understand that every pharmacy is open late, so unfortunately a lot are open on weekends. With this accessibility comes responsibility. That responsibility means we have to be able to restrict access to the medication in larger quantities.
Unfortunately, diversion happens when there's a large quantity. From my experience, patients do have legitimate pain, but they also see it as a revenue stream. They actually take some of the medication and then divert some of it. The larger-quantity reduction could reduce that tremendously.