My recent article on expired medications opened up a discussion of how to safely handle opioid narcotics such as morphine, hydrocodone, codeine or oxycodone in the home – a worthy topic considering the current national opioid addiction crisis!
The amount of opioids dispensed from pharmacies in the US quadrupled between 1999 and 2010, and an estimated 5.1 million Americans abuse prescription pain relievers – more than the number abusing cocaine, heroin, and LSD combined. Across the nation, opioids are over-prescribed both in quantity per prescription as well as for medical conditions that do not always require these powerfully addicting drugs. When prescribed in quantities that exceed what a patient needs or uses, it is tempting to keep the extra doses for future use. This is a dangerous proposition.
Consider what can happen to leftover opioids. In 2014, more than 10 million people in the US reported using prescription opioids for non-medical reasons. Seven out of 10 people who abuse prescription drugs get or take them from a family member or friend. Every day, on average, 2,500 teens use prescription drugs (not illegal “street” drugs) to get high for the first time. And 4 of 5 heroin users report that their first high was with a prescription opioid…in other words, a leftover.
There are several options for eliminating the problem of extra opioids. One or more of these may make the most sense to you:
- Bring them to a “take-back” location. Local police stations often have kiosks designed to accept leftover medications of all types. You can also find a location to bring your medicines by visiting mass.gov/drugdropbox. The Drug Enforcement Agency (DEA) also holds National Prescription Take Back Days about twice a year. For more information, please visit the DEA website.
- Discard them in your household trash. If there are no take-back locations near you, the FDA recommends disposing of most prescription medications in your household trash. First pour the medication into a baggie and add in an inedible substance such as kitty litter, coffee grounds or dirt. Tear off or scratch out any information that is on the label on the empty prescription bottle and throw that out separately. In general, do NOT flush any medicines down the toilet or sink. Visit the FDA drug disposal website to find out more.
- Lock them up. If you insist on keeping leftover opioid doses, it is important to lock them up and to count them periodically – discarding them safely as described above once they are expired. You may purchase a safe or lockbox for this purpose. But keeping narcotics in your home, even under lock, can be an invitation to robbery or misuse. It is usually far wiser to part with these leftovers, remembering that opioids are rarely the best choice for rapid pain relief of minor injuries (think ice, elevation, rest, and compression instead) and knowing how it is important for serious injuries to be evaluated by medical experts (who could quickly administer or prescribe an opioid if one is needed). There is no need to save extras for a future crisis.
- Pick up only what you need. Do not be shy about asking your doctor if there is a non-opioid medication or method to relieve your pain before accepting a prescription for an opioid. If your doctor deems your pain severe enough for an opioid, ask for the smallest quantity he/she expects you will need. You can also request a lower quantity when you pick up your prescription.
Studies show that patients typically need to take opioids for only a few days after a painful injury or surgery. National guidelines recommend no more than 3-5 days’ worth of opioids (if they are needed at all), and Massachusetts law requires prescribers to document the need for more than 7 days’ worth to treat acute pain under most circumstances. By Massachusetts law, you can also direct your health care providers not to prescribe an opioid for you at all, ever (with the option to change your mind at any time).
Remember that the above applies to all types of potentially addicting medicines. In addition to opioids, watch out for proper storage and disposal of drug such as benzodiazepines (such as diazepam, lorazepam or alprazolam), gabapentin, tramadol, and “combination” medicines that contain opioids plus acetaminophen.
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