Reduce Non-Medical Access to Prescription Drugs

Introductory Paragraph

It is essential that people who have prescription medications in their homes store them safely. When people begin to misuse prescription drugs, they often acquire them by stealing them from family, relatives, friends or from homes which they enter for other reasons (work, open houses, breaking and entering). If prescription drugs are safely stored, misuse can be stopped earlier, because people who have not yet developed a dependence on opioids usually do not go directly to illegal opioids like heroin or Fentanyl. Prescription drugs that are not safely stored can also be accidentally taken by young children or by curious pre-teens.

Key Information

Safe storage of prescription drugs within the home has been prioritized as a key strategy by many organizations and coalitions. Even if a community does an excellent job of reducing prescriptions and taking back or disposing of unused opioids, there will still be a lot of opioids in communities. Thirty-two percent of American adults received a prescription for opioids in the two years preceding 2018. In 2019, 22% of U.S. adults with chronic pain used a prescription opioid in the previous 3 months. Many people are legitimately being prescribed opioids for short-term pain management. These can be misused, stolen or accidentally consumed by children. Failure to securely store prescription drugs contributes to the opioid epidemic and other health hazards in several ways.

• Easy access to prescription drugs can lead to initial experimentation, especially by teens.

• Stealing prescription drugs, which is much easier when they are commonly available in unlocked medicine cabinets, is often a step toward more destructive misuse.

• Easy access to unsecured opioids or other prescription drugs contributes to theft by people who sell them or give them away.

• Children who access unsecured drugs sometimes take them, thinking they are candy.

Staggering Statistics

• Only 2 in 10 who have dangerous medications—such as opioid pain pills, stimulants used to treat ADHD, and sedatives—lock them up.

• A recent study of adults living in households with children found that prescription opioids were stored in a locked or latched place in only 32.6% of households with young children and 11.7% with older children.

• More than 1,600 teens begin abusing prescription drugs each day.

• 1 in every 4 teens in America say they have misused or abused a prescription drug at least once.

• 60,000 kids under the age of 5 accidentally ingest these dangerous drugs every year and wind up in emergency rooms.

• 12-17 year olds abuse prescription drugs more than ecstasy, heroin, crack/cocaine and methamphetamines combined.

• In one study, only 8.6% of the respondents reported locking up their opioid medication and only 20.9% reported using a latched location.

• The National Drug Intelligence Center notes that older people are especially vulnerable to theft of prescription drugs. They also indicate that over half of teens, ages 12 and up, obtained prescription drugs from a friend or family member "for free."

Succesful Strategies

There are four primary successful strategies for communities to consider. The four strategies are conducive for implementation in conjunction with each other, but are covered separately below:

• Campaigns - An information campaign enables a variety of sectors in the community to collaborate. For example, an awareness campaign could engage law enforcement in drug take-backs. When law enforcement hosts drop-off locations, it promotes the overall campaign. Health department staff could disseminate information. Schools could provide an avenue for reaching parents and informing them about the location of take-back events. Pharmacies and the businesses could be engaged in sponsoring the campaign. A few models of national campaigns are provided in the “Promising Practices” section below.

• Proper Disposal — In addition to take-backs and promotion of drop-off locations, there are medication neutralization kits that are available. These provide an appealing way to engage people to take action in a one-off event that increases their readiness to take more routine medication safety actions.

• Safe Storage — Increasing awareness about the importance of safe storage often goes hand-in-hand with providing members of the community free or affordable storage options. A variety of vendors associated with both safe storage and disposal products are listed in the “Available Tools and Resources” section below.

• Education— Families are generally more receptive to tips for medication safety than they might be for information about other forms of prevention. While any of the statistics above can be used in an education campaigns, some basic ideas can get people thinking about their own practices in a new way. For example, most people have not considered that it makes sense to keep a medication log or an inventory of all their medication types and amounts. Updating their inventory every six to twelve months keeps medication safety in their awareness. Likewise, people are ready to recall that the medicine cabinet in a bathroom is often not the best place to store prescriptions, since they should be stored in a cool, dry place. Humidity, heat, and the change in temperatures in the bathroom can alter the potency of some medications, and some storage devices can help protect medications from humidity, even if they are stored in bathrooms. This is a good lead-in to building a desire to obtain a lock-box.

Relevant Research

This report highlights survey results that reveal the disconnect between parent knowledge and behavior regarding safe storage of medicine.

Impactful Federal, State, and Local Policies

HHS 5-Point Plan. HHS developed a comprehensive strategy to improve access to prevention, treatment, and recovery support services. The strategy aims to support individuals to achieve long-term recovery and to prevent the health, social, and economic consequences associated with opioid misuse and addiction:

• Better Addiction Prevention, Treatment, and Recovery Services. This involves working across the continuum of care. It has evolved to explicitly include harm reduction.

• Better Data strengthens public health reporting to improve the timeliness and specificity of data and to inform a real-time public health response.

• Better Pain Management advances the practice of pain management to enable access to high-quality, evidence-based pain care which reduces the burden of pain for individuals, families, and society while reducing the inappropriate use of opioids.

• Better Targeting of Overdose Reversing Drugs. This has a particular focus on high-risk populations. Increasing the availability and distribution of overdose-reversing medications ensures broader provision of these drugs to people most likely to experience or respond to an overdose.

• Better Research. Supporting cutting-edge research advances our understanding of pain, overdose and addiction. This leads to the development of new treatment and identifies effective public health interventions to reduce opioid-related health harms.

Available Tools and Resources

• SAFE Project:
• "At-Home Drug Disposal" is a SAFE Project written article that discusses the importance of proper disposal for opioid/prescription medications at home and how to do so safely.
• See the wiki titled "Reduce Criminal Diversion of Prescription Drugs" for more detailed information on the illegal distribution and misuse of prescription drugs, encompassing activities like selling medications, doctor shopping, and theft or forgery of prescriptions.
• See the wiki titled "Expand Prescription Drug Take-Back and Disposal Programs" for more detailed information on prescription drug take-back and disposal programs that enhance safety by reducing accidental exposure, protect the environment by preventing medications from contaminating water sources, and decrease drug diversion, limiting the misuse of prescription drugs that are often obtained from family or friends.

Here is a small sample of products which can either be distributed or advertised by community coalitions for families to purchase. Some of these are low-cost items, useful as give-ways at community events. Some of the items could have logos of local business sponsors or coalition branding added:

• IKeyp provides a safe that offers storage for personal items that need to be securely stored yet regularly accessed. It is linked to an app on a smart phone.

• Pack4U equips pharmacies with single-dose packaging. Using blister packs instead of having an entire bottle filled with prescription pills has been shown to help prevent accident poisonings in children.

• Safer Lock provides 4-digit combination lock boxes and locking caps.

• TimerCaps have a built-in LCD stopwatch timer which displays how long it has been since the cap was last replaced. Timer caps come in different sizes, and they can replace an existing medicine bottle cap (or you can get a cap and bottle combination). TimerCaps are easy to use and don't require a change in patient behavior. They are also useful to track the timing since the last dosage -- reducing accidental overdoses and emergency room visits.

Promising Practices

Many communities have engaged in education and awareness efforts to increase prescription drug disposal and safe storage. There is potential to reach significantly more people by reaching a more diverse group of cross-sector partners in a campaign. The CDC promotes three different national campaigns:

• The National Action Plan for Adverse Drug Event Prevention (ADE Action Plan) identifies common, preventable, and measurable adverse drug events and aligns the efforts of federal health agencies to reduce patient harms from these ADEs nationwide.

• The PROTECT Initiative is an innovative collaboration led by CDC. PROTECT unites public health agencies, private sector companies, professional organizations, consumer/patient advocates, and academic experts to keep children safe from unintended medication overdoses.

• Up and Away Campaign. "Put your medicines up and away and out of sight." This campaign is designed to remind families about the importance of safe medicine storage.

There are numerous examples of campaigns that were started by local communities. One example in Rhode Island is the partnership between the South Kingstown Partnership for Prevention and Rebels Inspiring Positive Lifestyles. Their medication safety campaign held community awareness events and garnered local news publicity for their cause and were able to raise funds to send youth leaders to CADCA training.