Annual Meeting Research Awards
Effect of Drug Disposal Kits and Fact Sheets on Elimination of Leftover Prescription Opioids: The DISPOSE Multi-Arm Randomized Controlled Trial
By Mark C. Bicket, MD, PhD; Denise Fu, PharmD, BCACP; Constance L. Monitto, MD; Elizabeth White, RN; Suzanne A. Nesbit; Meghan D. Swarthout, PharmD, MBA, BCPS
Department of Anesthesiology and Critical Care Medicine
Johns Hopkins University School of Medicine
Baltimore, Maryland
Misuse of legitimately prescribed opioids has served as an initial exposure among many of the millions of Americans who suffer from opioid use disorder. In pediatrics, leftover opioids have served as a gateway drug for some and contributed to escalating rates of overdose in children and teens as well. Multiple studies have demonstrated that in the past, more opioids than needed to treat postoperative pain were often prescribed at hospital discharge. While over-dispensing may not be problematic if, once pain has resolved, leftover opioids are disposed of, this is often not the case. As a result, promoting opioid disposal is an important area for intervention in promoting safe opioid stewardship.
Recently, several commercially available products designed to help facilitate safe home disposal have been marketed. However, it is not known whether providing such a product at the time of prescription pick-up significantly impacts disposal rates. Therefore, we conducted a multi-arm randomized controlled trial to determine how passively providing commercial drug disposal kits affects disposal rates of leftover prescription opioids. From June 2019 to July 2019, 499 individuals who filled a short-term prescription for an immediate-release opioid at a Johns Hopkins Health System outpatient pharmacy were randomized to receive an informational handout detailing Food and Drug Administration-recommended ways to properly dispose of leftover opioids (n = 188), the informational handout and a drug disposal kit with instructions on its use (n = 170), or no intervention (n = 141).
Participants were contacted at three and/or six weeks after prescription pick-up and asked to complete a brief telephone survey. By six weeks, 227 individuals reported that they had stopped taking prescription opioids to treat pain and had leftover medication. We found no statistically significant differences in age, gender, race/ethnicity, prescriber credentials, the number of prescriptions provided, or the types of opioid used between the three study groups. No difference in safe disposal was observed between the non-intervention group (10% [6/63]) and the group that received disposal kits (14% [10/73] risk ratio, 1.44; 95% CI, 0.55 to 3.74) or the group that received a fact sheet (11% [10/91], risk ratio, 1.15; 95% CI, 0.44 to 3.01). Rates of opioid disposal by any means ranged between 13 and 19% with no significant difference observed among the three groups.
Our findings indicate that passive provision of educational handouts and drug disposal kits at the time of prescription opioid pick-up may not produce meaningful changes in opioid disposal behavior. However, comparing our results to those seen in other similar studies, suggests that active interventions may deserve further investigation.
