America has been in an opioid overdose crisis for more than 10 years. For nearly all that time, the medical community has understood that opioid addiction often starts at home with a legitimate prescription. It is often fueled by the easy availability of leftover painkillers stored in the medicine cabinet, where a patient, teen, child and visitor can access them without controls.
After my mother-in-law passed away of old age in January 2021, we were faced with a bagful of over-the-counter (OTC) and prescription meds: pills for nausea, headaches and pain, liquid diuretics, bunion ointment, wound care. What to do with this mess! Hospice had given us weeks’ worth of morphine that ultimately was untouched, because my mother-in-law was beyond pain by then.
We called local pharmacies, police stations and hotlines. Hospice would take back the hospital bed, but not the morphine. In the middle of Queens, New York, we couldn’t find a safe way to dispose of all those meds. Finally, we used cat litter to make gooey messes of all the meds, except the ointments, doing our best to ruin the morphine pills. We tied it up in several plastic bags and tossed them in the garbage, which, unfortunately, means landfill headaches for another generation.
A couple weeks ago, I attended an FDA/Duke University (Food and Drug Administration) workshop to discuss the safe disposal of opioids in the home. I would love to tell you that research on patient drug-disposal patterns and preferences had been completed and was guiding our discussion. But no. Ten years of terrible addictions breaking up families and killing people, and we, the US, don’t have a plan to prevent the No. 1 problem that starts addictions: in-home access to opioids.
At the FDA/Duke workshop, speakers presented three pilot community-level programs, each showing some success in getting rid of excess drugs in the home, but not one of them offered more than one disposal option for the patients. And none of them could tie their results to lower addiction or mortality rates in their communities.
There has been some progress over the past decade. Research has identified healthcare-provider prescribing habits as part of the problem. A decade ago, the average number of pills in one opioid prescription was 40. Education campaigns to increase prescriber awareness have been successful, because now the number of pain pills patients take home is about 20 per prescription. Great start, fewer excess pills. But surplus pills still create opportunities for abuse and addiction.
“The essence of the problem is we have no national disposal program that is co-designed with the end users in mind,” noted Fran Quintero Rawlings of Method Collective, a systems and design consultancy. I spoke with Fran and several other experts and doctors to prepare for the workshop. During the sessions, speakers told us that the only safe way to destroy meds is to incinerate them, which keeps them out of the ecosystem and away from harm. For most people, take-back programs, provided by pharmacies and police stations, are the only path to incineration of the drugs, and they can be very difficult to find.
So many bad things can happen when excess prescriptions stay in the home. Among the situations are:
- you continue taking the drugs longer than your pain justifies, to unhealthy use, or you take them for a different pain later, which is illegal and dangerous to your health
- you give them to a family member to help them with pain, which is also illegal and dangerous to their health
- children and teens who want to experiment with drugs can get to them, or younger children might eat them, thinking the brightly colored pills and capsules are candy, visitors with substance- use disorders may find and take them, or steal them to sell
All the doctors I spoke with agreed that many people want to keep their leftover pain drugs. Then, the painkillers are available for future problems, like treatment for if an errant toothache wakes them up at 3am, or if their partner or child sprains an ankle on a weekend and needs relief. The fact is, it’s illegal for you to take an oxycontin for pain, if your doctor didn’t prescribe it to you for that condition, or to give an “oxy” to someone else, even your spouse, which a doctor prescribed to you. That’s how dangerous opioids are.
When the occasional sprain or pain happens, “I would recommend rest, ice, heat and other nonpharmaceutical methods as first-line care, until you can see a healthcare professional. Only add OTC drugs as needed, as there are side effects with Tylenol and NSAIDs as well,” recommends Lillie Rosenthal, DO, doctor of osteopathic medicine, who works with pain patients in New York City and is a member of the MedShadow Medical Advisory Board.
“Think of them [opioids] like you would a gun,” Kevin L. Zacharoff, MD, Renaissance School of Medicine at Stony Brook University and a MedShadow Medical Advisory Board member, told me. “If you must keep old prescriptions and other dangerous or potentially addictive drugs in your home, get a lockbox or store them in a hidden place. Make sure that your drugs won’t harm other people.”
Unused Drug Disposal Options
Here’s a rundown of your options for disposing of unused drugs. Remember, the easiest way to limit the drugs in your home is to request fewer pills when your healthcare professional prescribes them. Insist that you want only enough for two or three days. Or use alternatives when possible, like acetaminophen, naproxen, ice, elevation and rest.
Save, in case needed later: In addition to the risks of drugs in the home, it’s illegal to use your prescription for any pain it was not prescribed for. It’s also illegal to let someone else use a drug prescribed to you.
Flush down the toilet: This is a last resort. It’s bad for the environment (fish don’t take well to drugs). However, if you have children or others at home with a history of a substance-use disorder and no other way to dispose of them quickly, flushing could save a life.
Medicine drop-off center: You might find one at a pharmacy or a police station.
Mix the drugs into cat litter or used coffee grounds: This method is supposed to make the drugs unusable and unable to be snorted or injected. My family soaked my mother-in-law’s pills in water, so they would better adhere to the litter and be harder to clean for later misuse. Unfortunately, they then went into the garbage, which means they went to a landfill and, someday, will leach into our soil and groundwater.
Mail-back envelope: A pharmacy or pharmaceutical company could provide the envelope, which is a great option for getting them out of the home quickly and safely.
Destroy: You can buy chemical solutions that will melt the meds and make them unusable. This works, but the sludge you end up with goes into your garbage, which in turn goes into a landfill. Sooner or later, the drugs and chemicals will leach into the ecosystem.
So what’s the best way? The one that’s available to you. It’s your responsibility to keep drugs prescribed for you safe and then to get rid of them appropriately.
Remember, when unneeded drugs are out of your home, they can’t be used for abuse or cause other harm.