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What Do Patients Do With Unused Opioid Medications?

Lewis, Eleanor T. PhD*; Cucciare, Michael A. PhD†,‡; Trafton, Jodie A. PhD*,§

doi: 10.1097/01.ajp.0000435447.96642.f4
Original Articles

Objectives: The volume of opioid medications being prescribed in the United States is increasing rapidly. Problems associated with the misuse of opioid medications are also increasing, in part because of medication diversion from legitimate prescriptions. However, little is known about what patients do with any unused opioid medications. This paper uses a qualitative analysis of patients’ self-report of medication storage and retention habits to begin to address this gap.

Methods: We analyzed responses to the Prescription Drug Use Questionnaire in conjunction with other data on prescription opioid use in a sample of 191 Veteran patients (83% of whom had a preexisting factor associated with higher rates of opioid misuse) who received one or more opioid prescriptions in the previous 12 months.

Results: Only 6.3% of participants disposed of extra medications and 24.1% reported having no extra opioids. A total of 65.4% of participants reported retaining some or all opioids even if they ceased taking the medication, and some participants accumulated large amounts of medication. A total of 34.0% of participants described engaging in sharing or diversion of opioids at least once, most often receiving them from a family member or a friend.

Discussion: A majority of patients retain unused opioids, and medication sharing is common. Interventions to improve monitoring of patient experience with opioid medication, educate patients about the dangers of opioid use by nonprescribed others, and increase information about medication disposal options could decrease the supply of opioid medications available for misuse.

*Center for Innovation to Implementation, Veterans Affairs—Palo Alto Health Care System, Menlo Park

§Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA

Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System

Department of Psychiatry and Behavioral Sciences, University of Arkansas for Medical Sciences, Little Rock, AR

Funded by RRP 07-316, “Validation of computerized risk assessment for prescription opioid abuse,” a grant awarded by the Department of Veterans’ Affairs (VA) Health Services Research and Development program (HSR&D) and the Quality Enhancement Research Initiative, Washington, DC. Additional support came from Grant # TRX 04-402 and Grant # IMA 04-156 from VA HSR&D, and by a Career Development Award-2 (CDA 08-004) to M.A.C. awarded by the VA HSR&D. The views expressed are those of the authors and not of the Department of Veterans Affairs. The authors declare no conflict of interest.

Reprints: Eleanor T. Lewis, PhD, Center for Innovation to Implementation, Veterans Affairs—Palo Alto Health Care System, 795 Willow Road (152-MPD) Menlo Park, CA 94025 (e-mail:

Received February 13, 2013

Accepted August 13, 2013

© 2014 by Lippincott Williams & Wilkins