A huge number of opioids go unused. So where do they go?
Pharmacists know that providing a safe place for medication disposal is important, especially as the opioid crisis worsens every day. But just how important is it? A new study on unused opioid rates highlights the necessity of safe disposal.
The study, “Prescription Opioid Analgesics Commonly Unused After Surgery,” reviewed six studies involving 810 patients. The authors looked at multiple outcomes, such as filling a prescription but not taking it or using only part of a prescription, to examine trends in opioid use.
Overall, the study found that up to 92% of patients reported that they had not used all their opioids.
The rates of unused opioids were high for both outpatient surgery (77% to 92%) and for inpatient surgery (67% to 90%). The majority of surgical settings the authors examined showed more than 80% unused opioid rates. Of those patients, only a small number (0% to 21%) did not fill their opioid prescription, or filled the prescription but did not take any (7% to 14%). Of the pills dispensed, between 42% and 71% went unused.
Most patients who did not take opioids (71% to 83%) felt that they had adequate pain control without, while some (16% to 29%) were concerned about adverse effects. Only one study examined patient worries over addiction, which concerned only 8% of patients avoiding opioids.
Most patients (54% to 70%) stored their opioid medications in a medicine cabinet or another box, while some (21% to 26%) stored them in a cupboard or wardrobe. A large number (73% to 77%) stored their opioids in unlocked containers.
Very few patients (4% to 30%) planned to dispose of their unused medications or actually disposed of them. Only 4% to 9% planned to use or used FDA-recommended disposal methods.
So why does this matter? The authors mention that the report highlights the issue of stockpiling, where opioid patients hoard the medication in the event that pain returns. This can lead to an oversupply of medication around the home. This can lead to other problems: A recent study in Pediatrics found that the majority (56.1%) of hospitalizations among children exposed to opioids were due to unintentional exposures. Another
showed that more than half (54%) of people who abused opioids obtained them from a friend or relative-most of those were bought, given for free, or taken without permission.
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Part of solving this problem is access medication take-back programs, which are periodically sponsored by organizations such as the DEA or pharmacy organizations. The next DEA National Prescription Take Back Day is October 28. Pharmacists can also use medication reviews, such as the upcoming National Check Your Meds Day, to promote safe storage and disposal practices. Other solutions include providing disposal kiosks in the pharmacy, which have been used in independents and chains alike. However, as the authors warn, pharmacies are a possible solution, but are forced to “assume unwanted costs and liabilities in taking back scheduled medications.”
The authors also recommend new approaches to prescribing, but warn that a “one-size-fits-all tactic” could leave many patients behind. Limits to opioid prescription lengths are gaining popularity, but some question their efficacy. A study published last Tuesday in the Annals of Medicine showed that around 75% of opioid prescriptions are written for 10% of patients. According to the authors of that study, strategies for combatting abuse should focus on that group of 10%, rather than sweeping changes to opioid prescribing laws and practices.
Other policy efforts, such as mandatory prescription drug monitoring programs and e-prescribing are also gaining popularity.