Safe Use, Storage, and Disposal of Opioid Drugs

Safe Use, Storage, and Disposal of Opioid Drugs

What are opioids?

Opioids (say: “oh-pee-oyds”) are powerful pain relievers your doctor can prescribe to manage acute and chronic pain. If you abuse opioids or do not take them correctly, they can cause overdose and even death.

Most opioids come in pill or tablet form and can be taken by mouth. Sometimes, doctors prescribe a potent opioid that comes in patch form (such as fentanyl or buprenorphine).

How do opioids work?

Opioids block pain signals in the brain. Many opioids are available in short- and long-acting forms. Short-acting forms work faster than long-acting forms, but for shorter periods. The long-acting forms – also known by their abbreviations, ER and LA – are used to treat long-lasting pain. Opioids may not safely remove all of your pain, but they will improve your daily function.

Each pain patch contains more medicine than a single pill because it is designed to release medicine over a period of three days.

How do I safely take opioids?

Opioids can cause unpleasant and even dangerous side effects if you take too much, take them too often, or mix them with alcohol, illegal drugs, or even other medicines. Tell your doctor about all other medicines and supplements you are taking to avoid unwanted or dangerous medication interactions. When you get your prescription filled, check the packaging to make sure that it is the right medicine prescribed for you. Read and follow the label directions carefully.

What are the signs of overmedication or overdose?

Anyone using opioids is at risk of overmedication or overdose if they take too much. You are much more at risk of overmedication or overdose if you have never taken opioids.

Some signs of overmedication include:

Some signs of overdose include:

  • Slurred speech, stumbling while walking, dizziness, or confusion
  • Excessive drowsiness or difficulty staying alert
  • Difficulty waking from sleep
  • Cannot stay awake or if awake, is unable to speak or be kept awake
  • Trouble breathing, including slow, shallow breathing or periods in which breathing stops
  • Limpness, lifelessness
  • Pale or clammy skin, or blue fingernails or lips
  • Slow or stopped heartbeat

What should I do if someone has taken too much medicine?

If you think that someone has taken too much medicine, try to rouse him or her by using one or more of the following techniques:

If the person responds, he or she should be kept awake for at least the next 2 hours. Closely watch the person to make sure further problems such as trouble breathing do not develop.

  • Speak in a loud voice.
  • Pinch his or her ear.
  • Rub your knuckles in the middle of his or her chest.

If the person does not respond:

  • Call 911 immediately and tell the operator that you have a medical emergency.
  • Give the operator as much information as possible, including your address and any breathing problems that the person may have.
  • If the person is having trouble breathing, the operator may ask if you are trained in cardiopulmonary resuscitation (CPR). You might be asked to perform CPR if you are trained to do so.
  • After calling 911, stay with the person until emergency services arrive, even if the person wakes up.

Anyone suspected of taking an overdose of opioids should see a doctor and may need to be considered for counseling and further treatment as appropriate.

Can an opioid overdose be reversed?

Naloxone is a prescription medicine that blocks the effects of opioids. It quickly reverses the breathing problems that result from an opioid overdose. Naloxone can be given by injection to a person who has overdosed.

Ten U.S. states currently allow family members and friends of people taking opioids to be trained to give naloxone for a suspected overdose. If you live in one of the following states, consider asking your doctor about the training.

  • California
  • Connecticut
  • District of Columbia
  • Illinois
  • Massachusetts
  • New Mexico
  • New York
  • North Carolina
  • Rhode Island
  • Virginia
  • Washington State

How do I safely store opioids?

The abuse of opioids is a significant public safety concern. Teenagers and young adults most commonly get these medicines from their own medicine cabinets, where another family member has stored them.

All opioids should be stored in their original packaging inside a locked cabinet, lockbox, or a location where others cannot easily access them.

Carefully note when and how much medicine you take in order to keep track of how much is left.

If you think that someone has taken your medicine, contact the police immediately to file a report.

How do I safely dispose of opioids?

Many communities have medicine take-back programs. Ask your family doctor for more information or visit the U.S. Drug Enforcement Administration’s Office of Diversion Control to learn more. You can also call your local waste management company to ask if there is a take-back program in your community.

Opioids — both pill and patch forms — often come with instructions for flushing unused medicine to prevent unintentional use or illegal abuse.

The FDA recommends always flushing used and leftover pain patches down the toilet. Even used patches still have enough medicine in them to be dangerous or deadly to pets, children, and others with a low tolerance for opioids. To dispose of a pain patch, fold it in half so the sticky sides stick together, then flush it immediately.

What if my community doesn’t allow flushing unused pills?

If your community warns against flushing unused medicines down the toilet, take the following steps instead:

If you are not sure about how to dispose of a medicine, ask your doctor.

  • Remove personal information from the prescription label and keep the medicine in its original container.
  • Add water to solid pills. Also add a nontoxic and unpalatable substance, such as coffee grounds or kitty litter to the container.
  • Seal the container with duct tape and place inside a second, unmarked container, then place in the trash.

Bibliography

Printable Patient Tip Sheet

The following information can help you safely use extended-release/long-acting opioid drugs prescribed by your family doctor. Print this page and bring it to your next appointment.

Patient Name: _____________________________________

Call 911 immediately if:

Talk to your family doctor:

  • You take too much medicine.
  • You have trouble breathing or shortness of breath.
  • A child has taken your medicine.
  • If the dose you are taking does not control your pain.
  • If you have any side effects.
  • If a skin rash develops in an area where you have placed a pain patch.
  • About all the medicines you take, including over-the-counter (OTC) medicines, vitamins, and dietary supplements.

Patient-Specific Information

Be sure to talk to your doctor about the following:

  • Your complete medical and family history, including any history of substance abuse of mental illness
  • The cause, severity, and nature of your pain (for example, throbbing, stabbing, burning)
  • Your treatment goals
  • All of the medicines you are currently taking
  • Any side effects you are experiencing

Take your opioid pain medicine exactly as prescribed by your family physician.

Date
Medicine
Dosage
Number of Refills*
Instructions for Use
Special Considerations

*Refills can only be requested during office visits. Refills cannot be issued by phone or email.

Do’s and Don’ts of Opioid Use

Do

  • Always remove an old pain patch before applying a new patch.
  • Talk to your doctor before changing the dosage of your pain reliever. If you miss a dose, do not take two doses without discussing this with your doctor.
  • Watch for signs of overmedication and ask others to watch you for those signs.
  • When taking liquid doses, use an accurate measuring device and measure out only the prescribed amount.

Don’t

  • Do not share opioids.
  • Do not combine opioids with alcohol or street drugs.
  • Never cut, chew, crush, or dissolve opioid tablets or capsules.
  • Never take your pain reliever while in the dark to avoid taking the wrong pill or amount.
  • Never cut or fold a pain patch you plan to use.
  • Never apply more than one pain patch at a time.
  • Never suck on a pain patch.
  • Do not expose a pain patch to a source of heat, such as a heating pad, while the patch is attached to your skin.
  • Do not change pain patches too often.
  • Do not drive a car or use heavy machinery until you have become used to the medicine’s effects.

DO:

  • Read the Medication Guide that comes with your medicine.
  • Take your medicine exactly as prescribed.
  • Use pain patches only as directed.
  • Watch for signs of overmedication, such as slurred speech, confusion, excessive drowsiness, and difficulty waking from sleep.
  • Store your medicine in its original packaging inside a locked cabinet, a lockbox, or a location where others can’t easily access it.
  • Flush unused medicine down the toilet. If your community warns against flushing unused medicines down the toilet, ask your doctor for information about proper disposal.

DON’T:

  • Don’t give your medicine to anyone else.
  • Don’t take medicine unless it was prescribed for you.
  • Don’t change your dosage or stop taking your medicine without talking to your family doctor first.
  • Don’t cut, chew, crush, or dissolve opioid tablets or capsules. If you can’t swallow your medicine whole, talk to your doctor.
  • Don’t use pain patches when taking other long-acting opioid drugs.
  • Don’t combine opioid drugs with alcohol or street drugs.
  • Don’t drive a car or use heavy machinery until you have become used to your medicine’s effects. Opioid drugs may impair your abilities.

Citations

  • Food and Drug Administration. Safe Disposal of Medicines. Accessed 02/13/13
  • Opioids911-Safety. How can I prevent problems with opioids?. Accessed 01/23/13
  • Pharmacology of Opioids in the Treatment of Chronic Pain Syndromes by Vallejo R, Barkin RL, Wang VC.(Pain Physician 07/01/11)
  • Project Lazarus. Community-based Overdose Prevention from North Carolina and the Community Care Chronic Pain Initiative. Accessed 02/13/13

Content provided by the California Academy of Family Physicians.  This educational activity is supported through the AAFP’s in-cooperation-with agreement with the Collaborative for REMS Education (CO*RE), that received an independent educational grant from the ER/LA Opioid Analgesic REMS Program Companies (RPC).