Opioid Disposal Boosted With Simple Intervention

Surgery patients were more likely to dispose of leftover opioid pills when an opioid disposal kit was mailed to them, a randomized clinical trial showed.

Among patients who received opioids after an orthopedic or urologic procedure, 60% of those who received an at-home disposal kit said they disposed of extra opioid tablets, reported Anish Agarwal, MD, MPH, MS, of the University of Pennsylvania in Philadelphia, and co-authors.

In contrast, 42.7% of patients who did not receive a kit said they disposed of their drugs. Baseline self-reported disposal rates were 25% to 30%, Agarwal and colleagues wrote in a JAMA Network Open research letter.

“At-home disposal offers a simple, just-in-time method,” Agarwal told MedPage Today. “The key here is reducing the amount of effort it takes for the individual to dispose. Mailing or physically taking unused tablets back are also good methods, but may require extra effort.”

“If we can improve disposal rates at scale, this could represent a tremendous opportunity to decrease risk to patients and anyone in their home or immediate circle,” Agarwal added. “Decreasing the number of circulating tablets may help reduce misuse and extended use.”

How to dispose of leftover opioids has come to the forefront in light of a recent FDA proposal that would require prepaid envelopes for outpatient opioid prescriptions so patients can mail back unused pills.

The FDA currently recommends disposal at permanent collection sites like pharmacy kiosks or take-back events. If these options are not readily available, the agency recommends flushing pills or mixing them with an unpalatable substance and disposing of them in household trash. Several alternatives have been studied, including trials of activated charcoal pouches to discard post-surgery opioids at home.

Agarwal and colleagues studied 235 people who had orthopedic or urologic surgery and were prescribed opioid pain medication. The trial took place from April 19 to June 1, 2021.

Participants were randomized to usual care or an intervention involving an at-home disposal kit. Usual care consisted of a text message hyperlink to nearby disposal locations. Intervention participants were mailed a disposal kit timed to arrive on postoperative day 4 to 7. The kit chemically sequesters pills in a polymer gel.

Overall, 110 people were in the usual care group and 125 were in the intervention group. Participants had a median age of about 57; 55% were men, 79.5% were white, and 14.6% were Black. About three-quarters of participants were opioid-naive.

Participants reported disposal by text messaging. Odds of self-reported disposal were 2.01 (95% CI 1.2-3.4) times higher in the intervention group. An additional 480 unused opioid pills were disposed of in the intervention group, the researchers estimated.

“The process of mailing the disposal kit is simple, inexpensive (approximately $1.50 per mailed kit), and scalable,” they wrote.

The study’s limitations included its reliance on self-reported disposal, Agarwal and co-authors acknowledged. People who agreed to participate in the study were more likely to be younger and white, and results might not apply to other groups.

“Unused prescription opioids pose a risk to individuals and communities in the form of persistent use, misuse, or diversion,” Agarwal said. “Novel ways of making disposal simple, easy, and timely are needed to help remind patients to dispose.”