In this study, 8.3% of the drug sample distribution units had expired, similar to the proportion reported by Hall and others (6.3%). The presence of expired medications reflects a lack of structure in the management of drug samples in institutions. Almost 50% of the clinics in this study did not manage drug samples in a structured way. For example, there was no designated individual to take care of samples according to an established procedure. More often than not, pharmaceutical representatives dropped off the samples themselves, and the nurses or physicians simply checked expiration dates before handing out the samples. Several other studies have highlighted the few resources that have been invested in this area, as well as the lack of effective drug sample management.

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In this study, 59% of the drug sample distribution units inventoried were not on Sainte-Justine local formulary. In the study by Haxby and others, 29% of drug samples given to patients were not on the hospital’s official list. A hospital’s drug formulary is established to ensure optimal drug use and patient safety. In the authors’ hospital, the drug list includes about 3000 products out of the approximately 26 000 available on the Canadian market. Drugs are listed on the formulary if they have good intrinsic efficacy and safety data, are adequately labelled, and fulfill local patient needs. It is clear that a manufacturer’s decision to offer drug samples is dictated by the emergence of new drugs and the search for a market share, rather than the needs of patients or health care professionals.

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In this study, important quantities of drug samples (78 955 doses worth Can$48 783) were found in a 500-bed university health centre. To the authors’ knowledge, no previous in-house study of this type has been reported. The variety of drugs, the amount of samples inventoried, and the very low level of compliance with local policy and procedures were surprising.

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Of the 84 identified locations, drug samples were found in 21 locations, all intended for ambulatory patients (i.e., outpatient clinics and day centres). No drug samples were found in inpatient care units.

Overall, the number of doses of drug samples (n = 78 955 doses) was 2.4 times greater than the number of doses of drug floor stock (n = 32 987 doses) (Table 1). The outpatient clinics with the largest stocks of drug samples were (in decreasing order) pneumology, obstetrics and gynecology, pediatrics, dermatology, and otorhinolaryngology, and these clinics accounted for 80% of the sample doses. The distribution of drug floor stock among the various clinics differed from that for the drug samples (Table 1).

At least 1 person was identified as being in charge of managing drug samples in 11 of the 21 locations. A total of 13 different types of storage areas were identified: examination rooms (n = 7), nurses’ offices (n = 5), nursing stations (n = 4), doctors’ rooms or offices (n = 3), rooms for measuring patients’ weight and height (n = 2), reception areas (n = 2), storerooms (n = 2), floor pharmacy (n = 1), photocopy room (n = 1), common work room (n = 1), test room (n = 1), corridor (n = 1), and recovery room (n = 1). Fourteen of these 31 storage areas did not have a lock. Six types of storage were identified: cabinet (n = 20), office area (n = 3), drawer (n = 3), storage shelf (n = 3), pantry (n = 1), and refrigerator (n = 1).

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This descriptive observational study was conducted in an urban university hospital centre. The Centre Hospitalier Universitaire Sainte-Justine in Montreal, Quebec, has 500 mother—child beds in 2 locations (450 beds at the main site and 5 0 beds at a rehabilitation site). The study was carried out at the main site, which has 21 inpatient locations (which together had 18 324 admissions in 2006/2007) and 63 outpatient locations (which had 198 227 outpatient visits and 67580 emergency visits in 2006/2007). At the time of the study, which was conducted from October 18 to November 1, 2007, the institution had about 1000 nurses, about 350 physicians, and 34 pharmacists.

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The management of drug samples in medical offices is not optimal. Pharmaceutical representatives often fill or update medication supplies without completing any written records or periodic documentation. The methods used for disposing of expired samples are unknown, although it is likely that samples are discarded with the regular garbage in some cases, rather than being disposed of safely, as required by pharmacists’ codes of practice (by incineration or burial, according to the relevant environmental laws).

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