What happened the last time you were prescribed an opioid? If you're like most people, you didn't finish them — and didn't dispose of them — in effect, making you a potential source of illicit drugs and addiction that has been exploding across America.
This rogue supply of painkiller is alarming, given the latest data on addiction deaths: Even after years of heightened attention from politicians and the press to the nationwide opioid epidemic, 2016 saw an increase in overdose deaths of 21 percent, with rates of synthetic-opioid deaths doubling, according to the Centers for Disease Control and Prevention.
"There are around 200 million opioid scripts a year. ... It's an extraordinary reserve," said Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University who worked on drug policy for the Obama administration. "That's just as many scripts as there are adults; it's such a huge reservoir to tap. ... Lots of people just don't think about it," Humphreys said.
As many as 92 percent of patients don't finish their painkillers, and less than 10 percent dispose of them properly — either flushing them down the toilet or returning them to a hospital, pharmacy or law enforcement, according to a new study published in the journal JAMA Surgery.
"For almost every injury we looked at, patients had pills they didn't use," said Johns Hopkins pain-management specialist Mark Bicket, who led the study. "They become a source for illicit use. Other adults use them, and children and adolescents can find them when they're exploring," he said.
At least two-thirds of a total of 810 patients didn't use their entire opioid prescription but kept the unused pills, according to the data Johns Hopkins studied, and roughly 75 percent of patients ignore warnings to keep opioids in a locked cabinet.
"If it was only one or two pills, it would be one thing," Bicket said. "But most patients have more than 10 — almost the entire prescription — just lying around." He said many patients hoard the drugs, not to get high but so they can react to a relapse of pain or some new injury without seeing a doctor again.
Many patients stop taking pills because their pain has receded, according to between 42 percent and 71 percent of those studied. A smaller group of patients stopped taking the pills because of side effects.
Either way, leaving the pills around the home leads to abuse. "Some teenage kids want to experiment, but a teenager can also be entrepreneurial," Humphreys said. "You can sell a 20-milligram OxyContin pill for $20 on the street." He added that other threats are beyond a family's ability to foresee: There have been cases where visitors to a real estate open house clean out pill cabinets.
Opioids account for 2 million people with a substance-abuse problem, according to the American Society of Addiction Medicine. Most people with opioid problems began by using pills they were prescribed as pain relievers, but more recent twists in the epidemic include a resurgence of heroin addiction and abuse of fentanyl, the drug that singer Prince overdosed on last year.
Drug overdoses in 2016 killed more than 64,000 Americans, with the largest numbers coming from people who abuse prescription pills such as oxycodone or hydrocodone, whose brand-name versions are OxyContin and Vicodin. More recently, the growth in overdose deaths has come mostly from fentanyl and heroin, the CDC data shows.