Active Interventions Needed to Ensure Patients Properly Dispose of Excess Opioid Medications

opioids, medication disposal, trash
hand throwing pills away. Health concept
In a 1:1:1 ratio, patients were randomly assigned to receive a drug disposal kit and fact sheet, fact sheet alone, or no additional items when filling their opioid prescription.

Passive interventions failed to increase rates of appropriate disposal of leftover prescription opioid pills, according to results of a multi-arm, parallel-group, randomized controlled trial, published in Pain Medicine.

Patients (N=499) were recruited at 2 Johns Hopkins Health System outpatient pharmacies in 2019. In a 1:1:1 ratio, patients were randomized to receive a drug disposal kit and fact sheet, fact sheet alone, or no additional items when filling their opioid prescription.

The fact sheet detailed opioid safe use, storage, and disposal protocols as defined by the US Food and Drug Administration. The disposal kit (DisposeRxÒ) comprised a powder and container that allowed for drug inactivation and disposal with household garbage.

Participants were contacted by telephone and surveyed about opioid use and disposal. Nearly half (45%) of study participants indicated they had leftover opioid medication. Among patients who had leftover medication, the median age was 34 (interquartile range [IQR], 16-56) years, 55% were women, and median daily oral morphine equivalents was 45 (IQR, 30-45) mg.

At 6 weeks, 14% of disposal kit and 11% of fact sheet recipients properly disposed of excess pills (risk ratio [RR], 1.25; 95% CI, 0.55-2.83). The control group disposed of excess medication at a similar rate (10%) as the disposal kit (RR, 1.44; 95% CI, 0.55-3.74) and the fact sheet (RR, 1.15; 95% CI, 0.44-3.01) recipients.

The most frequently used disposal methods were toilet flush (n=14), return to pharmacy (n=7), and disposal kit (n=4). One additional patient who used a disposal kit was not randomly assigned to the disposal kit group.

Safe opioid storage was reported by 8% in the disposal kit and control groups and 14% in the fact sheet cohort (P =.32).

Few individuals reported receiving proper disposal information from their health care provider (range, 10% to 15%; P =.57).

This study may have been limited by the lack of blinding and the reliance on patient-reported outcomes.

These data indicated that passive methods for encouraging proper disposal of excess opioid medications were relatively ineffective. Additional research into active interventions is needed to improve patient compliance.

Disclosure: One author declared affiliations with industry. Please see the original reference for a full list of authors’ disclosures.


Bicket MC, Fu D, Swarthout MD, White E, Nesbit SA, Monitto CL. Effect of drug disposal kits and fact sheets on elimination of leftover prescription opioids: the DISPOSE Multi-Arm Randomized Controlled Trial. Pain Med. 2021;22(4):961-969. doi:10.1093/pm/pnaa431