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Joyce C, Richman AR, Cox MJ, Helme DW, Jackson JT, Sesay M, Egan KL. Perceptions of disposal options for unused opioid analgesics among people who have been prescribed an opioid analgesic in North Carolina. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-12. [PMID: 39172050 DOI: 10.1080/00952990.2024.2386536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 07/12/2024] [Accepted: 07/27/2024] [Indexed: 08/23/2024]
Abstract
Background: Medication disposal programs have been promoted as one solution to the opioid crisis, but uptake by community members has been minimal.Objectives: To clarify perceptions of medication disposal options among people who have been prescribed an opioid analgesic in North Carolina to inform interventions that can facilitate the disposal of unused opioids.Methods: In 2022, we conducted focus groups with participants who received an opioid medication in the past year to gain information to develop an intervention related to the disposal of unused opioid medication (12 focus group discussions (FGDs); total N = 37; 30 identified as female, 6 as male, and 1 as another gender). Participants were shown a slide with the Food and Drug Administration's recommended disposal options and asked about their perceptions of each option. Themes were derived using an inductive, thematic, qualitative approach.Results: Seven themes about perceptions of medication disposal programs emerged from the data. Four of the themes reflect potential barriers to medication disposal: failed disposal attempts, lack of sufficient education on proper disposal, unclear meaning of specific disposal language, and concerns about existing disposal options. Three of the themes provide insight on potential facilitators of medication disposal: preference of low-cost disposal options, ease and accessibility among disposal methods, and preferred disposal methods.Conclusion: Patients should be provided clear and consistent guidance from prescribers and dispensing pharmacists on when and how to dispose of unused medications and opportunities to dispose of medications at no cost to the patient.
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Affiliation(s)
- Cassidy Joyce
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Alice R Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Melissa J Cox
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Donald W Helme
- Department of Communication, College of Communication and Information, University of Kentucky, Lexington, KY, USA
| | | | - Mahdi Sesay
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Kathleen L Egan
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Varisco T, Patel H, Saadi RA, Wanat M, Thornton D. Patients prefer free drug disposal options delivered by pharmacists at the point of care: Results of a decision tree analysis of a national factorial vignette panel survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104045. [PMID: 37156066 DOI: 10.1016/j.drugpo.2023.104045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/01/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Unused opioid medication in the home increases risk of medication diversion, misuse, and unintended harm. The United States Federal Food and Drug Administration is currently considering the implementation of a risk evaluation and mitigation strategy (REMS) program that would require US pharmacists to provide drug disposal products with opioid prescriptions. Still, little is known about consumer preference for drug disposal method. The objective of this study was to identify product and program characteristics associated with consumer preference for at-home drug disposal products. METHODS A 2x2x3x3 full-factorial design was employed to text-based vignettes representing opioid analgesic disposal scenarios. Each vignette varied on four characteristics: product cost (free vs paid), ease of use (a mail back envelope, bringing medication to a takeback site, and an at-home drug deactivation pouch), potential environmental impact (incineration), and point of access (pharmacy, community organization, and prescriber). Of the 36 possible vignettes, 12 were removed as they represented a non-realistic combination of vignette characteristics. The remaining 24 were administered to a panel of patients with controlled-substance use in the past six-months. Decision tree modeling and general linear mixed (GLM) models were used sequentially to identify product characteristics associated with patient drug preferences RESULTS: A total of 1,006 participants completed all vignette drug disposal scenarios. Regression tree analysis found that the most important predictor of use was cost followed by ease of access and product design. GLM showed that takeback programs offered at a pharmacy were the most preferred disposal option followed by at-home products (mailed envelope or deactivation system) dispensed with the prescription. CONCLUSION Programs that provide disposal resources directly to the patient at no cost with their prescription are likely to optimize willingness to dispose. Findings support the FDA's plan for a REMS program requiring pharmacies to distribute mail-back envelopes to patients when dispensed opioids.
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Affiliation(s)
- Tyler Varisco
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA.
| | - Harshil Patel
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Department of Pharmacy, The University of Texas Medical Brach Correctional Managed Care, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA
| | - Randa Al Saadi
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA
| | - Matthew Wanat
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA
| | - Douglas Thornton
- PREMIER Center, University of Houston, College of Pharmacy, Houston, TX, USA; Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USA; Prescription Drug Misuse Education and Research (PREMIER) Center, University of Houston College of Pharmacy, USA
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Schäfer WLA, Johnson JK, Wafford QE, Plummer SG, Stulberg JJ. Primary prevention of prescription opioid diversion: a systematic review of medication disposal interventions. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:548-558. [PMID: 34292095 DOI: 10.1080/00952990.2021.1937635] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: In the U.S., 50-75% of nonmedical users of prescription opioids obtain their pills through diversion by friends or relatives. Increasing disposal of unused opioid prescriptions is a fundamental primary prevention strategy in combatting the opioid epidemic.Objectives: To identify interventions for disposal of unused opioid pills and assess the evidence of their effectiveness on disposal-related outcomes.Methods: A search of four electronic databases was conducted (October 2019). We included all empirical studies, systematic literature reviews, and meta-analyses about study medication disposal interventions in the U.S. Studies of disposal interventions that did not include opioids were excluded. We abstracted data for the selected articles to describe the study design, and outcomes. Further, we assessed the quality of each study using the NIH Study Quality Assessment Tools.Results: We identified 25 articles that met our inclusion criteria. None of the 13 studies on drug take-back events or the two studies on donation boxes could draw conclusions about their effectiveness. Although studies on educational interventions found positive effects on knowledge acquisition, they did not find differences in disposal rates. Two randomized controlled trials on drug disposal bags found higher opioid disposal rates in their intervention arms compared to the control arms (57.1% vs 28.6% and 33.3%, p = .01; and 85.7% vs 64.9%, p = .03).Conclusions: Peer-reviewed publications on opioid disposal interventions are limited and either do not address effectiveness or have conflicting findings. Future research should address these limitations and further evaluate implementation and cost-effectiveness.
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Affiliation(s)
- Willemijn L A Schäfer
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie K Johnson
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Q Eileen Wafford
- Galter Health Sciences Library, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sarah G Plummer
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jonah J Stulberg
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Center for Health Services & Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Kearney M, Reynolds L, Blitzstein S, Chapin K, Massey P. Primary Prevention of Prescription Drug Misuse Among Culturally and Linguistically Diverse Suburban Communities. J Community Health 2018; 44:238-248. [PMID: 30315395 DOI: 10.1007/s10900-018-0579-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Comprehensive strategies for prescription drug misuse must reach culturally and linguistically diverse suburban populations to effectively combat the ongoing opioid epidemic. The purpose of this study was to conduct a community needs assessment and inform the development and implementation of culturally appropriate primary prevention strategies for community-based interventions, specifically related to medication disposal practices. Three data collection techniques were utilized: key informant interviews (n = 4), intercept surveys (n = 71), and focus group discussions (n = 8; 61 participants). To accommodate linguistically diverse subpopulations, surveys and focus groups were available in English, Spanish, Arabic, Russian, and Hindi. Participants were overwhelmingly female (survey: 70%/FGD: 84%), ethnic minorities (survey: 61%/FGD: 66%), and, on average, middle-aged [survey: 52 years (SD: 19)/FGD: 54 (15)]. Approximately one in three survey respondents (30%) had heard of drug-take back events, and one in ten (10%) had participated. Non-English speakers were less likely to both perceive a community problem with prescription drugs (β = - .35; p < .001) and be aware of take-back opportunities (β = - .23; p = .038). Focus group participants expressed confusion about appropriate medication disposal methods, identifying potential sources of conflicting information. Recent media coverage and political events have heightened stigma towards non-English speaking and non-native peoples, increasing their fear of law enforcement and other perceived threats. To encourage community engagement in take-back events, we identified multiple ways, such as multilingual materials and marketing campaigns, which may help marginalized suburban subpopulations feel less threatened and more included in prescription drug misuse prevention activities.
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Affiliation(s)
- Matthew Kearney
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Leslie Reynolds
- Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | | | | | - Philip Massey
- Drexel University Dornsife School of Public Health, 3215 Market Street Room 412 (Nesbitt Hall), Philadelphia, PA, 19104, USA.
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Kinrys G, Gold AK, Worthington JJ, Nierenberg AA. Medication disposal practices: Increasing patient and clinician education on safe methods. J Int Med Res 2018; 46:927-939. [PMID: 29322845 PMCID: PMC5972255 DOI: 10.1177/0300060517738681] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Recent research suggests that the nation’s water supply is contaminated with trace pharmaceuticals that exert a negative environmental and public health impact. Incorrect medication disposal methods (e.g. flushing medications down the toilet or drain) are a significant factor contributing to the presence of medication compounds in the aquatic environment. In this commentary, we provide a summary of the existing data on pharmaceuticals in the nation’s water as well as the role of improper medication disposal methods on water contamination. We discuss statistics on improper medication disposal practices among patients and clinicians as well as recent advances in proper medication disposal methods as a solution to this problem. Currently, many patients and clinicians are not aware of proper medication disposal practices. We summarize the importance of patient and clinician education in advancing environmental-safe medication disposal methods.
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Affiliation(s)
- Gustavo Kinrys
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Gustavo Kinrys, Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, USA.
| | - Alexandra K. Gold
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, USA
| | - John J. Worthington
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Andrew A. Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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