Improper Disposal of Prescription Opioids Among Young Adults

The opioid crisis has made headlines for a few years now, and policymakers have made many efforts to combat it. Nonetheless, overdoses and deaths are still occurring at an alarming rate. Between July 2016 and September 2017, opioid overdoses increased by 30% across the United States and by 70% in the Midwest alone.¹ The crisis particularly affects college-aged young adults. Even though opioid prescription rates are highest in elderly populations, the age group of those who are 18 to 25 years has the highest rate of painkiller misuse.² Misuse is considered taking a prescription in a way other than it was prescribed, taking another person’s prescription, or taking a prescription with the goal of getting high.³ Most people who use prescription opioids for nonmedical reasons acquire them informally from someone they know at no cost.⁴

This raises an important question about proper disposal of opioids and who has access to these prescriptions. Adolescents and young adults are commonly prescribed opioids after procedures such as wisdom tooth removal and surgeries following sports injuries. Patients who do not take the full prescription often do not know what to do with the extra pills. In fact, if someone has extra painkillers following a procedure, it can be easier to keep the pills around or give them to a friend than it is to dispose of them properly, simply because many patients do not know what proper disposal entails. This situation has resulted in young adults, who are unaware of the risks of misusing opioids, having easy access to opioids and, in turn, being at risk for addiction and dependence. This age group is similarly likely to be uninformed about the appropriate procedures for handling excess prescription pills.

THINGS I HAVE LEARNED ON THE JOB

Approximately 100 million opioid pills prescribed for wisdom tooth removal, or about half of the total opioids prescribed for the surgery, are left unused every year.⁵ In my work as a patient advocate, I have come across many young adults who have used opioids for medical reasons. Over time, I asked and learned what these young adults do with the pills, how they dispose of them, whether they keep them, and so on. Through myriad conversations, I have obtained information that might be of relevance to public health practitioners, academicians, government officials, physicians, dentists, and other advocates who are actively trying to decrease prescription opioid misuse.

I worked with a young man who described being prescribed 25 codeine pills after his wisdom tooth removal. Although he did not feel he needed 25 pills, he filled his prescription, used two pills and then gave the rest to his friend. A college student told me about returning for a refill of painkillers after complications with her tonsils removal. She was given a one-liter bottle of hydrocodone without showing any identification. One of the most telling stories I heard on the job was that of a young woman who was prescribed 40 oxycodone pills following her wisdom tooth removal. She took only 12 and kept the pills around until she had time to properly discard them, leaving 28 pills in her medicine cabinet. Another story I heard involved two young adults who felt themselves becoming dependent on opioids and actively decided to wean themselves from the pills, leaving the rest of the pills in the cabinet. A 20-year-old patient wisely decided to take ibuprofen instead of the pills prescribed because of the side effects associated with opioids but left most of the remaining prescription in the medicine cabinet.

These are just a few stories I have heard that confirm the importance of drug disposal directions and guidance in an age group that has high rates of opioid addiction. Even when patients recognize the dangers of opioids and the possibility of dependence, proper disposal is an issue and excess opioids can end up readily available to friends and family members.

RECOMMENDATIONS

Most of these young adults had bad experiences with opioids after their medical procedures and made the responsible decision to discontinue their use. Even so, almost all of them either kept the pills around or gave them to a friend or family member. This is consistent with national data, which reveal that most people who misuse a prescription opioid initiate it with an opioid that they received from a friend or family member for free.⁴ This availability of prescription drugs to nonpatients is particularly worrisome, considering that 80% of heroin users start with misusing a prescription opioid.⁶ Unused opioids sitting in medicine cabinets can be extremely dangerous and can lead to a highly addictive prescription falling into the hands of someone who could misuse the drug.

With death rates associated with opioids increasing at astonishing rates in recent years, many police stations, pharmacies, and community organizations have made it a point to increase the availability of pill drops where patients can properly dispose of prescription pills. Young adults should research these pill drops to ensure that their prescriptions do not become accessible to others. Similarly, pharmacists might consider adding a tag to the prescription bottle that describes how and where patients should dispose of the prescription. Additionally, patients can mix excess pills with an unappealing substance like coffee grounds or cat litter in a ziplock bag and dispose of this in the trash.⁷

Overall, it is best to play it safe when dealing with highly addictive prescription opioids. Improving disposal practices could significantly decrease the rates of misuse associated with both prescription and illicit opioids.