Evaluation of an activated carbon disposal system for safe disposal of model prescription sedative medications

Optimizing Appropriate Disposal of Unused Postoperative Opioid: What Happens to Unused Medication?

BACKGROUND

Increase in opioid prescribing practices has occurred with concurrent increases in the levels of abuse, addiction, and diversion of opioid pain medication. With 82.5 opioid prescriptions prescribed for every 100 U.S. citizens, the need for more effective strategies aimed at improving opioid disposal exist. Our study sought to examine the planned rates of appropriate opioid disposal after introduction of an activated charcoal home drug disposal system (Deterra®) in combination with formalized opioid disposal education.

METHODS

Participants were recruited from an academic, public safety-net hospital and grouped into 3 cohorts, no formalized opioid disposal education (No Education), written and verbal patient education on appropriate opioid disposal (Education), and Deterra® in addition to formalized opioid disposal education (Deterra). Outcomes included patients reporting unacceptable methods of opioid disposal, storage of unused opiates, and patient satisfaction with disposal instructions.

RESULTS

Reported unacceptable opioid disposal decreased from 80.6% (n = 87) in the no education group to 20% (n = 10) in the education group to 6% (n = 3) in the Deterra group (P < .001). Education decreased long-term storage of opioid medication after completion of usage from 42% (n = 36) to 2% (n = 1), P < .001. Between the education and Deterra groups, more patients felt that the disposal instructions were clear (94% (n = 47) vs 73% (n = 36), P = .006) and more followed acceptable disposal instructions (80% (n = 39) vs 94% (n = 47) P < .001).

CONCLUSION

Deterra® along with formal opioid disposal education increases patients reporting plans for compliance with appropriate opioid disposal.

Development and implementation of SafeMedWaste, a chemical denaturant for non-hazardous disposal of controlled medications

Substance use disorders are a significant public health issue. Options to dispose of controlled medications are limited, increasing the risk of diversion. Providing an alternative for disposal, a chemical denaturant, SafeMedWaste, was designed to destroy controlled substances irreversibly and safely be placed in non-hazardous landfills. Via HPLC–MS, four formulations of SafeMedWaste were tested with 34 different liquid controlled medications from DEA schedules I–V. Beta testing assessed the efficacy of SafeMedWaste in a clinical setting and on waste generated in a manufacturing setting. Furthermore, a formulation of SafeMedWaste was tested on solid controlled medications. All 34 of the liquid medications tested (e.g., amphetamine, diazepam, fentanyl, ketamine) were fully destroyed in SafeMedWaste within 2–24 h. Analysis of a beta test sample of SafeMedWaste containing fentanyl, midazolam, and morphine waste collected in a hospital showed full denaturation of these drugs in 24 h. Variants of SafeMedWaste were optimized to denature six different controlled substance waste samples from a manufacturing facility. In contrast to side-by-side studies with a charcoal disposal system using the same drugs, SafeMedWaste fully inactivated and destroyed the controlled substances in the waste streams. Another formulation of SafeMedWaste was tested on solid medications, which were fully denatured in 48–72 h. In conclusion, SafeMedWaste irreversibly denatures controlled medications that present a problem in our society.