Effect of Drug Disposal Kits and Fact Sheets on Elimination of Leftover Prescription Opioids: The DISPOSE Multi-Arm Randomized Controlled Trial

Abstract

Objective To determine how passively providing informational handouts and/or drug disposal kits affects rates of leftover prescription opioid disposal. Design A multi-arm parallel-group randomized controlled trial with masked outcome assessment and computer-guided randomization. Setting Johns Hopkins Health System outpatient pharmacies. Subjects Individuals who filled ≥1 short-term prescription for an immediate-release opioid for themselves or a family member. Methods In June 2019, 499 individuals were randomized to receive an informational handout detailing U.S. Food and Drug Administration–recommended ways to properly dispose of leftover opioids (n = 188), the informational handout and a drug disposal kit with instructions on its use (n = 170), or no intervention (n = 141) at prescription pickup. Subjects were subsequently contacted by telephone, and outcomes were assessed by a standardized survey. The primary outcome was the use of a safe opioid disposal method. Results By 6 weeks after prescription pickup, 227 eligible individuals reported they had stopped taking prescription opioids to treat pain and had leftover medication. No difference in safe disposal was observed between the non-intervention group (10% [6/63]) and the group that received disposal kits (14% [10/73]) (risk ratio = 1.44; 95% confidence interval: 0.55 to 3.74) or the group that received a fact sheet (11% [10/91]) (risk ratio = 1.15; 95% confidence interval: 0.44 to 3.01). Conclusions These findings suggest that passive provision of a drug disposal kit at prescription pickup did not increase rates of leftover opioid disposal when compared with provision of a fact sheet alone or no intervention. Active interventions may deserve further investigation.

Efficacy of a password‐protected, pill‐dispensing device with mail return capacity to enhance disposal of unused opioids after cancer surgery

“…14,17,[39][40][41][42][43][44][45] Although there is agreement about the need for disposal of unused pills, the optimal method is uncertain. 21,46 Published interventions have focused on patient education, [18][19][20][21][22][23][24] provision of drug disposal kits, [25][26][27][28][29][30][31][32]47 and take-back programs. [33][34][35] These initiatives have shown mixed results in trials and generally rely on patient self-report without a mechanism to directly verify opioid removal from the home.…”

“…16 Yet, although 70% of prescribed opioids go unused after surgery, less than 10% are disposed of properly. 17 Interventions to enhance disposal of unused pills have focused on patient education,, [18][19][20][21][22][23][24] provision of drug disposal kits, [25][26][27][28][29][30][31][32] and take-back programs. [33][34][35] These endeavors have shown mixed results in trials and are likely insufficient in isolation.…”

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

“…151 More recently, even with greater awareness of the opioid crisis, patient education handouts did not increase opioid disposal. 152,153 Although education of children's caregivers on proper storage and disposal was reported by 60% and 50%, respectively, locked storage and disposal were reported by only 18% and 25%. 66 Moreover, there is insufficient knowledge among those providers who would need to be the educators.…”

“…Providing patients with a bag containing an inactivating modality (e.g., activated charcoal, coffee grounds) for in-home opioid disposal was found in various studies to double the disposal rate compared with an educational pamphlet (57% vs. 29%), 152 increase it by 50% (33% vs. 19%), 75 increase it by 20%, 165 or have no effect at all. 153 An interactive Web-based educational program combined with a disposal kit was more effective than just a kit alone. 75 After pediatric surgery, provision of a mail-back envelope resulted in opioid return by 19% of patents, comprising 58% of the prescriptions written.…”

A safe in-home disposal system with every opioid prescription? Food and Drug Administration is considering a potential new Risk Evaluation and Mitigation Strategy that could impact pharmacists

“…The use of commercial in-home drug disposal products (typically involving a drug deactivation system) is becoming more prevalent and is being evaluated as an option for safe and effective opioid disposal. 14,17,18 Evidence is mixed on whether the provision of commercial in-home drug disposal products to patients or their caregivers increases [19][20][21] or has no effect 22 on disposal of unused opioids.…”