Prescribing the right amount of opioid tablets to help ease severe pain after surgery can be a challenge. Patients—and their symptoms—can vary widely. While doctors are prescribing fewer opioids to lessen the threat of dependence, they still prescribe more pills than patients need, and those extra painkillers can lead to misuse and harm.     

LDI Senior Fellow Anish Agarwal and colleagues recently tested an inexpensive solution: a disposal kit that encourages patients to dispose of the opioid painkillers they didn’t use. The kits help patients disable pills by mixing them with water and a powdered polymer gel, which then can be thrown safely in the trash.

Patients given a kit disposed their opioids at a rate 10.6% higher than control, according to the study in BMJ Quality, which included LDI Senior Fellows M. Kit Delgado, Daniel Lee, and Zarina S. Ali as well as Penn colleagues Eric Shan, Ruiying Xiong, and Michael Katzman from Penn Medicine Princeton.

So, giving surgery patients a disposal kit at discharge can raise disposal rates. But questions remain about whether there was selection bias – those using the kits may have been more likely than nonusers to respond to follow-up inquiries about opioid disposal – and whether this intervention would work at scale.

Opioid deaths peaked in 2023 at over 110,000 fatalities and have since fallen to about 84,000 people a year, according to the CDC. Multiple factors appear to be in play, including more harm reduction efforts and better access to treatment drugs like buprenorphine and methadone. But more ideas are needed.  

Would giving more disposal kits help? Agarwal, the paper’s senior author, discusses this below. 

What problem with opioids and surgery did you set out to solve?

Agarwal: Opioids are commonly prescribed and used following surgery, especially as we anticipate severe pain in the first few days. However, most of the time the majority of these prescriptions are unused, increasing the risk of persistent use or misuse in the future. It’s hard for surgeons to predict the exact amount a patient needs, so we sought to evaluate whether providing an at-home opioid disposal kits at the time of surgery would improve patients’ disposal rates.

What are your most important findings on opioid disposal and why?

Agarwal: Our study found that providing a very simple, at home disposal kit to patients when they are discharged increased the likelihood of patients properly disposing of their leftover opioids, with a 10.6 percentage point increase in disposal rates. This suggests that a simple, low-cost intervention can significantly impact opioid safety and reduce excess opioids in the community.

What other opioid disposal strategies have been tested and sound promising?

Agarwal: Other studies, some led by our group and some not, have explored mailing these disposal kits to patients, pharmacy-based take-back programs, and automated text messaging reminders to encourage opioid disposal. While all these strategies show promise, integrating disposal methods directly into the discharge process may provide the most immediate and scalable impact. Really the goal is to make doing the safest thing very easy. 

Who would pay for the opioid disposal kit? How could it practically be included in care?

Agarwal: Given the low cost of disposal kits ($1 to $2 each), hospitals, insurers, or other agencies could absorb the cost as part of standard post-surgical care. Kits could be included in discharge materials alongside medication instructions, ensuring patients receive them as part of their recovery process.

What policy recommendations do you have to keep opioids from causing harm?

Agarwal: Policymakers should consider incentivizing the distribution of disposal kits at discharge for opioid prescriptions. Additionally, improving access to take-back programs or disposal kits with prescriptions could enhance safe disposal practices.

Where are you going next with the opioid research?

Agarwal: Future research should explore scaling this intervention across different surgical settings and health care systems. Additionally, investigating patient adherence, alternative disposal methods, and cost-effectiveness analyses could further inform best practices for optimal opioid stewardship.

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The study, “Effect of Providing At-Home Opioid Disposal Kits at Discharge After an Orthopaedic Surgery,” was published on January 1, 2025, in BMJ Open Quality. Authors include Eric Shan, Ruiying Xiong, Michael Katzman, Zarina Ali, Daniel Lee, M Kit Delgado, and Anish Agarwal.

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