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Package inserts for opioids lack clear messages for safe storage, disposal

Safe storage and disposal messages were not explicitly mentioned on many package inserts for opioid analgesics and were inconsistent across opioid types, according to findings published in Annals of Internal Medicine.

“Providers rarely counsel patients on safe storage and disposal [of opioid analgesics] despite promising evidence supporting such interventions as an effective mechanism to improve patient behaviors,” Mitchell L. Doucette, PhD, MS, from Johns Hopkins Bloomberg School of Public Health, and colleagues wrote. “Drug package inserts include prescribing information for providers and are an avenue for conveying information on safe storage and disposal. How medication packaging presents this information to providers is unknown.”

Doucette and colleagues assessed the information provided on package inserts for six commonly prescribed and misused opioid analgesics to characterize their storage and disposal messages. The six opioids examined included hydrocodone, hydromorphone, tramadol, fentanyl, morphine and oxycodone.

The researchers excluded 10 package inserts for opioids intended for hospital use, yielding a total sample of 98 inserts.

One message on safe storage was identified and stated that the medication should be securely stored to prevent theft. A total of 35 package inserts contained this safe storage message; of which, two-thirds were for oxycodone (n = 16) or morphine (n =8).

Three messages for safe disposal were identified. These messages stated that the unused opioids should either be discarded (n = 31) or flushed down the toilet (n = 34) or the providers should advise their patients to discard unused medications (n = 28). Safe disposal messages were mainly observed on package inserts for oxycodone and morphine.

Inserts for tramadol contained no messages on storage or disposal and only one out of 33 inserts for hydrocodone contained a storage or disposal message.

“Although we found promising information on safe storage and disposal in package inserts, the messaging was inconsistent across pain reliever types and infrequent or absent for some products,” Doucette and colleagues concluded. “This finding was disappointing, because consistent and explicit messaging is an important component of effective education.”

“Providers are uniquely positioned to promote safe storage and disposal behaviors in patients, and appropriate education may decrease medication diversion and unintentional poisonings,” they added.

The researchers suggested that providing storage and disposal information on package inserts may help providers counsel their patients on safe practices and advocated for policymakers to mandate the inclusion of such information on inserts for opioid analgesics. – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.