November 24, 2017
Are Opioids in Your Medicine Cabinet?
Be Well

Are Opioids in Your Medicine Cabinet?

by John Swartzberg, M.D.  

We are experiencing a horrific epidemic of prescription opioid overuse deaths in the U.S. In the past four years, as many Americans died from such overdoses (not including deaths from heroin and other illegal opioids) as died during the entire Vietnam war. These medications play an important role in relieving pain when used appropriately. But too often these narcotics are misused—notably by people in pain who develop tolerance to them or become dependent on them or by people who use them for nonmedical purposes (for instance, because of addiction, to get high, or to relax). A big part of the problem is the oversupply of opioid pain relievers, resulting in a nationwide reservoir of leftover drugs, which can end up in the hands of family members and friends, for medical or nonmedical purposes. It’s estimated that nearly half of people who misuse opioid medications obtain them this way.

Just look in your own medicine cabinet. A few weeks ago I found in ours a five-year-old bottle of Tylenol with codeine (a weak opioid), nearly full, from when I broke my ankle. I mentioned this to a friend, who admitted he has several containers of oxycodone (Oxycontin is a brand name) or hydrocodone (Vicodin is a brand name) left over from dental, hip, and hand surgeries. They might, he said, come in handy if he had another excruciating toothache.

Recent research shows that stockpiling opioids is a bad idea:

• More than 90 million noninstitutionalized Americans used prescription opioids in 2015, according to a new study in the Annals of Internal Medicine. Nearly 12 million admitted misusing them—meaning they took drugs that were prescribed for someone else (friend or family) or were obtained illegally, took them for a reason other than directed by a doctor, or took them in excessive amounts.

• A study in JAMA Internal Medicine in 2016 surveyed more than 1,000 people who used opioid medications during the past year and found that most had leftovers. Among those with leftovers, 61 percent reported keeping them for future use. One in five shared leftover opioids with another person. Fewer than half recalled receiving information about safe storage and disposal of the drugs. Only 9 percent stored the drugs in a locked location, as recommended.

• A study posted on JAMA Surgery in August 2017 analyzed six studies of people who underwent surgical procedures and found that 67 to 92 percent of patients reported having leftover opioids; usually more than half the tablets remained. And about three-quarters of them reported that their drugs were not stored in locked containers. Few people (4 to 30 percent) planned to or actually disposed of the leftover drugs, and even fewer followed FDA advice on how to properly do so. “The combination of unused opioids, poor storage practices, and lack of disposal sets the stage for the diversion of opioids for nonmedical use,” the study concluded.

Doctors face a delicate balance when prescribing opioids. Limiting the number of patients prescribed the drugs or reducing the quantities can lead to pain undertreatment, while supplying generous amounts contributes to the surplus of drugs that can be misused at a later date or given to others.Prescribing guidelines suggest that for acute pain conditions, opioids should be prescribed for only three to seven days at a time, and only the lowest effective dose should be used. When possible, non-opioid pain relievers as well as nonpharmacological approaches should be recommended first. We need more medication take-back programs at pharmacies and health care facilities.

What can you do? If you are prescribed opioid drugs, don’t share them with anyone, keep them in a safe place (preferably locked if there are children or teenagers in your house), and if you have any leftovers safely dispose of them. Clean out old drugs, including leftover antibiotics, from your medicine cabinet—don’t hold on to them “just in case.” To learn more about opioids and opioid abuse, visit this CDC web page.