The prescription opioid epidemic continues with few signs of abatement.1 Most adolescents and adults reporting recent nonmedical use of opioid medications obtain these medications through their family or friends.2 Minimal research has examined knowledge and practices related to opioid medication sharing, storage, and disposal among US adults who recently received prescriptions for these medications despite this group serving as a source for individuals using opioid medications for nonmedical purposes. We conducted a national survey among US adults with recent opioid medication use to examine the pervasiveness of sharing opioid medications, medication storage and disposal practices, and the sources of information received.
We sampled survey participants from a source3 that uses probability- and address-based sampling to construct a nationally representative panel. We sampled randomly from the general pool of adult panelists and oversampled adults with at least 1 child living in the household. Data were deidentified. A screening question restricted the sample to adults with opioid medication use during the past year. This study was reviewed and approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board. The study was conducted from February 24 to March 16, 2015.
Among the 4836 sampled panelists, 3281 (67.8%) completed the screening question. Among the 1055 individuals determined to be eligible based on their past-year use of opioid medications, 1032 (97.8%) completed the survey. Respondents answered questions about their practices and beliefs related to sharing, storing, and disposal of opioid medications as well as sources of information received on these topics. Statistical analyses incorporated survey weights to account for sampling design and nonresponse.
A total of 20.7% (weighted percentage) reported ever having shared opioid medications with another person (Table 1). Among this group, the primary reason for sharing medication was to help the other person manage pain (73.0%). Few respondents reported being likely to let a relative (13.7%) or close friend (7.7%) use their opioid medication in the future. Some respondents reported storing their opioid medication in a locked (8.6%) or locked or latched (20.9%) location.
At the time of the survey, 440 respondents (46.7%) were still using opioid medications. More than half of the respondents had or expected to have leftover medication. Among those with leftover opioid medications, 61.3% reported keeping them for future use.
Nearly half of the adults with recent opioid medication use did not recall receiving information on safe storage (48.7%) or proper disposal (45.3%) (Table 2). Among the 505 participants who reported receiving information on safe storage practices, primary sources of information included medication packaging (46.7%), the pharmacist (44.1%), and the physician or nurse (32.3%). Among the 548 respondents who reported receiving information on proper disposal, sources included the pharmacist (34.7%), print or television news (31.3%), and medication packaging (29.6%).
Findings suggest that current practices related to sharing, storing, and disposing of opioid medications, as well as communication of information on these topics, are suboptimal. Altering prescribing practices to reduce the quantity of opioid medications that patients receive may limit the opportunities for nonmedical use of the drugs. Evaluating the effects of the Centers for Disease Control and Prevention’s recently released guidelines for prescribing opioid medications for chronic pain4 and the US Food and Drug Administration’s opioid medication labeling changes5 are important areas for research.
A limitation of this study was use of self-reported data, which may be subject to social desirability bias although the web-based panel survey mode reduces this concern. Although respondents were sampled from a nationally representative panel, there is no census of adults with past-year opioid medication use; therefore, we cannot verify that this study sample is representative of US adults with recent opioid medication use.
More research is needed to identify effective strategies to advance safer practices related to opioid medication sharing, storage, and disposal.6 In the meantime, reducing the prescribing of large quantities of opioid medications and disseminating clear recommendations on safe storage and disposal of opioid medications widely to the public and prescribers may reduce risks.
Corresponding Author: Alene Kennedy-Hendricks, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway St, Room 311, Baltimore, MD 21205 (firstname.lastname@example.org).
Published Online: June 13, 2016. doi:10.1001/jamainternmed.2016.2543.
Author Contributions: Dr Kennedy-Hendricks had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Kennedy-Hendricks, Gielen, McDonald, McGinty, Barry.
Acquisition, analysis, or interpretation of data: Kennedy-Hendricks, Gielen, McDonald, Shields, Barry.
Drafting of the manuscript: Kennedy-Hendricks.
Critical revision of the manuscript for important intellectual content: Kennedy-Hendricks, Gielen, McDonald McGinty, Shields, Barry.
Statistical analysis: Kennedy-Hendricks.
Obtained funding: Barry.
Administrative, technical, or material support: McDonald.
Study supervision: Gielen, McGinty, Barry.
Conflict of Interest Disclosures: None reported.
Funding/Support: This research was supported by unrestricted research grant 114061 from American International Group, Inc.
Role of the Funder/Sponsor: The American International Group, Inc, had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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