An evaluation on the drug repository landscape in Nova Scotia

Abstract

In 2014, Canada spent $33.9 billion on medications. Extrapolating from the US, it is estimated $2.4 billion worth of medication go unused in Canada. Since 1997, at least 38 states have some form of medication reuse program, while no Canadian province does in the truest sense. The programs in the US are broken down into four types depending on structure: Closed-Focused, Closed-Broad, Open-Focused, Open-Broad. The motivation for each program is different. The evolution of programs in the US largely rested on story and power but the same factors have not worked in Canada. Five Nova Scotian stakeholders were interviewed on why this is the case. Several issues around logic, power, story, morality, validation and diffusion were identified. This paper finds story has less meaning in Nova Scotia, government is not a source of power, more data is required, and there is a lack of normative legitimacy in this area. Change in Nova Scotia will require buy-in from a group with less structural power but high connectivity to the patient group. Pilot programs should focus on high return on drug cost and/or patient need.