California pharmacies rarely take back unused opioids

By Lisa Rapaport

(Reuters Health) – Only one in ten California pharmacies has programs to take back unused prescription opioids, and only one in five gives consumers accurate information about disposal. This comes from a study that says drug stores could do more to combat drug abuse.

For the “Secret Shopper” study, researchers called 898 pharmacies in California to inquire about the availability of withdrawal programs for leftover opioids and antibiotics and to find out how to safely dispose of these drugs at home.

“The risk of unused and unwanted prescription drugs is considerable – from accidental poisoning by children to pollution to intentional abuse,” said lead study author Dr. Hillary Copp from the University of California, San Francisco.

“The FDA recommends dropping medication at a take-back point as the best option for disposal,” Copp said via email. “However, there are specific recommendations for disposing of drugs at home when the consumer does not have access to a take-back point.”

Only 19% of pharmacies correctly stated that they should return unused opioids to a drugstore or flush unused opioids in the toilet. Only 11% of pharmacies offered to take back unused opioids at their location.

With antibiotics, 47% of pharmacies rightly advised callers to return leftovers to a drugstore or mix unused medication with inedible substances such as coffee grounds or cat litter and place in a sealed container before the medication is thrown in the trash. Only 19% of pharmacies offered to take back unused antibiotics.

Throwing leftover antibiotics in the trash helps prevent people from taking them in the future for diseases that they can’t cure, which contributes to the development of antibiotic-resistant superbugs that cannot be treated with available medication, said Copp. By rinsing out antibiotics, they can get into the water supply, which also contributes to antibiotic resistance.

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However, rinsing opioids prevents them from falling into the wrong hands and contributing to substance abuse, addiction, and overdose. Addicts could still take opioids that they find in the trash, even mixed with dirt, cat litter, or other substances, said Copp.

All of the secret buyers in the study claimed to be parents of children who had recently had surgery. Callers asked pharmacies what to do with two medication residues: the antibiotic Bactrim (sulfamethoxazole trimethoprim) and the liquid Hycet (hydrocodone acetaminophen), a pain reliever that contains an opioid compound.

Pharmacies gave callers the correct information about antibiotic and opioid disposal on weekdays more than on weekends.

One limitation of the study is that the results from California, where about 10% of national pharmacies are located, may not reflect what would happen elsewhere, as the study team found in the Annals of Internal Medicine.

“The lack of consistent and clear information for patients is worrying, particularly given the risk of misuse of medicines that stay at home,” said Stacie Dusetzina, a researcher at Vanderbilt University’s medical school in Nashville, Tennessee Study involved.

“Given the different disposal strategies for different medications, it seems helpful to offer patients more options for returning medicines to pharmacies for proper disposal,” Dusetzina said by email.

The study results indicate that many pharmacies may not be sufficient as educators and as safe disposal locations, according to Dr. Chana Sacks from Massachusetts General Hospital and Harvard Medical School in Boston.

“Patients may have other sources of information about drug disposal issues – they can look them up online before, for example, calling their pharmacy,” said Sacks, who was not involved in the study, via email. “Ideally, however, pharmacies are a place patients can rely on to get accurate information about all aspects of medication, including safe disposal.”

Source: Annals of Internal Medicine, online December 30, 2019.

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