Association for Public Policy Analysis & Management

The opioid addiction epidemic has been declared a national public health emergency, causing on average 91 deaths in the U.S. every day, of which 44 percent are attributed to the overdose of legally obtained prescription opioids (CDC 2017). More than one-third of opioid-related deaths are attributed to secondary users of prescription opioids with two-thirds of abusers obtaining painkillers from family and friends (CDC 2017). Secure disposal of unused medications is one strategy to reduce the availability of opioids for diversion or abuse to secondary users after they have been dispensed.

Our study seeks to determine whether patients are more likely to return unused opioids when informed and incentivized about a medication disposal program compared to passively observing a disposal kiosk in their pharmacy. A 2014 survey of beliefs and behaviors regarding unused and expired medication among a sample of 200 community pharmacy patients found that vulnerable populations were more likely to lack knowledge of and access to proper medication disposal locations (Kozak et al. 2015).We hypothesize that informing patients at the point of dispensing the medication, sending reminders via text message, and providing a financial incentive can significantly boost return rates.

To test this, we have designed a randomized control trial (RCT), funded by the Abdul Latif Jameel Poverty Action Lab (JPAL), to evaluate an opioid buyback program at a community health center. The intervention is currently underway at five in-house pharmacies owned by the Greater Lawrence Family Health Center yielding a total sample size of roughly 2,400 acute opioid prescriptions randomized across treatment and control groups. Two main treatment arms are being implemented across different pharmacy locations. At the largest site, the treatment group will receive information on how to return unused medication plus the financial incentive. At the other four locations, the treatment group will only receive information on how to return unused medication. One of the larger sites in the second treatment arm will also send a text reminder at the end of the month.

We will measure the percent of patients returning opioids as well as the amount and type of medication returned across both groups. We will also compare the amount returned to the amount prescribed by type of medication to assess the potential quantity diverted from secondary use. We will explore the degree of heterogeneity in outcomes across different groups according to patient characteristics that predict opioid addiction such as age, gender, and diagnosis. Finally, we will also directly measure information spillovers to the control group as well as other members of the community. This is an important channel to study as public health care interventions often have an impact on the general population because of spillover effects, increasing both the efficiency and effectiveness of such programs. The lessons learned from this RCT pilot program regarding the take-up rate and the cost-benefit ratio can help inform efforts at the state level to implement such a program on a larger scale.