CO-MORBID PAIN & SUBSTANCE USE DISORDERS Effect of Drug Disposal Kits and Fact Sheets on Elimination of Leftover Prescription Opioids: The DISPOSE Multi-Arm Randomized Controlled Trial Mark C. Bicket, MD, PhD,* ,† Denise Fu, PharmD, BCACP, ‡ Meghan D. Swarthout, PharmD, MBA, BCPS, ‡,§ Elizabeth White, RN, ¶ Suzanne A. Nesbit, PharmD, BCPS, § and Constance L. Monitto, MD ¶ *Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan; † Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan; ‡ Pharmacy Services, Johns Hopkins Home Care Group, Baltimore, Maryland; § Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland; ¶ Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Correspondence to: Constance L. Monitto, MD, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Charlotte Bloomberg Children’s Center, 1800 Orleans Street, Suite 6349A, Baltimore, MD 21287, USA. Tel: 410-955-7610; Fax: 410-367- 2232; E-mail: cmonitt1@jhmi.edu. Funding sources: This trial was funded by the Department of Pharmacy at the Johns Hopkins Health System, Pharmacy Services at Johns Hopkins Home Care Group, and the Department of Anesthesiology and Critical Care Medicine at the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. Dr. Bicket received salary support from the Foundation for Anesthesia Education and Research. Role of the funder/sponsor: The funders had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. Conflicts of interest: The authors declare no conflicts related directly to this investigation. Dr. Bicket reports grants from the Foundation for Anesthesia Education and Research, personal fees and other from Axial Healthcare, and personal fees from Alosa outside the submitted work. Trial registration: clinicaltrials.gov Identifier: NCT03855241. Abstract Objective. To determine how passively providing informational handouts and/or drug disposal kits affects rates of leftover prescription opioid disposal. Design. A multi-arm parallel-group randomized controlled trial with masked outcome assess- ment and computer-guided randomization. Setting. Johns Hopkins Health System outpatient pharmacies. Subjects. Individuals who filled 1 short-term prescription for an immediate-release opioid for themselves or a family mem- ber. Methods. In June 2019, 499 individuals were randomized to receive an informational handout detailing U.S. Food and Drug Administration–recommended ways to properly dispose of leftover opioids (n ¼ 188), the informa- tional handout and a drug disposal kit with instructions on its use (n ¼ 170), or no intervention (n ¼ 141) at prescrip- tion pickup. Subjects were subsequently contacted by telephone, and outcomes were assessed by a standardized survey. The primary outcome was the use of a safe opioid disposal method. Results. By 6 weeks after prescription pickup, 227 eligible individuals reported they had stopped taking prescription opioids to treat pain and had leftover medica- tion. No difference in safe disposal was observed between the non-intervention group (10% [6/63]) and the group that re- ceived disposal kits (14% [10/73]) (risk ratio ¼ 1.44; 95% confidence interval: 0.55 to 3.74) or the group that received a fact sheet (11% [10/91]) (risk ratio ¼ 1.15; 95% confidence interval: 0.44 to 3.01). Conclusions. These findings suggest that passive provision of a drug disposal kit at prescription pickup did not increase rates of leftover opioid disposal when compared with provision of a fact sheet alone or no intervention. Active interventions may deserve further investigation. Key Words: Pain; Acute; Analgesics; Opioid; Prescription Drug Misuse; Medical Waste Disposal; Opioid Stewardship V C The Author(s) 2021. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 961 Pain Medicine, 22(4), 2021, 961–969 doi: 10.1093/pm/pnaa431 Advance Access Publication Date: 12 February 2021 Original Research Article Downloaded from https://academic.oup.com/painmedicine/article/22/4/961/6133940 by guest on 04 December 2021