My stepfather passed away in January after a long illness. Like millions of patients with metastatic cancer, he was receiving aggressive pain management that included high doses of multiple opioids toward the end of his life. Within days of his passing, my wife, her siblings and I attempted to do what was responsible by properly disposing of the highly addictive drugs. But how should we do this?
We were in the middle of a brainstorming session when my brother-in-law suggested flushing them down the toilet. We all laughed, thinking there had to be a better way. First, we took all the pills to a big pharmacy in Orlando. A pharmacy technician informed us that the pharmacy does not accept disposable medication; they had no way to throw them away. He suggested we go to the local fire station.
Firefighters also told us they accept sharp objects but not opioids. They advised us to go to the county sheriff’s office, which was closed on Saturdays. We were unsuccessful after driving to three locations, all within a few square miles of the large hospital where my father-in-law had received all his care.
My wife is an assistant professor of nursing, and we see ourselves as responsible health care professionals who are determined to do the right thing, especially when it comes to health care. Proper disposal of these dangerous medications was a top priority for us, but what happens to these medications when it’s not a family’s priority? Medicines are often saved by family members who think they can use them later, and that’s where problems can arise.
We were lucky enough to be in one of Florida’s largest cities, close to a number of medical facilities and resources, and still went wild geese hunting. I spoke to the captain of a fire station in Miami, and he told me that they were instructed never to accept drugs because they had no way of getting rid of them. It is certainly not an isolated problem. If no one in big cities like Orlando and Miami is tackling this problem, what is happening in more rural areas that rely on volunteers?
We physicians are on the front lines of the opioid epidemic. We are the first to take care of these patients, and often we are accused of being at the origin of the epidemic, with interventions targeting our prescriptions. But why is it an emergency medicine problem? Most EMS medical directors are emergency physicians, and it appears fire departments and EMS should accept opioid depots and arrange with hospitals to receive the drugs for disposal.
Reducing the number of opioids that are likely to fall into the wrong hands and perpetuating the opioid epidemic should be a priority. Reducing the number of prescribed medications and treating pain without opioids are only part of the solution. Most of the time, opioids are prescribed to the right patients for the right reasons, but we need to create an easier way for patients and families to get rid of them when they no longer need them.
Perhaps we could learn from a strategy used to reduce gun violence. Many police departments have gun buy-back programs to reduce the number of guns used and sold on the streets. I am considering a similar program to decrease street opioids that may be used by our future patients. Compensation could be given to those who return opioids to the emergency department or other locations.
how does the story end? The sheriff’s office had my sister-in-law put them in plastic zip lock bags and put them in a locked box inside their building, which was not a healthy experience for a girl grieving, who was her father’s primary caregiver. Maybe flushing them down the toilet would have been the most reasonable solution.
Dr Hendershotis a second-year emergency medicine resident at the University of Miami/Jackson Health System. He plans to pursue an EMS scholarship after graduation.