Why People Do Not Dispose of Unused Opioids

This article, in a slightly edited form, first appeared on Pain News Network on February 29, 2019.


“Who Is Keeping Their Unused Opioids and Why?” It’s an important question, especially since we’re currently in the midst of a drug crisis. The last thing we want are more drugs being diverted onto the street and circulated for non-medical use. The question was researched by Luke A. Neill, M.D., et al., and published in Pain Medicine.

The article provides partial results of a larger study. Specifically, it reports the responses in a survey of 235 patients who received a hydrocodone prescription following an emergency room (ER) visit. The study was conducted between July 2015 and August 2017..

Unsurprisingly, the Majority of Patients Keep Their Unused Opioids

All patients in the study were given information about how to safely dispose of their unused hydrocodone. Researchers contacted the patients, the month after they were treated in the emergency room, three times. The study reported the number of patients who disposed of their opioids and those who did not.

Of the 235 patients discharged from the ER with an opioid, 50 percent said they had not disposed of their medication. Fewer than 50 percent said they had disposed of the medication, and a few of the patients responded that they “didn’t know.”

Patients who had not disposed of their medication were asked why. They responded with statements like, “in case I have pain,” “just in case,” and, “You never know. If I need it [when I’m traveling out of the country], I can use it.”

Another national study conducted in 2015 reported that more than 60 percent of patients had not disposed of their opioids. That’s an even higher percentage of patients who were holding onto unused medicine than the more recent study found.

The Problem May Increase Due to Policy Changes

During the past several years, partly in an effort to decrease the number of unused opioids, there has been a sweeping change in attitudes and practices of dispensing opioids in emergency rooms. According to the Centers for Disease Control and Prevention (CDC), the rates of prescribing opioids in ERs decreased by one-third from 2006 to 2017.

Since patients currently receive fewer opioids from the ER than in the past, they are likely to have fewer unused pills. However, paradoxically, that may create more incentive for them to hold onto the unused opioids in case they need them in the future.

It is not just emergency rooms that are providing patients with fewer opioids. People discharged following surgeries receive less medication, too, even though more 80 percent of patients feel their post-op pain was inadequately treated.

Pain is not only a state of mind. Under-treated acute pain can cause permanent harm. In a recent issue of Anesthesiology, editor-in-Chief Evan D. Kharasch, M.D., Ph.D. and several of his colleagues penned an editorial, Rational Perioperative Opioid Management in the Era of Opioid Crisis. It states that the lack of evidence of less abuse by limiting opioids for post-operative pain is leading to unintended consequences. The authors specifically note that poorly controlled acute pain can lead to chronic pain.

People Worry Whether They Will Get the Pain Medication They May Need

Many people clearly want to hold onto their unused medications. This is not new. However, the problem may worsen because, more than ever, patients who are in pain fear that they will not be able to get the medication they need.

Keeping unused opioids is ill-advised for many reasons, the most important of which is that opioids should never be used except under the direction of a qualified provider. But there’s another side to the story. If providers are going to refuse to treat pain, people will want to hold onto the medication they have been prescribed in order to avoid future suffering.

Of course, the intention of limiting the amount of opioids prescribed is to reduce the amount of drugs that could be diverted for non-medical use. But policies and practices designed to limit the amount of unused opioids may actually be dangerously creating a need to preserve, rather than dispose of, unused medication.

To paraphrase Dr. Kharasch, let us avoid making people in pain pay with unnecessary suffering for the opioid overprescribing sins of others.


Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, The Painful Truth,” and co-producer of the documentary,It Hurts Until You Die.” Opinions expressed here are those of the author alone and do not reflect the views or policy of PRA Health Sciences.

You can find him on Twitter: @LynnRWebsterMD.




  1. Abigail on March 1, 2020 at 12:20 am

    I was severely damaged by a pharmaceutical and developed CRPS on top of it. I live in levels of pain that most people don’t know exist. On top of that I didn’t qualify for disability so I have to still work. It’s absolutely INSANE that a person like me is forced out to work in excruciating pain. Yet those bills are coming in. It HURTS when I know so many who are faking disability. I went to Urgent Care and couldn’t afford the copay and left in tears yet all around me were immigrants getting free medical care for the damned sniffles. I also went on a forum and these people were on disability for years and years and sit on there all day and shoot the breeze. They were whining that Republicans were taking some of their goodies. It made me SICK. Who in the heck do they think pays for those goodies and why don’t they get off their rear ends and work from home?

    I am SICK TO DEATH of seeing people fake injuries, fake illness, and who go on disability and stay on it for years even when they’re well enough to work from home. These people are ruining it for those of us forced out to work to support their lazy rear ends. I talked to one faker on Phoenix Rising who was on disability for years because of fatigue. She told me she recovered but remained on disability because she liked her free time. How about that. She gives no second thought to stealing from the rest of us. And theft is what it is. But all the whiners whine because Trump wants to have them refile which they should so Ms. Lazy Arse can pull her own fat weight instead of making the rest of us pull it. She’s one of many many many Americans who give no 2nd thought to stealing from the rest of us.

    Do I sound bitter? Damned right I am. I’m sick of being forced out to work while these people know how to play the game and I didn’t. I’m the one who really SHOULD be on disability yet have to watch as this woman sits home and collects a check that people like me have to work in agony to produce. No wonder America is collapsing before our eyes. No one has morals anymore. There is so much graft and selfishness everywhere. That’s why a friend told me when someone comes in whose on Medicaid the doctors and nurses won’t go out of their way to help them because they’re working their backsides off to pay for it.

  2. Gail Honadle on March 1, 2020 at 4:22 pm

    Those of us who truly need them for long standing illnesses or accidents, can’t get them. I had to go through Jaw Re-sculpture on 2 days of 7.5 Norco, have a lot of health painful issues, that are intractable level. It took 4 days for the level pain started going down. Nor can I take OTC crap. At nearly 72 have the usual itis that I can’t take those meds. Any doctor who advises Ibuprofen and other OTC of it’s Ilk Conveniently forget they are Blood Thinners NOT TO BE GIVEN POST OP. SO I’m stuck in level 10 pain, can’t walk more than a few feet, GI is Gastropresis, Now a Type 2 Diabetic, Colon nearly stopped functioning. They are 2 opposing diets. 1 NO fiber, the other Lots of Fiber NO middle ground. I’m tired of trying to keep my Colon moving and Projectile Vomiting out of the blue.

  3. Susan on March 4, 2020 at 5:52 pm

    Abigail, you are blaming the wrong people. It is exceptionally difficult to get on Social Security
    Disability. The gatekeepers to this program are instructed to automatically deny the first application, not because it is assumed that all the applicants are malingering, but to save the government money. Quit blaming immigrants, lazy people and fat people for your predicament. Your legitimate anger should be at a government that refuses to fully fund the social safety nets, yet authorizes that the majority of tax money spent to the military. You are not the only person in legitimate pain that the system refuses to accommodate. There are many people dying of terminal conditions in terrible pain as well who have been denied the services that they are legally entitled to. There are many people in nursing homes who suffer excruciating pain because the doctor’s serving them refuse to prescribe opioids for fear of the rogue DEA. These conditions continue despite the dominant political party in power. You are blaming immigrants because they are an easy target while you let the true perpetrators off scott free.

Leave a Comment