Patterns of Storage, Use, and Disposal of Opioids Among Cancer Outpatients

Abstract

Purpose. Improper storage, use, and disposal of prescribed opioids can lead to diversion or accidental poisoning. Our objective was to determine the patterns of storage, utilization, and disposal of opioids among cancer outpatients. Patients and Methods. We surveyed 300 adult cancer outpatients receiving opioids in our supportive care center and collected information regarding opioid use, storage, and disposal, along with scores on the CAGE (cut down, annoyed, guilty, eye-opener) alcoholism screening questionnaire. Unsafe use was defined as sharing or losing opioids; unsafe storage was defined as storing opioids in plain sight. Results. The median age was 57 years. CAGE was positive in 58 of 300 patients (19%), and 26 (9%) had a history of illicit drug use. Fifty-six (19%) stored opioids in plain sight, 208 (69%) kept opioids hidden but unlocked, and only 28 (9%) locked their opioids. CAGE-positive patients (p 5 .007) and those with a history of illicit drug use (p 5 .0002) or smoking (p 5 .03) were more likely to lock their opioids. Seventy-eight (26%) reported unsafe use by sharing (9%) or losing (17%) their opioids. Patients who were never married or single (odds ratio: 2.92; 95% confidence interval: 1.48-5.77; p 5 .006), were CAGE positive (40% vs. 21%; p 5 .003), or had a history of illicit drug use (42% vs. 23%; p 5 .031) were more likely to use opioids unsafely. Overall, 223 of 300 patients (74%) were unaware of proper opioid disposal methods, and 138 (46%) had unused opioids at home. Conclusion. A large proportion of cancer patients improperly and unsafely use, store, and dispose of opioids, highlighting the need for establishment of easily accessed patient education and drug take-back programs. The Oncologist 2014;19:780-785 Implications for Practice: In our study, a large proportion of cancer outpatients did not store, use, and dispose of opioids safely. Our findings reveal the need for universal education of all patients receiving opioids regarding safety around opioid use to minimize the risks of diversion or accidental poisoning. Strict implementation of patient education resources at the time all opioids are prescribed (by physicians) and dispensed (by pharmacists) could significantly decrease the amount of unused opioids available for diversion or accidental poisoning.

Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study

“…10 Recent studies revealed that only 9% of oncology patients and 0% of patients recently discharged from the emergency department with an opioid prescription stored opioids in a locked area. 11,12 Published data are lacking to show that improper storage and disposal of opioid medications may be associated with an increase in opioid abuse, morbidity, or mortality; however, approximately 70% of those using opioids for non-medical purposes acquired opioids from friends or relatives prescribed these medications. 13 Diversion in our youth population is a growing concern as 90% of addictions start during the teenage years, with 20% abusing opioids.…”

“…These domains were selected based on deficits in safe opioid handling and disposal reported previously as well as common questions that patients at our institution asked about opioid analgesics which did not seem to be adequately addressed by prescribers. [10][11][12] A formal evaluation of the pamphlet was not performed, but it was piloted in preoperative and postoperative patients to ensure that the content was at an appropriate reading level.…”

Utilization of Ministry of Health Medication Return Programme, Knowledge and Disposal Practice of Unused Medication in Malaysia

“…Several international studies have shown that 48-75% of their population are aware that improper disposal of unwanted medication will lead to contamination of the environment. [9][10][11][12] The most common way to discard unwanted medication in majority of the countries is to throw it into the trash, [13][14][15][16] except for the Swedish where returning to the pharmacy is the predominant method to "dispose" unused medication. [17] A systematic review reported that due to the paucity of evidence, connection between knowledge on environment impact of inappropriate disposal and the preference toward disposal method cannot be established.…”

Proper Drug Disposal: Studying a Solution to Household Prescription and Over-the- Counter Drug Abuse

“…However, despite the recent increase in and reported efficacy of drug take-back programs, recent studies suggest that the mere presence of such programs is not sufficient. Many individuals continue to employ incorrect drug disposal methods, which can largely be attributed to a lack of education on safe disposal practices [44][45][46]. Overall, we propose that reduced prescription and OTC drug abuse hinges on a combined effort that integrates education, growth and expansion of drug disposal programs, and elimination of environmental stressors (refer to and OTC drugs as well as safe methods of drug disposal.…”

“…In addition, those individuals who had been previously instructed on correct disposal methods were more likely to think that returning medications to a pharmacy was acceptable. More recently, Reddy et al [44] surveyed cancer patients receiving opioids on their medication disposal practices. 74% of patients were not aware of correct drug disposal methods and 46% of patients had unused drugs in their home.…”