An Inexpensive, Scalable Option for Encouraging Safe Disposal of Leftover Opioids

Who knew that something as simple as snail mail could be the answer to safely disposing of unused prescription opioids?

In a study published by JAMA Network Open, researchers from the Perelman School of Medicine at the University of Pennsylvania outline an option that could help to remove leftover opioid pills from the community: mailing an opioid disposal kit to patients who are prescribed opioids for acute pain management at discharge.

They found that 60% of patients who received the opioid disposal kit and who had leftover opioid pills properly disposed of them after surgery, compared with 43% of patients who had not received the opioid disposal kit.

“I was pleased to see that such a simple, ‘snail mail’ approach could change behavior and promote self-reported disposal,” said the study’s lead author, Anish Agarwal, MD, an Assistant Professor of Emergency Medicine and Chief Wellness Officer in the Department of Emergency Medicine at Penn Medicine.

“The opioid epidemic clearly continues to be front and center for patients, and the concerns with opioid use and misuse are becoming a real part of the conversation between physicians and patients. I think patients are more aware of the risks and consequences of using opioids and storing them in their homes.”

Challenges of Safe Disposal

Leftover opioid medications are a concern for their potential to be misused, either by the person they were prescribed to or someone else taking them. But just throwing leftover pills into the trash may not be the best option.

“Throwing them in the trash can be dangerous if [the pills] are ingested by kids or animals, and there are environmental concerns,” said the study’s senior author, M. Kit Delgado, MD, an Assistant Professor of Emergency Medicine and Epidemiology and Deputy Director of the Penn Medicine Nudge Unit.

“When safe disposal sites are not available, the FDA recommends that certain high-risk medications, including opioids, be flushed down the toilet due to their high-risk nature. However, there are also environmental concerns with doing this.”

Another Layer of Convenience

Although safe disposal sites, such as certain pharmacies, are the best option, patients often don’t use them because they may not be easily accessible or because it takes extra effort. With that in mind, Dr. Agarwal, Dr. Delgado, and their colleagues decided to test whether an added layer of convenience – mailing safe disposal kits – might make a difference.

For this study, 235 patients were randomized to 1 of the following:

  • Texted instructions to dispose of their unused opioids, along with a link detailing the locations of local safe disposal points to drop off their unused opioid tablets (usual care group)
  • Texted instructions plus receipt of a mailed opioid disposal kit 4 to 7 days after surgery (intervention group)

All patients had undergone an orthopaedic or urologic procedure between April 19, 2021, and June 1, 2021, and had been prescribed opioid pain medication for their recovery.

Inexpensive, Scalable Option

Some national studies show that only 20% to 30% of patients properly dispose of their leftover opioids, compared with 60% of the intervention group, which means that the impact of the mailed opioid disposal kits could be even greater than what was observed in this study. Although only 125 patients were in the intervention group, they safely disposed of 480 unused opioid pills.

“This is a smaller study, but removing almost 500 opioid tablets out of medicine cabinets and out of communities where they could do harm could be impactful,” Dr. Agarwal said.

“One could imagine that if scaled up to the thousands of surgeries that are done per year in our health system and millions done in the US, this [intervention] could be extremely impactful at scale.”

Mailing the kits is not prohibitively expensive, costing less than $2 each, and is a simple, scalable option for disposing of unused opioids after surgery, the study authors said.


Agarwal AK, Lee D, Ali Z, Wu Y, Cognilio M, Uritsky T, Delgado MK. Effect of mailing an at-home disposal kit on unused opioid disposal after surgery: a randomized clinical trial. JAMA Netw Open. 2022 May 2;5(5):e2210724. doi: 10.1001/jamanetworkopen.2022.10724.

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