Buyback Program of Unused Prescription Opioids in US Rural Communities, 2017–2018

Liu, Jean Y.; Franklin, Julie S.; Gesek, Frank A.; Anderson, Joseph C.

doi:10.2105/ajph.2020.305730

Cited by 10 publications

(6 citation statements)

References 41 publications

(41 reference statements)

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“…These results suggest the 29% return rate of leftover opioids (when paid up to $50) reported by a Veterans Affairs pilot study is not anomalous and financial incentives alone are not enough to drive leftover opioid disposal. 26 , 27 Our findings also may explain why most interventions providing home disposal bags to patients reported disposal rates of 55%–86%. 19 – 21 Disposal bags allow patients to neutralize and dispose of leftover opioids at home with regular trash quickly and safely.…”

Section: Discussionmentioning

confidence: 67%

“…The Drug Enforcement Administration launched the first nationwide prescription take-back program in 2010. 16 Since then, drop boxes, 17 community take-back events, 18 home disposal bags, 19 – 22 patient education, 23 – 25 and financial incentives 26 , 27 have been used to promote opioid disposal. These interventions have had mixed success.…”

Section: Introductionmentioning

confidence: 99%

“… 22 One survey found 84% of patients would be more likely to use a drug take-back service if they were offered a small financial incentive, but a Veterans Affairs pilot study found only 29% of rural veterans returned leftover opioids despite being offered $5 per returned tablet (max $50). 26 , 27 Why certain interventions have been more successful than others remains unclear. 8 , 9 Our group and others previously identified convenience, financial incentives, disposal method awareness, low perceived risk of nondisposal, mistrust of law enforcement, future use, and forgetfulness as facilitators and barriers to disposal.…”

Section: Introductionmentioning

confidence: 99%

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Patient Willingness to Dispose of Leftover Opioids After Surgery

Draper

Bleicher²,

Kobayashi³

et al. 2022

Annals of Surgery Open

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Objectives: We examined how convenience and financial incentives influence patient willingness to dispose of leftover prescription opioids after surgery. We also identified additional barriers and facilitators to disposal. Background: In the United States, up to 70% of surgical patients are prescribed opioids and up to 92% will have leftover tablets. Most do not dispose of leftover opioids, increasing the risk for opioid-related harm. Current interventions promoting opioid disposal have shown mixed success. Methods: We conducted a mixed methods study using a standard gamble survey and semi-structured interviews. Participants estimated willingness to dispose in 16 scenarios with varying convenience (time requirements of <5, 15, 30, and 60 minutes) and financial incentives ($0, $5, $25, $50). We estimated the likelihood of disposal using a multivariable mixed effects modified Poisson regression model. Semi-structured interviews explored how convenience, financial incentives, and other barriers and facilitators influenced decisions to dispose. Results: Fifty-five participants were surveyed and 42 were interviewed. Most were willing to dispose when the time required was <15 minutes. Few were willing to dispose if the process required 60 minutes, although a $50 financial incentive increased rates from 9% to 36%. Anxiety about future pain, opioid scarcity, recreational use, family safety, moral beliefs, addiction, theft, and environmental harm also influenced decision-making. Conclusions: Interventions promoting opioid disposal should focus on convenience, but the selective use of financial incentives can be effective. Tailoring interventions to individual barriers and facilitators could also increase disposal rates.

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Section: Discussionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patient Willingness to Dispose of Leftover Opioids After Surgery

Draper

Bleicher²,

Kobayashi³

et al. 2022

Annals of Surgery Open

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“…29,30 The lone study using financial incentives to promote opioid disposal found that only 30% of veterans participated, despite being paid $5 per returned tablet (max $50). 31 Prior studies by our group and others suggest that providing postoperative home-disposal bags resulted in 55%-95% of patients disposing of their leftover opioids. [32][33][34][35][36] However, a subsequent trial showed disappointing results, with only 14% of patients disposing of their opioids.…”

Section: Introductionmentioning

confidence: 91%

“…Interventions using only education to promote disposal (e.g., handouts and videos) have shown either null 26–28 or modest effects (i.e., absolute increases in disposal of 11%–22%) 29,30 . The lone study using financial incentives to promote opioid disposal found that only 30% of veterans participated, despite being paid $5 per returned tablet (max $50) 31 …”

Section: Introductionmentioning

confidence: 99%

Evaluating a health system‐wide opioid disposal intervention distributing home‐disposal bags

Huang,

Bleicher,

Torre

et al. 2023

Health Services Research

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ObjectiveTo evaluate a health system‐wide intervention distributing free home‐disposal bags to surgery patients prescribed opioids.Data Sources and Study SettingWe collected patient surveys and electronic medical record data at an academic health system.Study DesignWe conducted a prospective observational study. The bags were primarily distributed at pharmacies, though pharmacists delivered bags to some patients. The primary outcome was disposal of leftover opioids (effectiveness). Secondary outcomes were patient willingness to dispose and factors associated with disposal (effectiveness), recalling receipt of the bag (reach), and recalling receipt of bags and disposal over time (maintenance). We used a modified Poisson regression to evaluate the relative risk of disposal. Inverse probability of treatment weighting, based on propensity scores, was used to account for differences between survey responders and non‐responders and reduce nonresponse bias.Data Collection/Extraction MethodsFrom August 2020 to May 2021, we surveyed patients 2 weeks after discharge (allowing for home opioid use). Eligibility criteria were age ≥18, English being primary language, valid email address, hospitalization ≤30 days, discharge home, and an opioid prescription sent to a system pharmacy.Principal FindingsWe identified 5134 patients with 2174 completing the survey (response rate 42.3%). Among respondents, 1375 (63.8%) recalled receiving the disposal bag. Among 1075 respondents with leftover opioids, 284 (26.4%) disposed, 552 (51.3%) planned to dispose, 79 (7.4%) did not plan to dispose, 69 (6.4%) had undecided, and 91 (8.5%) had not considered disposal. Recalling receipt of the bag (incidence rate ratio [IRR] 1.25, 95% confidence interval [CI] 1.13–1.37) was positively associated with disposal. Patients who used opioids in the last year were less likely to dispose (IRR 0.82, 95% CI 0.73–0.93). Disposal rates remained stable over the study period while recalling receipt of bags trended up.ConclusionsA pragmatic implementation of a disposal intervention resulted in lower disposal rates than prior trials.

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