The Centers for Disease Control says the number of prescription opioid overdose deaths in the U.S. more than quadrupled since 1999. One Rockford pharmacist says reducing the number of prescriptions – both new and unused – may help reduce the recreational use of those prescriptions, but it may not help people who actually need the medications.
“Patients need to be aware that leftover prescriptions add to the opioid epidemic problem and also are a safety hazard for people in their homes,” said Laura Meyer-Junco, a professor at the University of Illinois: Chicago College of Pharmacy in Rockford. “So really, they need to dispose of these medications as quickly as possible and not let them be leftover opioids.”
Meyer-Junco’s areas of expertise include pain management and opioid use. She says the Food and Drug Administration put stricter refill restrictions in place a few years ago to limit the number of prescribed opioids.
“Which I think is a noble move, and I think it may be, since 2012, there has been a reduction in the number of opioid bottles laying around in people’s homes,” Meyer-Junco said.
But Meyer-Junco says ranking certain opioids in a higher class and limiting refills has been a struggle for patients who have legitimate pain complaints. There also may be the misconception that short-acting opioids are safer, she adds, but there’s a greater risk of what she calls the “peak effect,” or the associated good feeling a patient gets when taking the opioid.
“So sometimes what I see is where patients often will express a greater preference for certain opioids,” Meyer-Junco said. “It might not mean that they’re drug-seeking; it could be some sort of behavior that we have instilled in them by prescribing a lot of these short-acting opioids.”
Meyer-Junco says there are abuse-deterrent formulas available for the long-acting opioids, whereas there aren’t any for the short-acting ones. But she says a mixture of the two types may be effective for pain management and avoiding the risk of addiction.
“The CDC really has come out with new guidelines that suggest that we should, yes, start with a short-acting agent to make sure the patient tolerates the dose and actually is an acceptable level of pain control, and then consolidate into a long-acting agent,” she said. “And that’s probably a good idea to minimize the peak effect, where they feel the dopamine release and get more of that ‘feel-good’ feeling that makes them want to continue to use, and a higher dose is maybe then prescribed.”
Almost 9 million opioid prescriptions were recorded in 2014 through the Illinois Prescription Monitoring Program of the Illinois Department of Human Services. That number went down by four percent in 2015 and down by 18 percent last year.
Meyer-Junco says medical professionals should consider integrating their prescription systems with the state’s monitoring program.
“I think it’s just very eye-opening to see, you know, what kind of filling practices patients have with their opioids or other controlled substances like benzodiazepines, which can be a big problem,” she said. “So it’s a very useful tool, and I would encourage people to use them.”
Meyer-Junco says one way to get rid of excess prescription opioids is to drop them off at a location that observes the DEA’s National Take-Back Day, which happens twice per year, or to take those prescriptions to pharmacies that use private collection agencies year-round.
“You can’t just drop them off at your pharmacy … the physician, when he writes you a new prescription for a different opioid, can’t accept your half-full bottle of the other opioid that didn’t work out for you,” Meyer-Junco said. “It would be great if we could, because I think that would cut down on the leftover medications, but instead, the collectors of unused opioid prescriptions have to be authorized by the DEA.”
If you can’t get to the nearest DEA-authorized collection site, Meyer-Junco says there are other ways to dispose of old medications.
The Illinois Environmental Protection Agency discourages flushing old prescriptions down the toilet and cites a study that found those drugs in water supplies in 30 different states. However, the FDA still considers flushing old medications an acceptable disposal method, but only if bottle instructions say to do so.
If you still would rather not take that environmental risk, Meyer-Junco offers other disposal alternatives.
“Basically, you want to mix up the medications in something that’s kind of a gross substance, something that someone is not going to want to go through to retrieve your old prescription,” Meyer-Junco said. “So, if you have kitty litter, it’s recommended to do that or coffee grounds, and also try to seal it in some sort of plastic or sealable container.”
About 68 tons of old prescriptions were collected in Illinois during the last three National Take-Back Days. That’s about five percent of the total number of prescriptions taken across the country, according to the U.S. Drug Enforcement Administration.
While opioids are included in the types of drugs that are turned in to take-back locations, nothing tracks the number of each medication type that is handed over. That’s according to Special Agent James Jones, with the Chicago Division of the DEA.
“Take-back is not tested,” Jones said. “It is simply destroyed to try to create a safer community, basically.”
However, Jones says data is collected for opioids obtained in a drug investigation. He says more than 400 kilograms of opioids were seized by the DEA in Illinois last year. That’s more than a fifty-percent increase from 2015.
“We will seize that contraband, and then provide it to the lab for testing,” Jones said. “And then when we get the lab report back, the lab tells us what we’ve actually seized.”
Jones says even drug dealers are surprised by those lab results.
“Sometimes the drug traffickers … they may think they have heroin, when actually what they’re trying to sell is a kilogram of fentanyl, which is very lethal,” Jones said. “So not even the defendants sometimes are aware of what they’re distributing.”
One last possible effect of using these drugs is disposing of the prescription bottles in a way that keeps the patient safe. Before you throw out those old medications or drop them off at a DEA-authorized collection site, Meyer-Junco says you need to check the bottle first.
“A lot of those vials will have, you know, address and patient-specific information on there, and people should be aware that they should be scratching that information out and being very careful about disposing information that is very personal,” Meyer-Junco said.