What If a Thief Steals Drugs from a Mailbox?

For those who have wondered if people steal medications delivered to patients' homes, a recent case report published in the

Annals of Pharmacotherapy in October 2017 provides confirmation. The essence of the case is that a 24-year-old man, who had a history of biopolar disorder, depression, and overdosing on medications during suicide attempts, broke into a mailbox and took a combination product of carvedilol and lisinopril. Fortunately, his blood pressure never dropped to dangerous levels and was kept afloat by noninvasive positive pressure ventilation, and his heart rate only dropped to 56 beats per minute. He ended up being discharged 2 days after admission to an emergency department.

In their report, the authors pointed out there are issues with medications being lost in transit by delivery services but that Federal Express and the US Postal Service have no real say on the matter as long as federal state and local laws are followed. So, it really boils to making sure that packages containing medication do not stand out.

The authors called for more stringent requirements, but not everyone is going to go out and buy a lock box for their mail. Having a signature on delivery is a possible solution, though that would be difficult for patients who are not always home. If people have to wait at home for a drug, they might as well pick it up at their local pharmacy on their own time. In this case, the legal implications were not clear: Would anyone have been held accountable had the patient died from this attempt, particularly if that would have changed the overall story?

Some companies have looked into using drones to deliver medications, and on-demand drug delivery services are gaining traction. Do these services have their own rewards and risks compared with mail order alone? There are pros and cons to each, but mail order for chronic therapy will rule supreme for the time being. Ultimately, medication diversion stemming from delivery services may not be entirely avoidable without really the raising costs of the services.

Reference

Kanter JA, Chhabra N, Zell-Kanter M. Mailbox tox: ingestion of a pharmaceutical product stolen from a mailbox. Ann Pharmacother. 2018;52(3):299.

doi:

10.1177/1060028017737789.