Resistance to FDA opioid-disposal plan raises concerns about CADCA

December 8, 2022 5:39 PM

At its surface, it seems like a simple problem with a simple solution. Across the country, medicine cabinets are littered with unused, potentially addictive opioids. So the federal government wants to distribute prepaid envelopes alongside new painkiller prescriptions, allowing Americans to mail back their leftovers. But the seemingly innocuous proposal has generated opposition from a surprising source: the Community Anti-Drug Coalitions of America, a powerful nonprofit organization that has dominated drug policy advocacy in Washington for decades.
posted by Etrigan (37 comments total)

I get the conflict of interest, but I also see why the disintegration pouches make more sense. Mail theft in my city is on the rise, most often for checks, but if recognizable envelopes entered the mail stream I can see how the temptation would be to branch out.

As Anish Agarwal says in the article, there's "no one-size-fits-all solution." I recently used both methods (disintegration pouches and mail-in envelopes) to dispose of the vast cornucopia of my late husband's drugs. The pouches are designed to be thrown in the trash, which was nice. I don't know how they get rid of the mail-in stuff, but honestly the alternative for many people is flushing drugs down the toilet where they end up in the wastewater system, or else leaving them in your medicine cabinet to tempt anyone who encounters them. A good portion of my husband's presecriptions were poisonous rather than addictive (oral chemo).

Since I belong to a recovery program, some of my fellow members were very concerned about the presence of drugs in my house. Apparently the situation would be too tempting for them. I'm nearly fifty years sober and never much cared for pills, so it didn't occur to me; it was just part of getting all the stuff out of my house that reminded me of how bad things were for him at the end.
posted by Peach at 5:50 PM on December 8, 2022 [20 favorites]

When I switched prescriptions midstream, the pain management clinic made me bring in my unused pills and put them in the hospital’s medicine disposal.
posted by The Underpants Monster at 5:51 PM on December 8, 2022 [4 favorites]

If these are distinctive envelopes, yes, I can definitely see them becoming a target for theft along the way...especially as there's no recipient awaiting them at the end.
posted by praemunire at 6:32 PM on December 8, 2022

I'm sitting on a few medications from a surgery I had over a decade ago. I thought about bringing them back to the pharmacy, but the closest one that takes old drugs is a solar unit away. So they just sit there. I don't want to throw them into the garbage stream, I don't want to toss them into a toilet or whatever, I just want them to be responsibly disposed. So I just sit on them. I'm never going to even think about taking them. I just kind of feel like any pharmacy that gives out drugs should be able to take them back? It should be that easy? Well, I guess that would take some regulation since the pharmacies are basically all monopolies now, and it's impossible to even buy fccking deodorant there now. But at least they're in charge of vaccinating us, I guess.
posted by General Malaise at 6:32 PM on December 8, 2022 [9 favorites]

Here's the thing - the CADCA have been some of the staunchest of the drug warriors that have routinely pushed falsehoods and scare tactics in the War on Drugs. Not to mention (as the article points out) that they have conflicts of interest here.
posted by NoxAeternum at 6:41 PM on December 8, 2022 [14 favorites]

I’m with @General_Malaise. Make pharmacies responsible for disposing them. Presumably they have the occasional medication that passes its expiry before they dose it out that they have to get rid of anyway.
posted by heyitsgogi at 7:42 PM on December 8, 2022 [10 favorites]

There's already a model for this in needle exchanges. There's one near here that has a drop-box for the personal sharps bins the needles come in.
posted by adept256 at 7:55 PM on December 8, 2022 [6 favorites]

I am 90% sure that my dads hospice meds came with an envelop to send back what was left. The hospital pharmacy nearby actually has a disposal bin, but it has friendly been full when I have seen it. The pharmacy staff won’t touch it- they have to wait for whatever service comes and empties it
posted by CostcoCultist at 8:03 PM on December 8, 2022

Make pharmacies responsible for disposing them.

We can make stores take back empty bottles (in some states.) This shouldn't be difficult.
posted by ChurchHatesTucker at 8:15 PM on December 8, 2022

Bitterly tongue in cheek, but I wish people with unused opiates could give them to narcoleptics. Research has shown that opiates increases orexin in the brain (anecdotally, opiates make me feel so alert and awake) but the prevalence of opioid addiction has stalled that research, it seems. C’mon, we’re given amphetamines and GHfuckingB already, so please trust us with the opiates, thx.
posted by Ruki at 8:17 PM on December 8, 2022 [10 favorites]

There's already a model for this in needle exchanges
The opposition here to the introduction of sharps boxes in every public toilet was astounding, with the entirely predictable cries that providing a safe place to dispose of needles would inevitably and immediately result in hordes of crazed drug addicts stumbling around every park and shopping centre assaulting children and the elderly at will.

I guess that outcome is taking a little longer than the naysayers predicted because, so far, the only visible result is fewer kids ending up with needlestick injuries from playing in the park and fewer sanitation workers injured while emptying public rubbish bins.

I would hope the FDA is smart enough to not label return envelopes with 'caution: addictive drugs inside' so, while there is some potential for envelopes to be stolen in the mail system, the odds have to be much lower than some curious teenager sampling the leftovers in dad's medicine cabinet.
posted by dg at 8:19 PM on December 8, 2022 [6 favorites]

I always figured mail theft was mostly a theft from mailboxes kind of thing that outgoing mail would mostly be immune from. Is there a significant portion of theft that is perpetrated by postal employees?
posted by Mitheral at 8:43 PM on December 8, 2022 [1 favorite]

Is there a significant portion of theft that is perpetrated by postal employees?

There are a number of safeguards, but a fair number of them don't apply if (a) there is predictably high-value, small-volume/weight material in recognizable envelopes; (b) the envelopes enter the system via mailbox so they can't be tracked until they reach the office; and (c) there is no one expecting that material at the other end. Requiring the envelopes to be taken directly to the post office (or picked up by scheduled pickup, perhaps?) would help, but increase friction for people wanting to return the drugs.
posted by praemunire at 8:54 PM on December 8, 2022 [1 favorite]

General Malaise (and anyone else who wants to dispose or discard prescription meds) the Wal-Mart near me has a freestanding thing that looks just like a blue mailbox for discarding medications right by the pharmacy counter. I just put them in a baggie and pop them right in there. Police stations have things like that too. Maybe the Wal-Marts and police stations near you have those things too.
posted by 41swans at 9:54 PM on December 8, 2022

I'm sitting on a few medications from a surgery I had over a decade ago.

Call your local fire station and see if they have a safe drugs disposal bin. A lot of them do.
posted by Jacqueline at 10:28 PM on December 8, 2022

There's a disposal box in the lobby of my local small-town police station. Is that unusual?
posted by Nerd of the North at 11:08 PM on December 8, 2022 [1 favorite]

I presume a segment of people that want to get rid of risky drugs don't trust the police.

Fear News has been saying for decades the time to get rid of these is on halloween. 🙄
posted by adept256 at 11:22 PM on December 8, 2022 [4 favorites]

A lot of addicts are cash strapped and would probably love some free drugs, not quite sure how to make that easy to do though...
posted by Meatbomb at 12:55 AM on December 9, 2022

Probably not the unwanted drug-drop at the local police station, I guess.
posted by dg at 1:11 AM on December 9, 2022

In Australia you can take unused medicines back to pretty much any pharmacy for disposal. Is that not a thing in the USA?
posted by chiquitita at 2:26 AM on December 9, 2022 [2 favorites]

Also in the UK you can take unused medicines back to any pharmacy.
posted by Lanark at 3:58 AM on December 9, 2022

Is there a significant portion of theft that is perpetrated by postal employees?

Thieves have recently been mugging postal employees and stealing their keys, meaning the keys to the collection boxes are in circulation now. The post office being the post office, rekeying the locks isn't exactly a high priority for them.

I'm not sure what happened to the Postal Inspection Service, though. They used to have quite the reputation to the point that very few people were willing to fuck with the mail because getting on their radar meant a near certainty of a prison sentence in your future.
posted by wierdo at 3:59 AM on December 9, 2022 [1 favorite]

When my stepfather died, my mom charged me with disposing of his meds when I came down for the funeral. I ended up going all the way from her suburban residence to the main downtown police station, which was the only place that had one of those medication disposal boxes. (You had to go inside the station to dump them.)
posted by Kitteh at 4:04 AM on December 9, 2022

I know that police stations in Chicago have disposal boxes—secure, metal things with hinged slots like a mail box. I've seen them on a couple occasions when voting. I have no idea how legitimate any of this is, considering the terrible reputation of Chicago cops.
posted by SoberHighland at 4:35 AM on December 9, 2022

Is there in fact a problem generated by throwing opioids in the trash? Outside a bottle, don’t the compounds rapidly break down?
posted by aspersioncast at 5:29 AM on December 9, 2022

I was playing a new rally game and driving through Ypres. My car landed upside down in a field, so I had a good look at the pretty red flowers. They were poppies! Of course, this was the place where they became a symbol of remembrance.

So Belgium has poppies growing wild, seems to be ok. My car, not so ok.
posted by adept256 at 6:02 AM on December 9, 2022

adept256, my 8th-grade shop class (ag track) project was a bed of poppies. From what my teacher said, they turned out great.

Maybe I should have mentioned drug farming on my immigration documents.
posted by tigrrrlily at 6:09 AM on December 9, 2022 [1 favorite]

This seems like solving such a non-problem. Overwhelmingly, the most common and concerning opioids can be safely flushed. Non-opioids including antidepressants and steroids have some plausible wastewater environmental effects. Tramadol is reasonably common and probably not good to flush, but it's also a weak opioid and uncommonly abused.
posted by a robot made out of meat at 6:52 AM on December 9, 2022 [5 favorites]

Tramadol is reasonably common and probably not good to flush, but it's also a weak opioid and uncommonly abused.

You couldn't tell this from the hoops they make you jump through to get it, though. I'm a chronic pain patient with a do-not-pass-go-but-go-straight-to-the-ER allergy to all the NSAIDs after decades of using them to manage autoimmune problems. For the first "month" of the year I can get a "week's" supply of pain pills a week at a time. This year I finally managed to get a full month's supply at the end of November. And I or the person picking up my meds (usually Mr Epigrams) has to go into the pharmacy and sign with a driver's license each time, so no delivery options. There are times I go without pain medication during the day to make sure I have enough to sleep at night. And I know I'm a relatively mild case as these things go, too. It doesn't surprise me that there are folks with worse pain out there who have resorted to suicide.

But helping me dispose of the same drug safely? That's a bridge too far, clearly.
posted by gentlyepigrams at 7:09 AM on December 9, 2022 [7 favorites]

>Is there in fact a problem generated by throwing opioids in the trash?
As far as I can tell, no. This GAO report to Congress recommends flushing things that are "on the flushable list", and for the rest putting them in the trash. Ideally after mixing them with something gross to deter anyone encountering them.
posted by mrgoldenbrown at 7:16 AM on December 9, 2022

Correction - that same GAO report does mention elsewhere that pharmaceuticals do sometimes escape landfill containment, so unless you know your trash goes to an incinerator, it's not ideal.
posted by mrgoldenbrown at 7:21 AM on December 9, 2022

This GAO report to Congress...
I like to imagine, without opening that link, that it isn't prescription drug specific and is just a Government Accountability Office report about what to flush and what not to flush. Important work.
posted by shenkerism at 8:15 AM on December 9, 2022 [1 favorite]

Outside a bottle, don’t the compounds rapidly break down

Outside a bottle, but still in the form of pills? Probably not. I don’t know whether anybody will think to look in your trash for drugs but seems like a hazard to animals and kids.

If you mean flushing them, I have no idea how well they biodegrade/filter out.
posted by atoxyl at 10:33 AM on December 9, 2022 [1 favorite]

The disintegrating envelopes are great, except the ones I can get, you can only treat 1, maybe 2 bottles of medication with one envelope. A lot of the people cleaning out unused meds after someone has passed have like 40-50 bottles to go through. So you often can't get enough of the envelopes.

I feel like with some stuff, knowing how expensive it is-- I'm surprised I haven't heard about reuse networks similar to what people did with leftover HIV prescriptions back when. Then again, sharing prescriptions is a pretty easy way to get locked up forever, so it's probably good that people don't share freely what they're doing.

Whatever the solution is, it has to be easy and lazy. I don't know, maybe there could be a big dissolving barrel with a slot in it at the pharmacy or the post office or something.
posted by blnkfrnk at 11:14 AM on December 9, 2022

The prevalence of opioids is one of the things that wastewater sampling looks for, along with things like COVID, so I gather opioids persist just fine.
posted by Peach at 7:07 PM on December 9, 2022 [2 favorites]

Back here again for another day in the life of a chronic pain patient. Just opened a snail mail from the pharmacy branch of my health insurance company explaining that Opioids Are Bad and Opioids Will Probably Not Solve My Pain Problems. Of course I just got that large supply, which is probably what provoked the system to spit out that letter, but ofc nowhere am I given any hint of where/how to dispose of the pain meds that I shouldn't need/be using. *eyeroll*
posted by gentlyepigrams at 4:15 PM on December 11, 2022

Yeah, I got the Opioids Will Not Help You talk from my physical therapist just recently. I didn't feel like an argument, but I really wanted to say, "They're doing more for me than you ever did."
posted by The Underpants Monster at 5:30 PM on December 11, 2022