Medications in emergencies

01 — Temperature and medication potency

Heat breaks medications down. Cold causes some to crystallize or separate. Either can make them ineffective or unsafe.

Most oral medications, including tablets and capsules, should be stored at room temperature between 59 and 77 degrees Fahrenheit in a cool, dry place away from light. Heat exposure causes chemical breakdown, which means the drug may not work as intended and may produce breakdown byproducts. Some medications that are affected by heat include antibiotics, hormone-based drugs (birth control, thyroid medications), anti-seizure medications, and rescue inhalers. A car left in the sun can reach temperatures well above 100 degrees Fahrenheit, making it one of the worst places to store medications, even temporarily.

Cold temperatures can cause liquid medications to separate or become clumpy. Freezing causes insulin to form crystals that damage its effectiveness. Unlike heat-damaged medications, frozen medications usually appear unchanged, which makes accidental freezing particularly dangerous.

If medications have been exposed to extreme temperatures during a power outage, flood, or evacuation, contact a pharmacist before using them. There is usually no visible way to tell if a medication has degraded.

02 — Insulin storage in emergencies

Opened insulin can last up to 28 days unrefrigerated — but not in extreme heat, and never if it has been frozen.

Insulin requires careful handling during power outages, evacuations, and disasters. According to FDA guidance for emergency conditions, insulin products in vials or cartridges, whether opened or unopened, may be stored unrefrigerated at temperatures between 59 and 86 degrees Fahrenheit for up to 28 days and continue to work effectively.

During an emergency, keeping insulin as cool as possible without freezing it is the priority. A small cooler with an ice pack wrapped in a cloth works well. Direct contact with ice or ice packs can freeze insulin, so always use a barrier. Keep insulin out of direct sunlight and away from heat sources. Monitor blood sugar more frequently when using insulin that has been stored under non-ideal conditions, as its effectiveness may be reduced. Seek medical attention as soon as the emergency allows.

If insulin looks cloudy when it is normally clear, or if a normally cloudy insulin looks unusual, it may have been compromised. Discard it and seek a replacement if at all possible.

03 — Household medication list

A medication list is one of the most useful documents a household can prepare before an emergency — and one of the most commonly missing ones.

In an emergency, especially when separated from your primary care provider or pharmacy, a current medication list allows emergency personnel to provide safe and appropriate care. It also helps you obtain emergency prescription fills when your pharmacy records are unavailable.

A complete household medication list should include for each person and each medication:

• Medication name (generic and brand name)
• Dose (strength and amount taken per dose)
• Frequency (how often and at what times)
• What condition it treats
• Prescribing physician's name and contact
• Pharmacy name, phone number, and prescription number
• Known drug allergies or adverse reactions
• Any relevant medical conditions (diabetes, heart disease, epilepsy, etc.)

Store a printed copy in your emergency kit, a digital copy in a password-protected location accessible from any device, and a copy given to a trusted person outside your household. Review and update it when any medication changes.

04 — Controlled substances in emergencies

Keep controlled substances in their original labeled containers. Carry a copy of the prescription. Cross-border rules are stricter.

Controlled substances — including opioid pain medications, ADHD medications, benzodiazepines, and certain sleep aids — are subject to federal and state regulations that do not suspend during an emergency. During an evacuation or emergency, the most important rules are:

Keep medications in their original pharmacy-labeled containers. The label serves as legal documentation that the medication is lawfully prescribed to you. Transferring controlled substances to unlabeled containers or pill organizers creates legal ambiguity and can lead to confiscation by law enforcement or border agents.

Carry a copy of the original prescription or a letter from your prescribing physician. During extended emergencies when refills are needed, this documentation helps pharmacies provide emergency supplies. Most states allow a limited emergency supply (often 72 hours to 7 days) for controlled substances when the prescribing physician cannot be reached, but policies vary by state and drug schedule.

Do not share controlled substances with other household members, even in an emergency. This constitutes illegal distribution regardless of circumstance.