By Katrina Capapas, Pharm.D., PGY1 pharmacy resident and Cheryl Genord, R.Ph., pharmacy clinical specialist in pain management, St. Joseph Mercy Hospital, Ann Arbor, MI
Prescription drug misuse and abuse continues to be a problem throughout the United States. Particularly, the dramatic increase of prescription opioids since 1999 has resulted in unrestricted availability of unused opioids and has unlocked opportunities for abuse and addiction.1 Per the Centers of Disease Control and Prevention (CD), prescribers wrote 66.5 opioid prescriptions for every 100 Americans in 2016.2 In 2015, the total number of prescribed opioids equated to 640 morphine milliequivalents (MME), which equates to every American being medicated around the clock for three weeks.3 Additionally, Jones et al. evaluated a national survey that identified sources of opioids for non-medical use; the authors found that up to 56 percent of survey responders reported obtaining opioids from a friend or relative for free.4
At the end of 2017, Michigan lawmakers passed new legislation to help curb the opioid epidemic and promote proper prescribing and disposal of opioids.5 The policy includes a provision where a prescriber or health professional must address the patient with the following information before prescribing an opioid:
1. The dangers of opioid addiction.
2. How to properly dispose of an opioid.
3. Diversion of a controlled substance is a felony.
4. A discussion on the harm of opioid exposure to the fetus for pregnant patients.
In light of the new policy, pharmacists can help patients by providing information on how to remove unwanted or unused opioids to reduce the chance of accidental misuse. Below are ways to dispose of unwanted prescription opioids and other medications:
1.Take-Back Programs: Patients can take old, unused or unwanted medications to an authorized pharmacy for proper disposal. Michigan pharmacy locations are available online here via the Michigan Department of Environmental Quality.5,9 The Michigan Pharmacists Association also holds an annual Medication Disposal Event on the south Capitol lawn in Lansing; the next event will be held on Tuesday, Sept. 11, 2018, from 10:30 am – 1:30 pm.6 Additionally, the Michigan OPEN hosts take-back programs throughout the state.7 The last take-back event in September 2017 collected 17,500 opioid pills from consumers. Visit the website here for updates on the next take-back event.
Patients can find local law enforcement agencies participating in the "Big Red Barrel" program to dispose these medications.8 All 29 Michigan State Police posts are collecting scheduled prescription medications every Monday through Friday. To find a law enforcement agency, visit www.Michigan-Open.org/takebackmap/.
2. Disposal in Household Trash: if patients are unable to dispose their medications at a participating pharmacy or law enforcement agency, the Food and Drug Administration (FDA) provides four simple steps on how to dispose medications in the trash:11
A. Mix medicines in unpalatable substances such as dirt, kitty litter or used coffee grounds. Do not crush tablets or capsules.
B. Place the mixture in a container such as a sealed plastic bag.
C. Throw the container in your household trash.
D. Scratch out all personal information on the prescription bottle of your empty pill bottle or empty medicine package, then dispose of the container.
Patients can also dispose of unwanted opioids using the Deterra® deactivating system.12 Deterra® uses a patented activated carbon technology to immediately deactivate opioids and other medications, and is available in different sizes for purchase on the internet or at local pharmacies. The packaging itself is biodegradable and will not significantly contribute to landfills.
3. Flushing of Medicines: Some medications can pose harmful risks if not disposed of immediately. The FDA recommends certain medications, including opioids, to be flushed down the toilet if a take-back program or other means of disposal is not available to prevent harm to other people (for more information, see the FDA Flush List).13 In light of concerns about medications in the water supply, the FDA released a study that examined ecological and human-health risks.14 Fifteen active ingredients were studied, which included buprenorphine, hydrocodone, hydromorphone, methadone, morphine, oxycodone, and oxymorphone. The study concluded that the medications were not associated with significant risks through ingestion of water or fish.
Pharmacists play an essential role in decreasing the opioid reservoir. Promoting proper opioid use and disposal is among the numerous ways they can educate patients and ultimately act as a line of defense against the opioid epidemic.
1. Analysis of Opioid Prescription Practices Finds Areas of Concern. NIH website. https://www.drugabuse.gov/news-events/news-releases/2011/04/analysis-opioid-prescription-practices-finds-areas-concern. Accessed December 18, 2017.
2. Annual Surveillance Report of Drug-related Risks and Outcomes. CDC website. https://www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf. Accessed December 18, 2017.
3. Opioid Prescribing. CDC website. https://www.cdc.gov/vitalsigns/opioids/infographic.html#graphic-a. Accessed December 18, 2017.
4. Jones CM, Paulozzi LJ, Mack KA. Sources of Prescription Opioid Pain Relievers by Frequency of Past Year Nonmedical Use. JAMA Intern Med. 2014;174(5):802-803.
5. Medication Disposal. Michigan Pharmacists Association website. http://www.michiganpharmacists.org/medicationdisposal. Accessed December 18, 2017.
5. Senate Bill 0217 (2017). Michigan Legislature website. http://www.legislature.mi.gov/(S(0j3pch3hodgym1moji4sf1gp))/mileg.aspx?page=BillStatus&objectname=2017-SB-0274. Accessed January 14, 2018.