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How to get involved in unused opioid disposal

Have you had or currently have extra or expired opioids in your possession? Ever had a friend tell you that they have some and wanted to know what to do them? Pharmacists and other healthcare providers get asked these questions quite a bit. It is important to educate on why, when, and where disposal of these substances takes place. Unfortunately, holding onto these medications can be very dangerous if they aren’t disposed of properly. Three potentially harmful situations have been identified.

First, storing unused opioids in a non-secured area can lead to accidental ingestion. Opioids are among the most common medications accidentally ingested by children leading to emergency room visits.1 Almost one out of every 180 children aged two years has an emergency-room visit each year because of a medication overdose.1 Besides children, anyone that has access to your home could potentially ingest the medication or remove them from your home for other reasons. People that could be found guilty of stealing medications that you may not consider include child or dog sitters, housekeepers, family, subcontractors, or friends. Opioids within the home should be treated like guns and placed in a designated, secure and discrete area.

Next, some patients have the misconception that unused opioids should be flushed down the toilet as a primary option. Drug takeback centers are the recommended way to forfeit opioids. Disposing meds into the sewer supply can lead to traces of medication in tap drinking water, however the FDA concluded negligible risk to humans and the environment.2 Flushing is only recommended for certain drugs if a takeback option is not readily available.

Finally, the unused opioids can lead to prescription drug abuse. Although users may think they know what they are ingesting and their personal limits, laced products are widely available, sometimes have no noticeable difference in appearance, and can easily lead to respiratory failure and death. For example, in Connecticut, the number of deaths involving cocaine and fentanyl together has increased 420% in the past three years, while heroin and fentanyl claimed even more lives.3

The U.S. Drug Enforcement Administration (DEA) sponsors National Prescription Drug Take Back Day each year. This year it will be held on April 25, 2020. Since 2010, this initiative has seized 12.7 million pounds of unused or expired prescription medication and vape devices.4 This program serves as both a valuable resource to the community and a stage to examine the causes of medication waste.1 Current sites that offer takeback include community pharmacies, schools of pharmacy, and local business organizations. Is your school, church, place of business, gym, or grocery store part of takeback?

Starting a new takeback site can be overwhelming but establishing a timeline with each task can help make it more manageable. The first step would be to form an event team that at minimum would contain a law enforcement officer, pharmacist, and community sponsors. Next is to find a location that is safe and accessible for walk up or drive through service. It is vital to check with the Department of Environmental Conservation, the Department of Health, local law enforcement, and the DEA in order to comply with state and federal regulations. Next step is to provide the law enforcement agency with the municipal-waste combustion facility that will perform the destruction. Organizing supplies and volunteer staff will help keep the event organized. Publicize the event through local and social media to increase awareness. Finally, set up law enforcement transportation of the collected opioids to the destruction site.1

Health care practitioner counseling on unused opioid medications is a quick and easy way to educate patients. Pharmacists, due to their accessibility and expertise in medication knowledge, can be highly active in preventing harm and diversion. Participants who received counseling were more likely to have properly disposed unused opioids.5 Practitioners should undergo detailed training to ensure they educate their patients correctly and are able to do it in an efficient way that does not significantly interrupt workflow.

I encourage anyone that needs to dispose of opioids to find a controlled substance public disposal location in your area. When I entered my zip code, I was able to find a community pharmacy only five miles away that I pass on a regular basis. This is the easiest and safest way to dispose of unused opioid medications. For more information on alternative disposal practices, visit the FDA website.

References:

  1. https://www.uspharmacist.com/article/role-of-the-pharmacist-in-proper-medication-disposal
  2. https://www.fda.gov/drugs/disposal-unused-medicines-what-you-should-know/drug-disposal-flush-potentially-dangerous-medicine#FlushList
  3. https://www.npr.org/sections/health-shots/2018/03/29/597717402/fentanyl-laced-cocaine-becoming-a-deadly-problem-among-drug-users
  4. https://www.getsmartaboutdrugs.gov/content/national-take-back-day
  5. https://www.japha.org/article/S1544-3191(19)30348-6/fulltext