Florida Pharmacist Discusses Medication Preparedness for Hurricanes

The peak of hurricane season occurs between mid-August and late October, and in the past few weeks, hurricanes Helene and Milton have been making headlines as they sweep across the Atlantic.

Eye of a hurricane / EvgeniyQW - stock.adobe.com

To prepare for a hurricane, residents in its path must consider a number of factors. These include developing evacuation plans, securing homes, stocking up on non-perishable food, and crucially, maintaining an adequate supply of medications. However, significant challenges arise in the aftermath of hurricanes, as health care systems and pharmacies often face severe disruptions in care.

In the wake of these disruptions, patients must know how to keep their medications safe. In a recent interview with Drug Topics, Brad Phillips, PharmD, BCACP, clinical assistant professor and assistant director at the University of Florida College of Pharmacy Orlando campus, offered valuable insights into navigating medication-related disaster preparedness before, during, and after the storm.

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Drug Topics: How should pharmacists advise patients to prepare their medications for a hurricane, given the potential for supply chain disruptions and power outages?

Brad Phillips, PharmD, BCACP: Planning ahead is key. Some things that I've recommended to patients is maintaining a current list of their medications, including prescription and OTC medications, as well as the dose of said medication and the reason that they are taking it.

I also encourage patients to obtain early refills if needed, especially during a state of emergency. This is something that the governor of the state can declare, and during times of states of emergency, if there are any refills remaining for that prescription, they can be pulled early, providing the patient anywhere from a 30- to a 90-day supply. That obviously depends on the state, but most recommendations during any kind of disaster state to always have at least 14 days of medical supplies available with you.

Another thing is discussing the storage requirements of medications with patients. Which medications need to be at room temperature? Which medications need to be in the refrigerator or freezer?

The other thing, which I think is an unspoken piece, is really "knowing before you go." What I mean by that is identifying and contacting designated hurricane shelters or secondary residences that patients might visit to determine the capabilities available to them. Although some shelters have refrigeration or freezing capabilities, some of them don't. This is where I think that pre-planning can come into play.

Also, pharmacists should have multiple shelters in mind to direct patients to. The reason why is because not all shelters might be open during times of emergency preparedness, in which case, it's always better to have multiple options than the first option falling through.

Another thing that I like to emphasize with my patients is the after-the-storm aspect. Educating my patients to make sure that they're examining their medications for any damage or tampering that may have occurred, while also keeping track of those medications and how much you have after the storm, is important. I feel like that's very often overlooked with the storm, because your priorities are drastically different; your priorities are personal safety as well as basic need fulfillment, and so that can often go overlooked as you're starting to run out of some of those medical supplies. That’s another area that I like to emphasize with my patients here in Florida.

Drug Topics: What essential items or supplies should pharmacists recommend to patients to have on hand to protect medications during a power outage, such as cooling packs or insulated bags?

Phillips: Leaning into those, I highly recommend cooling packs, especially for patients that have medications that require refrigeration. Plus, having a supply of either reusable cooling packs or disposable cooling packs, is important.

Insulated bags or coolers are another great idea, but the caveat to that is making sure that patients use high-quality coolers, as some cloth coolers and bags have the potential to be waterlogged and don't hold temperatures as well as others. So, making sure that patients have a high-quality cooler that doesn't experience any leaking or temperature fluctuations is key. Other things I recommend is waterproof containers or bags specifically for the storage of medications, to make sure that that medication is kept in a cool, dry place.

Other things to consider are battery-powered or manual thermometers. Now, these are thermometers that can go into storage spaces to monitor the temperature of medications, especially those that are needed to be kept within a specific range, such as refrigerated medications. It can guarantee that those medications are being kept at the appropriate temperatures.

Lastly, backup power sources—in recent years, I think these are more attainable and more capable from a storage and portability standpoint—such as portable generators or battery packs that can provide power to cooling devices is something else patients should have in their arsenal. There are also batteries that have solar power charging capabilities, and even others that can be charged off a car battery. Like I said, in recent years, there's been a lot of development in the capacity and portability of these type of devices that can empower patients during these times.

Drug Topics: What medications are particularly sensitive to temperature changes?

Phillips: The biggest one that a lot of patients resonate with is insulin. Insulin is a product used for diabetes, as well as blood sugar control, and must be kept refrigerated. It can be stored at room temperature for up to 28 days, but by this time, it’s usually used up and the patient needs to go on to the next pen or the next vial. So, I usually recommend patients keep the insulin product refrigerated until first use, at which time the product can be kept at room temperature, but all the subsequent products should be kept within that refrigerated space. As an example, a patient can use one vial or take one pen out for 28 days of use at room temperature, or until they finish it, and then leave the others in the fridge and only pull them when the next one is needed.

There are other medications that require refrigeration, such as biological agents and antibiotics, certain eye drops, ear drops, hormone therapies, and probiotics. Other medications that have been shown to have some sensitivity to temperature changes are thyroid medications, inhalers, antibiotics, as well as emergency medications such as EpiPens that are used for allergic reactions, or nitroglycerin, which is a little pill that's used for chest pains.

I would say the biggest thing that helps patients stay informed of their medications is the prescription information sheet that comes with every prescription that gets dispensed. These sheets are required to discuss the storage requirements of said medication that's being dispensed. So, in addition to your pharmacist, those papers are really good resources for patients to identify which of those medications might have temperature sensitivities.

Drug Topics: If medications become compromised due to a power outage, how should patients properly dispose of them?

Phillips: That’s a common question that pharmacists get in and outside of disaster preparedness, but one thing that has been increasing in popularity is drug take back programs. There are a lot of established drug take back programs which are helpful because they have established drop off locations, and those can be found through a simple internet search or by use of the Drug Enforcement Administration website, which will identify drug take back programs in your area.

Also, there are certain medications that can be flushed down the toilet. Actually, the FDA has a flush list, and they specifically identify medications that are at high risk of abuse, such as pain medications or opioids, that can be flushed. Now, there is some controversy about flushing medications from an environmental standpoint. However, it has been shown that the risk of harm from accidental exposure to said medications vastly outweighs the negligible environmental effects, so flushing is an appropriate option.

Lastly, a common one is household trash. I recommend that patients remove their medications from their original containers so that they're not as easily identified and place them in a sealable container with an unpalatable substance, such as coffee grounds, dirty cat litter—essentially, the less appealing, the better to put medication in.

No matter how patients dispose of their medications, another recommendation that I feel like is the most important step is making sure to remove any personal information that is associated with the medication prior to disposal.

Drug Topics: How can pharmacists effectively communicate with patients during and after a power outage, especially in cases where patients may have limited access to information or resources?

Phillips: This goes back to the common theme of pre-event planning. Going both ways, it is key that the pharmacist has updated emergency contact information for the patient and that the patient knows who to contact at the pharmacy. Also, pharmacists should make sure that the patient's medication list is up to date and that the patient is provided with those medication information sheets in case they have any questions regarding said medications.

There can be a lot of communication barriers throughout disaster preparedness, but again, in this day and age, there's a lot more routes of communication that exist. I think text messaging services have drastically improved. Now, this is usually something that a patient has to elect into at their retail pharmacy, but that is another mode of communication that a pharmacy can provide for the sake of patients that are filling at that pharmacy. Emails are another route as well.

Social media, local TV, and radio also come out with announcements, both before, during, and after the storm. Additionally, retail pharmacies and pharmacies in the community grow very strong community partnerships with their local shelters and community centers to disseminate information while coordinating with local health care providers. Pre-event planning is key, and there's a lot more routes of communication, but checking to see which one of those the patient is most comfortable with and making sure that they're able to receive information is crucial.

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