Current estimates suggest that 70-90% of opioids prescribed after surgery go unused, with most patients not disposing these medications that can become a common source of misuse and abuse, explains Chad Brummett, MD. Current disposal options are limited to US Drug Enforcement Administration-authorized opioid collectors (law enforcement agencies, pharmacies, and organized pill-drop events), and many patients are unaware of them. For a randomized controlled trial published in JAMA Surgery, Dr. Brummett and colleagues tested the hypothesis that patients provided with an activated charcoal bag allowing for in-home safe disposal of opioids would improve compliance with unused opioids when compared with a usual care group or a group receiving an educational worksheet that detailed how to find safe disposal sites in their community.
“We found that odds of disposal were 3.8 times higher among those patients receiving an activated charcoal bag when compared with the usual care group,” says Dr. Brummett. “The activated charcoal bag also significantly improved disposal when compared with the educational worksheet control group. This study shows that a low-cost device allowing for safe, environmentally friendly disposal of opioids led to a very meaningful increase in self-reported disposal of unused medications.” Decreasing the number of unused opioids in the community could greatly decrease diversion, misuse, and abuse as well as help prevent future morbidity and mortality, Dr. Brummett adds.
Looking ahead, he notes that future studies should consider the optimal timing and location for providing the activated charcoal bag or a similar device. Studies are also needed to assess whether educational interventions together with in-home disposal devices could further improve disposal, whether follow-up reminders may be helpful, or both.