In the midst of an epidemic of prescription painkiller addiction and overdose deaths, a new Johns Hopkins Bloomberg School of Public Health survey suggests that more than half of patients prescribed opioids have leftover pills -- and many save them to use later.
The researchers, reporting June 13, 2016 in JAMA Internal Medicine, also found that nearly half of those surveyed reported receiving no information on how to safely store their medications, either to keep them from young children who could accidentally ingest them or from adolescents or other adults looking to get high. Nor were they given information on how to safely dispose of their medications. Fewer than seven percent of people with extra pills reported taking advantage of "take back" programs that enable patients to turn in unused pain medication either to pharmacies, police departments or the Drug Enforcement Administration for disposal.
"These painkillers are much riskier than has been understood and the volume of prescribing and use has contributed to an opioid epidemic in this country," says study leader Alene Kennedy-Hendricks, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School. "It's not clear why so many of our survey respondents reported having leftover medication, but it could be that they were prescribed more medication than they needed."
Says the study's senior author Colleen L. Barry, PhD, MPP, a professor who directs Bloomberg's Center for Mental Health and Addiction Policy Research: "The fact that people are sharing their leftover prescription painkillers at such high rates is a big concern. It's fine to give a friend a Tylenol if they're having pain but it's not fine to give your OxyContin to someone without a prescription."
Over the past decade, there has been a sharp increase in the rates of prescription painkiller addiction and overdose deaths. Drug overdose - the majority of which involve opioid pain relievers -- was the leading cause of injury death in 2014 among people between the ages of 25 and 64, and drug overdose has surpassed car crashes as the leading cause of injury death among this group.
In March, the U.S. Centers for Disease Control and Prevention urged doctors to avoid prescribing powerful opioid painkillers for patients with chronic pain, saying the risks from such drugs outweigh the benefits for most people. Prolonged use of these medications can lead to addiction, putting people at much higher risk for overdose and raising the risk of heroin use since it is cheaper, worsening the heroin epidemic.
For the study, a collaboration between the Johns Hopkins Center for Mental Health and Addiction Policy Research and the Johns Hopkins Center for Injury Research and Policy, the researchers used GfK's KnowledgePanel to construct a national sample of 1,032 U.S. adults who had used prescription painkillers in the previous year. The survey was fielded in February and March 2015. Among those who were no longer using prescription pain relievers at the time of survey (592 respondents), 60.6 percent reported having leftover pills and 61.3 percent of those with leftover pills said they had kept them for future use rather than disposing of them.
Among all respondents, one in five reported they'd shared their medication with another person, with a large number saying they gave them to someone who needed them for pain. Nearly 14 percent said they were likely to share their prescription painkillers with a family member in the future and nearly eight percent said they would share with a close friend.
Fewer than 10 percent said they kept their opioid pain medication in a locked location. Nearly half said they weren't given information on safe storage or proper disposal of leftover medication. More than 69 percent of those who got instructions said they had received information about turning over the remaining medication to a pharmacist or a "take back" program, but few actually did. Fewer than 10 percent reported throwing leftover medication out in the trash after mixing it with something inedible like used coffee grounds, a safe method for disposing of medication.
Kennedy-Hendricks says that physicians should, when prescribing these medications, discuss the inappropriateness of sharing and how to safely store and dispose of them.
"We don't make it easy for people to get rid of these medications," she says. "We need to do a better job so that we can reduce the risks not only to patients but to their family members."
Says Barry: "We're at a watershed moment. Until recently, we have treated these medications like they're not dangerous. But the public, the medical community and policymakers are now beginning to understand that these are dangerous medications and need to be treated as such. If we don't change our approach, we are going to continue to see the epidemic grow."
"Medication sharing, storage, and disposal practice among U.S. adults with recent opioid medication use" was written by Alene Kennedy-Hendricks, PhD; Andrea Gielen, ScD; Eileen McDonald, MS; Emma E. McGinty, PhD, MS; Wendy Shields, MPH; and Colleen L. Barry, PhD, MPP. This study was supported by an unrestricted research grant from AIG.
JAMA Internal Medicine