If you’ve ever wondered what would happen to your epinephrine if you thoroughly abused it, I have some insight!
A few years ago, I stopped disposing of expired EpiPens. I had the vague intention of having a family Epi Practice Party, but instead they just sat there. Then I began thinking about the few studies that have been done on epinephrine storage conditions, and I wondered how hard it would be for me to intentionally make the solution in the pens discolor using heat or cold (as that is the only indicator a user has as to whether the epinephrine is viable.) I had to wait for the hot days of summer to use my car as an oven, replicating the conditions that someone in the “real world” might put their pens through.
Discoloring the epinephrine proved much harder than I expected, so I shifted my focus over to how the abused EpiPens would fire, and the results surprised me! Watch the video below to see the results!
About these results (watch the video first!)
To be honest, I expected that the frozen pen wouldn’t behave, but the hot pen surprised me. I’m now wondering if there is any chance that this pen would have misfired no matter what conditions it was kept it–in other words, did the heat cause the problem, or was this pen defective in the first place? Mylan DID have a recall last year. None of our EpiPens were included in the recall, but I remember the recall making me scratch my head a few times, and I wondered if there were more defective pens than the recall suggested.
To this end, I fully intend to expand this experiment. I’d like to cook several more pens to see if this problem happens again, so stay tuned and I’ll update this post (and our YouTube and Social Media) as information becomes available.
About my methods
I began on June 28, 2018. I took three EpiPen Jrs, all from the same lot and with the same expiration. I marked one as “Control,” one as “Hot Car,” and one as “Freezer.” It was supposed to be a 100 degree day.
On day 1 I had the control on my counter, one in the Freezer (which I measured at around -12 degrees), and one in my Hot Car. For the Hot Car, I parked it outside in our driveway, facing south, with the pen on the dash in direct sunlight. I checked the pens and measured the temperature hourly on that first day, and the hottest it got inside the car was between 180 and 200 degrees Fahrenheit (my thermometers did not agree with one another.)
At around hour 3, the solution in the pen in the Freezer started to look like an ice cube–I could see little striated lines that you would typically see in ice. None of my pictures really picked that up, but it’s what I could see in person. I thought the Hot Car pen looked a little cloudier a few times, but that was just wishful thinking, because when I compared it to the Control, it was still just as clear.
I have since realized that checking the Hot Car pen hourly was completely unnecessary. This experiment was live in our Instagram stories that day, and several followers chimed in that they’d left EpiPens (accidentally or on purpose) in the car for YEARS and the solution never discolored.
So I gave up on hourly checking but decided to keep going for a while. I left the frozen pen in the Freezer for 12 days straight, day and night.
I continued to move my car into the garage at night, but I parked it in the driveway again every day (not always bright and early, but every day) for the next two weeks. We did get some cloud cover in the afternoons on the first few days, but the pen got cooked for a portion of most of those days.
On day 3, I added a second pen to the freezer and the dash–that was when it occurred to me that they might behave differently fresh out of the freezer (or hot car) than if they were allowed to return to room temperature.
All 5 pens had the same expiration (August ’17), though the 4th and 5th pens came from a different lot than the first three.
I labeled them “Hot Car 1,” “Hot Car 2,” “Freezer 1,” and “Freezer 2.” With pen 1 for each being the ones I started with on June 28. Pens 1 were those that I allowed to return to room temp. Pens 2 were those that stayed hot/cold until moments before firing.
So to make sure it’s clear, the Control, Hot Car 1, and Freezer 1 were all from the same lot (ended in 78). Hot Car 2 and Freezer 2 came from a lot ending in 75.
(The pen that jammed was Hot Car 1, and it came from the same lot as my Control and Freezer 1.
On Monday, July 9th I stopped cooking the first hot pen, and pulled the first frozen pen out of the freezer. The other pens stayed in the hot car and freezer. I had intended to fire them that day, but the day got away from me, as did Tuesday, so I fired them late afternoon on Wed, July 11, 2018. (So by losing track of time, the extra pens received as much abuse as the first ones.)
The hot pens never discolored. As I mentioned, the frozen pens looked frozen, but upon thawing, the solution from the frozen pen looked clear again.
I chose my firing method (something I’ve seen the esteemed Dr. Julie Brown do) because I suspected that the epinephrine in the frozen pens was an ice block, and thought it might either refuse to fire at all, or do what it did (fire the needle but was unable to eject the medication.) Injecting them into fruit would not have revealed that the medication did not come out.
Since my initial day of experimentation, I’ve been in close contact with Jen Burch of Blue Bear Aware. She had been performing some of her own tests, trying out a temperature sensor and corresponding app for epinephrine monitoring. We’ve shared a lot of info on the effects of temperature on epinephrine. The two of us agree that epinephrine does degrade in extreme temps, though the studies have indicated that some epinephrine is still viable. It seems that epinephrine needs to go through substantial abuse of certain types in order to become discolored–that means that clear solution DOES NOT mean epinephrine that is at 100% potency. Almost all studies done on the subject have been done on epinephrine in vials, not in auto-injectors, so we have no real idea how the different storage methods might affect the medication. Unfortunately, neither of us has the tools to actually test the epinephrine for efficacy.
Jen also graciously shared one of her temp devices with me, so my further experiments will have more accurate temperature data. As the two of us geeks get more information on user effects of temperature on auto-injectors, we will compile it and share with all of you!