No Givesies, No Takesies, No Backsies? Evaluation of a Community Health Center Opioid Buyback Program

• In Event: Health Policy for Children

Abstract

Abuse, addiction, and overdose of prescription opioids have been at crisis levels for decades. Surprisingly, 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. However, studies show that both lack of knowledge and distance to a disposal kiosk prevent patients from returning unused medications or disposing of them properly (Lystlund,  et al., 2014).

Using a randomized control trial, we tested whether patients were more likely to return unused opioids when informed and incentivized to safely dispose their medication. We focused on an economically disadvantaged, largely Hispanic population of patients who received medical care from a community health center with multiple locations in a mid-sized city in Massachusetts with one of the highest opioid overdose rates in the nation. Patients who were prescribed an opioid for an acute diagnosis such as surgery or injury were randomized into treatment and control groups by pharmacy staff across calendar days within each site. The intervention included an educational consultation with the pharmacist about their opioid prescription and how to dispose of it safely, with either a monetary incentive, text message reminder, or mail-back envelope to incentivize the return of any unused medication. We then compared the rate at which patients in the treatment group returned their unused medication relative to that of the control group, while also exploring heterogeneity in treatment effects across patient characteristics. 

We find several important and surprising, results. First, the program had a statistically significant positive but small (4 percentage point) impact on the likelihood that patients returned their unused opioid medication. These effects increased slightly when adding the financial incentive, text message reminder, or mail back envelope, Second, the amount of medication prescribed for a given condition varied widely and surprisingly, patients who were prescribed smaller amounts were more likely to return their medication, perhaps due to lower severity of the medical condition for which it was prescribed. Third, some patients declined to pick-up their medication when the pharmacist notified them it was an opioid, despite providers being required by state law to discuss any opioid medication with their patients.

Our results have important implications for making the most efficient use of public resources to address the opioid crisis. First, while medication return programs can be useful in removing opioids from a small number of households, stricter prescribing limits are more likely to reduce the amount of opioids obtained by secondary users. Second, financial incentives may not be most effective method to change behavior when the amount offered is constrained by regulations, and patients report being more motivated to return their medication out of concern for themselves or their loved ones. Finally, there is still a role for patient education regarding opioid medication and pharmacists might play an important second line of defense after clinicians.

Author

• Peiran Cheng, Northeastern University
  Presenting Author