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Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department

  • Julio Silvestre (a1) (a2), Akhila Reddy (a3), Maxine de la Cruz (a3), Jimin Wu (a4), Diane Liu (a4), Eduardo Bruera (a3) and Knox H. Todd (a1)...



Approximately 75% of prescription opioid abusers obtain the drug from an acquaintance, which may be a consequence of improper opioid storage, use, disposal, and lack of patient education. We aimed to determine the opioid storage, use, and disposal patterns in patients presenting to the emergency department (ED) of a comprehensive cancer center.


We surveyed 113 patients receiving opioids for at least 2 months upon presenting to the ED and collected information regarding opioid use, storage, and disposal. Unsafe storage was defined as storing opioids in plain sight, and unsafe use was defined as sharing or losing opioids.


The median age was 53 years, 55% were female, 64% were white, and 86% had advanced cancer. Of those surveyed, 36% stored opioids in plain sight, 53% kept them hidden but unlocked, and only 15% locked their opioids. However, 73% agreed that they would use a lockbox if given one. Patients who reported that others had asked them for their pain medications (p = 0.004) and those who would use a lockbox if given one (p = 0.019) were more likely to keep them locked. Some 13 patients (12%) used opioids unsafely by either sharing (5%) or losing (8%) them. Patients who reported being prescribed more pain pills than required (p = 0.032) were more likely to practice unsafe use. Most (78%) were unaware of proper opioid disposal methods, 6% believed they were prescribed more medication than required, and 67% had unused opioids at home. Only 13% previously received education about safe disposal of opioids. Overall, 77% (87) of patients reported unsafe storage, unsafe use, or possessed unused opioids at home.

Significance of Results:

Many cancer patients presenting to the ED improperly and unsafely store, use, or dispose of opioids, thus highlighting a need to investigate the impact of patient education on such practices.


Corresponding author

Address correspondence and reprint requests to: Akhila Reddy, Department of Palliative Care and Rehabilitation Medicine, Unit 1414, The University of Texas MD Anderson Cancer, 1515 Holcombe Boulevard, Houston, Texas 77030. E-mail:


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These authors contributed equally to the work of the study.



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Bates, C., Laciak, R., Southwick, A., et al. (2011). Overprescription of postoperative narcotics: A look at postoperative pain medication delivery, consumption and disposal in urological practice. The Journal of Urology, 185(2), 551555.
Boleda, M.A., Galceran, M.A. & Ventura, F. (2009). Monitoring of opiates, cannabinoids and their metabolites in wastewater, surface water and finished water in Catalonia, Spain. Water Research, 43(4), 11261136.
Bruera, E. & Kim, H.N. (2003). Cancer pain. The Journal of the American Medical Association, 290(18), 24762479.
Centers for Disease Control and Prevention (2010). Adult use of prescription opioid pain medications: Utah, 2008. Morbidity and Mortality Weekly Report, 59(6), 153157. Available from
Choo, E.K., Douriez, C. & Green, T. (2014). Gender and prescription opioid misuse in the emergency department. Academic Emergency Medicine, 21(12), 14931498.
Dart, R.C., Surratt, H.L., Cicero, T.J., et al. (2015). Trends in opioid analgesic abuse and mortality in the United States. The New England Journal of Medicine, 372(3), 241248.
Fortner, B.V., Okon, T.A. & Portenoy, R.K. (2002). A survey of pain-related hospitalizations, emergency department visits, and physician office visits reported by cancer patients with and without history of breakthrough pain. The Journal of Pain, 3(1), 3844.
Hall, A.J., Logan, J.E., Toblin, R.L., et al. (2008). Patterns of abuse among unintentional pharmaceutical overdose fatalities. The Journal of the American Medical Association, 300(22), 26132620.
Jones, C.M., Mack, K.A. & Paulozzi, L.J. (2013). Pharmaceutical overdose deaths, United States, 2010. The Journal of the American Medical Association, 309(7), 657659.
Lewis, E.T., Cucciare, M.A. & Trafton, J.A. (2014). What do patients do with unused opioid medications? The Clinical Journal of Pain, 30(8), 654662.
Maher, D.P., Kissen, M., Danovitch, I., et al. (2014). Perioperative substance use disorder, opioid diversion, and opioid misuse by a medical professional undergoing orthopedic surgery. Journal of Opioid Management, 10(6), 437440.
Manchikanti, L., Helm, S. 2nd, Fellows, B., et al. (2012). Opioid epidemic in the United States. Pain Physician, 15(Suppl. 3), ES9ES38.
Marcus, S.M. (2011). Reducing opioid abuse and diversion. The Journal of the American Medical Association, 306(4), 381382.
Poon, S.J. & Greenwood-Ericksen, M.B. (2014). The opioid prescription epidemic and the role of emergency medicine. Annals of Emergency Medicine, 64(5), 490495.
Reddy, A., Yennurajalingam, S., Pulivarthi, K., et al. (2013). Frequency, outcome, and predictors of success within 6 weeks of an opioid rotation among outpatients with cancer receiving strong opioids. The Oncologist, 18(2), 212220.
Reddy, A., de la Cruz, M., Rodriguez, E.M., et al. (2014 a). Patterns of storage, use, and disposal of opioids among cancer outpatients. The Oncologist, 19(7), 780785.
Reddy, A., Yennurajalingam, S., de la Cruz, M., et al. (2014 b). Factors associated with survival after opioid rotation in cancer patients presenting to an outpatient supportive care center. Journal of Pain and Symptom Management, 48(1), 9298.
Tanabe, P., Paice, J.A., Stancati, J., et al. (2012). How do emergency department patients store and dispose of opioids after discharge? A pilot study. Journal of Emergency Nursing, 38(3), 273279.
Tarling, M.M., van den Berg, N., Strunin, L., et al. (1996). The use of absorbent materials for the disposal of controlled drugs. Anaesthesia, 51(9), 836838.
Tong, A.Y., Peake, B.M. & Braund, R. (2011). Disposal practices for unused medications around the world. Environment International, 37(1), 292298.
U.S. Department of Environmental Protection (2014). How to dispose of medicines properly. Available at
U.S. Food and Drug Administration (2014). Disposal of unused medicines: What you should know. Available from
Volkow, N.D. & McLellan, T.A. (2011). Curtailing diversion and abuse of opioid analgesics without jeopardizing pain treatment. The Journal of the American Medical Association, 305(13), 13461347.
Volkow, N.D., McLellan, T.A., Cotto, J.H., et al. (2011). Characteristics of opioid prescriptions in 2009. The Journal of the American Medical Association, 305(13), 12991301.
Welham, G.C., Mount, J.K. & Gilson, A.M. (2015). Type and frequency of opioid pain medications returned for disposal. Drugs—Real World Outcomes, 2, 129135. Available from
Williams, N., Robertson, J., McGorm, K., et al. (2009). What factors affect medication-storage practice among patients on methadone maintenance treatment? The International Journal of Pharmacy Practice, 17(4), 231235.
Wisniewski, A.M., Purdy, C.H. & Blondell, R.D. (2008). The epidemiologic association between opioid prescribing, non-medical use, and emergency department visits. Journal of Addictive Diseases, 27(1), 111.
Yokell, M.A., Delgado, M.K., Zaller, N.D., et al. (2014). Presentation of prescription and nonprescription opioid overdoses to US emergency departments. JAMA Intern Medicine, 174(12), 20342037.


Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department

  • Julio Silvestre (a1) (a2), Akhila Reddy (a3), Maxine de la Cruz (a3), Jimin Wu (a4), Diane Liu (a4), Eduardo Bruera (a3) and Knox H. Todd (a1)...


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