How Should I Carry My Prescription Opioids When I Leave Home?

By Crystal Lindell

Personally, I carry my daily dose of morphine and Norco in a Tylenol bottle whenever I leave the house. Just two or three pills rattling around in there, mixed with some regular OTC pain meds and a couple of TUMS thrown in for good measure.

I have been taking prescription opioids on a daily basis since 2013 and, like all long-term opioid users, I had to figure out how to store and travel with controlled substances.

A lot of guidelines you’ll get from your doctor about this seem to be based on the idea that anyone taking daily Norco must be spending all day, everyday in bed.

But if you have chronic pain, you know the truth: The whole point of daily opioids is that they help you get out of bed.

I take prescription opioids so that I can work, spend time with loved ones, and run errands.

In other words, I specifically take them so that I can leave the house. That means, a lot of the time, when I’m popping a pill with a bottle of water, I’m not at home.  

Unfortunately, this reality doesn’t mesh with some of the absurd rules a lot of pain patient contracts have. I’m supposed to store all my pills in their original bottles at all times. I also have been told that they will not be replaced if stolen.

As such, I can only assume that the people who wrote those contracts envision pain patients being bed-bound with a locked safe on their nightstand that they can only open when a dose is due. 

Because that’s the only scenario where it would make sense to keep all your pills in their original bottle. I highly doubt that my doctor actually wants me walking around Walmart with 53 hydrocodone pills rattling around in the original bottle, just in case I need to take a single pill before I get home.

That’s a massively high-risk situation. 

If anyone robbed me, they would walk away with almost a month’s worth of my prescription. And then, based on my pain contract, none of them would be replaced – even if I filed a police report. So I’d literally just be forced into immediate opioid withdrawal.

And I’m not exactly going to carry around a locked safe in my purse to keep the pills protected. That’s absurd. Anything that would actually keep the pills safe from a potential robber would be way too big to carry around with me as I browse the clearance section for pajamas.

Of course, this all means that if I ever run into legal trouble, a cop might wonder why I have a Norco pill in the Tylenol bottle in my purse. 

Some states allow for "reasonable repackaging" of medication into more convenient containers, like a daily pill planner. But state laws are usually more strict about controlled substances being kept in their original pharmacy container, because that makes it easier for the police to verify the medication is yours.

I fully understand that I could get in legal trouble, but I personally would rather risk that scenario than the possibility of a month’s worth of my prescription being lost or stolen during a trip to Taco Bell.

So yes, I keep some of my prescription opioids in a bottle that they did not originally come in. And yes, I mix them with other pills in that bottle. And while that scenario comes with some legal risk, I think it actually comes with much less personal risk. 

And, I will add, the rest of my prescriptions are always at home in their original bottles, safely stored in a very secure locked safe.

I’m not a perfect pain patient, but I’m not sure there’s any such thing. All we can do is all we can do.

Why I Keep Quiet About My Use of Prescription Opioids

By Crystal Lindell

When I first started taking prescription opioids on a daily basis in 2013, I didn’t hide that information from anyone. I told my friends at church, my family, and even my then-boss.

I was in way too much pain to spend any energy worrying about what anyone thought about me or the pills I was popping.

At the time, I was still working in the corporate world. And I quickly began to see and experience the stigma that comes with opioids. It wasn’t long before every mistake I made and every emotion I had were blamed on the fact that I was taking Norco.

I still remember the time a man at work lost his temper on me. When I felt like I had the very appropriate reaction of sobbing at my desk, my then-boss immediately dismissed it to both me and the man who had screamed at me by explaining that I was “on lots of new medications.”

So, over the years, I have learned to withhold my pain medication use to new people. Sadly, this decision has only been reinforced by the fact that things have gotten worse over the last decade when it comes to opioids being a taboo. 

The media narrative that a 5 mg hydrocodone tablet is the same thing as a baggie of street fentanyl has caught on. Now, people who may not have even known what hydrocodone was in 2013 are hyper aware that it’s part of the “opioid epidemic.”

So, I hide my pain pill usage in real life. It may sound paranoid, but I have been undercover enough times to see the truth. 

When people think I’m healthy, they open up about how they really feel about opioid users. There are lots of comments dismissing us as lazy, saying things like, “Maybe he should stop getting high all the time” anytime they make even a small mistake.

I’m then put in the awkward position of having to decide whether to let it slide or defend them.

There’s a very strong part of me that wants to be the “good” opioid user. I want to show others what it looks like when people take opioids “responsibly.” I want to defend other people who take pain pills.

The problem is, once I admit that I use them too, I’m immediately moved out of the “good” opioid user category, because in their minds there’s no such thing. Going forward, everything I do would be seen through the lens of them thinking I’m high all the time.

It’s an impossible situation.

For now, I have found that the best way to navigate it in real life is to hide my health issues and my pain medication usage as long as possible. 

Yes, I write about all of it very openly online, and anyone looking for “dirt” on me would have no problem finding the truth. But most people lack such levels of information-seeking determination.

So, as long as I show up, seem alert, and come across as put together, there’s no reason anyone has to know that the pills I keep in the Tylenol bottle in my purse are actually prescription Norco.

Illicit Use of Rx Opioids Down Significantly

By Pat Anson

The illicit use of prescription opioids by patients undergoing addiction treatment has fallen dramatically over the past decade, according to a new analysis by Millennium Health. 

The drug testing company analyzed nearly 1.7 million urine samples collected from patients diagnosed with substance use disorder (SUD). The findings show that opioid pain medication now plays only a minor role in the nation’s drug crisis, while the use of stimulants is growing.  

In 2016, up to 80% of the patients who tested positive for illicit fentanyl also tested positive for a prescription opioid that was not prescribed to them. 

By 2025, only 4.9% of patients tested positive for both fentanyl and an illicit prescription opioid. There was a lot of regional variability in the numbers, with 9.1% of SUD patients in the South testing positive for both fentanyl and Rx opioids, compared to only 4.1% in the West.

Positive Drug Tests for Fentanyl and Prescription Opioids

SOURCE: MILLENNIUM HEALTH

“Within the population using fentanyl, we've seen a continued drop in the detection of prescription opioids in those using fentanyl. In 2025 the positivity rate for prescription opioids, I’m talking about hydrocodone, hydromorphone, oxycodone, oxymorphone, tramadol as a group, are at all-time lows in our database,” said Eric Dawson, PharmD, Vice President of Clinical Affairs at Millennium Health.

The findings suggest that fewer prescription opioids are being diverted into the illicit drug supply. That makes sense, as opioid prescribing has fallen sharply over the past decade and the medications are difficult for many pain patients to get. According to the DEA, the estimated diversion rates for hydrocodone (0.53%) and oxycodone (0.69%) in 2026 are both well under one percent.

In their place, illicit drug users have increasingly turned to stimulants, such as methamphetamine and cocaine. Millennium’s data shows that while fentanyl and opioid use have declined in recent years, stimulant use has risen steadily.

Positive Drug Tests for Fentanyl, Opioids and Stimulants

SOURCE: MILLENNIUM HEALTH

“It makes us wonder if we're now moving to something more prominent, larger. I don't know the right word there, but a stimulant era,” Dawson told PNN.

“I continue to hear it everywhere I travel. Stimulants, methamphetamine and cocaine, are just incredibly plentiful in so many communities, and extremely inexpensive. And so, if you present a drug in front of a population that tends to use drugs and it's cheap or free and potent, they tend to gravitate toward that.” 

Another trend that appears in Millenium Health’s drug testing data is the growing detection of kratom and its alkaloids, mitragynine and 7-hydroxymitragynine (7-OH).

In 2016, less than 1.5% of patients nationwide being treated for SUD tested positive for a kratom alkaloid. By 2025, that had grown to about 3 percent, with even higher levels in the South.

Positive Drug Tests for Kratom

SOURCE: MILLENNIUM HEALTH

Part of that growth can be attributed to the wider availability of kratom and increased awareness that the herbal supplement can be used to treat pain, anxiety and other health conditions. 

The federal government estimates that 1.7 million Americans used kratom in 2021. The American Kratom Association, a kratom advocacy group, puts the number much higher, at 10 to16 million Americans.

The growing awareness about kratom has spread to addiction treatment providers. In 2016, only about a third of Millennium Health’s urine drug tests included a request from a provider to test for kratom. By 2025, over 77% of urine drug tests included an analysis for kratom.

State Laws Had Little Impact on Opioid Prescribing

By Pat Anson, PNN Editor

When the CDC’s opioid prescribing guideline was released in 2016, dozens of states began efforts to codify the guideline’s “voluntary” recommendations into laws and regulations. To date, according to The Pew Charitable Trust, 40 states limit the dose or initial supply of opioid medication, and all 50 states have implemented prescription drug monitoring programs (PDMPs) to track opioid prescriptions and the doctors who write them.

On the surface, it may appear the state policies are working, because opioid prescribing in the U.S. has plunged over 40 percent, to levels not seen in 20 years. But a large new study found that state laws regulating opioids have had very little effect on prescribing – suggesting that other factors may be at work making doctors reluctant to prescribe opioids.

Researchers at Johns Hopkins Bloomberg School of Public Health studied commercial insurance claims for nearly 7.7 million adults in 13 “treatment states” that limited prescribing, established PDMPs or targeted pill mills. The analysis included data for nearly 2 million patients diagnosed with arthritis, low back pain, headache, fiibromyalgia or neuropathic pain.

The study findings, published in Annals of Internal Medicine, show that prescribing and PDMP laws in treatment states were associated with an average change of less than 1% in the proportion of patients receiving an opioid prescription.

For example, in Idaho an estimated 9.18% of pain patients received an opioid prescription prior to the state passing a mandatory PDMP law that required doctors to look up a patient’s prescription drug history. In the first two years of the law’s implementation, that percentage fell only slightly to 9.03% of patients.

State laws have also had a negligible impact on dose and supply. Patients who received an opioid prescription in treatment states had an average change of less than one day in the supply of opioids and an average dosage change of less than 4 morphine milligram equivalents (MME) per day.

“We did not find an association between state opioid prescribing laws and receipt of opioid prescriptions or guideline-concordant nonopioid pain treatments among commercially insured adults. Across the 13 states that implemented laws, the change in treatment attributable to the law was consistently small in magnitude and not
statistically significant,” researchers reported.

“The findings suggest that the decreasing volume of opioid prescribing in the United States may be driven more by shifting clinical guidelines, professional norms, or other factors than by these laws.”

PNN asked lead author Beth McGinty, PhD, if the “other factors” that caused opioid prescribing to decline were the CDC guideline itself or the chilling effect many doctors felt from expanded investigations by state medical boards, law enforcement and the Drug Enforcement Administration.

“Our study was not designed to identify those other factors, so I can’t say for sure what has driven these declines.  Overall declines could be due to changing clinical practices nationwide in response to the CDC guidelines or many others,” McGinty replied in an email.

“Declines could also be driven by a range of other efforts to curb opioid prescribing, perhaps the DEA investigations you mention but also other efforts like health system interventions to reduce prescribing. As I said above, our study was designed to evaluate just the state laws, not these other factors, so I can’t say for sure."

“It's really hard to tell exactly what the findings here mean, despite a valiant effort on the part of the researchers,” says Bob Twillman, PhD, former Executive Director of the Academy of Integrative Pain Management.

Twillman says the CDC guideline was “weaponized” in so many ways by regulators, insurers and states that it’s difficult to measure the impact of any single policy or regulation. It was the cumulative impact of them all that drove down opioid prescribing.

“In truth, the most that you can conclude from this study is that these laws did not appear to reduce prescribing. Unfortunately, in the context of an avalanche of other policies, that conclusion doesn't paint a very accurate picture of what is happening to patients because of all the policies,” Twillman told PNN.

State Laws Failed to Reduce Overdoses

McGinty’s study is not the first to find that PDMPs have been largely ineffective – and may even be making the opioid crisis worse. A 2021 study by the Reason Foundation found that overdoses from illicit fentanyl and heroin increased in states after PDMP’s were adopted. A 2018 study by researchers at Columbia University and University of California, Davis had similar findings. 

State laws that limit the dose and quantity of prescription opioids have also failed to stop overdoses from increasing.

In 2016, Massachusetts became the first state in the nation to limit the initial supply of opioid prescriptions to 7 days. The law has had little impact on overdoses. Over 2,000 people still die annually from opioid overdoses in Massachusetts, a rate that has remained steady. The most recent data shows that illicit fentanyl was involved in 92 percent of overdose deaths in the state.

It was the 2016 CDC guideline that encouraged Massachusetts and many other states to adopt limits on initial opioid prescriptions. For short-term acute pain, the guideline said that opioids for “three days or less will often be sufficient; more than seven days will rarely be needed.”

A newly revised draft guideline drops any reference to the number of days and gives physicians more latitude, recommending that opioids be prescribed for acute pain “for no longer than the expected duration of pain severe enough to require opioids.”

Overdose Deaths Fell by 4.1% in 2018

By Pat Anson, PNN Editor

A new analysis by the CDC has confirmed earlier estimates that drug overdose deaths in the U.S. decreased by 4.1% in 2018, the first decline in the nation’s overdose rate in nearly three decades.

The decline was led by a drop in overdoses involving prescription opioids (-13.5%) and heroin (-4.1%). Much of that progress was offset by a 10% increase in deaths involving synthetic opioids, a category that includes illicit fentanyl and fentanyl analogs.

Fentanyl and other synthetic opioids were involved in 31,335 overdose deaths -- nearly half of the 70,237 drug deaths in 2018 and over two-thirds of the 46,802 opioid deaths.

The 14,975 deaths linked to prescription opioids represent about 22% of the total number of fatal overdoses.

“Decreases in overdose deaths involving prescription opioids and heroin reflect the effectiveness of public health efforts to protect Americans and their families,” CDC Director Robert Redfield, MD, said in a statement. “While we continue work to improve those outcomes, we are also addressing the increase in overdose deaths involving synthetic opioids. We must bring this epidemic to an end.”

U.S. DRUG OVERDOSE DEATHS IN 2018

SOURCE: CDC

Synthetic opioid deaths in 2018 increased in the Northeast, South and West and remained stable in the Midwest. The highest synthetic opioid death rate (34 deaths for every 100,000 people) occurred in West Virginia, which also has the highest death rate involving prescription opioids (13.1 deaths per 100,000 people).

Seventeen states experienced declines in prescription opioid deaths in 2018, with no states experiencing significant increases.

While opioid prescribing has been declining since 2012, much of the CDC’s public messaging remains focused on reducing the use of opioid pain medication.

“Because of the reductions observed in deaths involving prescription opioids, continued efforts to encourage safe prescribing practices, such as following the CDC Guideline for Prescribing Opioids for Chronic Pain might be enhanced by increased use of nonopioid and nonpharmacologic treatments for pain,” wrote Nana Wilson, PhD, a CDC epidemiologist and lead author of the study.

“Additional public health efforts to reduce opioid-involved overdose deaths include expanding the distribution of naloxone, addressing polysubstance use, and increasing the provision of medication-assisted treatment.”

Wilson and her colleagues noted that an increase in overdose deaths among African-American and Hispanics showed a need for “culturally tailored interventions” to address health and other societal factors.   

While the decline in overdose deaths in 2018 is encouraging, preliminary CDC data indicates the trend is not continuing into 2019. Deaths are increasing from synthetic opioids, cocaine, methamphetamine and psychostimulants such as attention deficit disorder drugs.

Overdose deaths often involve multiple drugs, so a single death might be included in more than one category and be counted multiple times. The quality of the data also varies widely from state to state. Only 39 states have good to excellent overdose data, according to the CDC.

Study Debunks Myths About Origins of Opioid Abuse

By Pat Anson, PNN Editor

It’s become a popular myth – and for some, a propaganda tool – to claim that opioid pain medication is a gateway drug to heroin and other street drugs.

An opioid education campaign called The Truth About Opioids – funded with taxpayer dollars from the White House Office of National Drug Control Policy — declares in big bold letters on its website that “80% of heroin users started with a prescription painkiller.”

The 80% figure stems from a 2013 study that found four out of five new heroin users had previously abused prescription opioids by using them non-medically.

Importantly, the heroin users were not asked if they had a valid prescription for opioids or even where they got them – but that doesn’t stop federal agencies from citing the study as proof that illegal drug use often starts with a legal opioid prescription.

The Drug Enforcement Administration last year used the 80% figure to justify steep cuts in the supply of prescription opioids, claiming in the Federal Register that addicts often get hooked “after first obtaining these drugs from their health care providers.”

“The 80% statistic is misleading and encourages faulty assumptions about the overdose crisis and medical care,” Roger Chriss explained in a PNN column last year.

A new study by researchers at Penn State University debunks the myth that the opioid crisis was driven primarily by doctors’ prescriptions. The researchers conducted a series of surveys and in-depth interviews with opioid abusers in southwestern Pennsylvania -- a region hard hit by opioid addiction -- asking detailed questions about their drug use.

The study was small – 125 people were surveyed and 30 of them were interviewed – but the findings provide a an important new insight into the origins of opioid abuse and the role played by painkillers.

"What emerged from our study -- and really emerged because we decided to do these qualitative interviews in addition to a survey component -- was a pretty different narrative than the national one,” said lead author Ashton Verdery, PhD, an assistant professor of sociology, demography and social data analytics at Penn State. "There's a lot about that narrative that I think is an overly simplistic way of thinking about this."

‘Opioids Were Never the First Drug’

Verdery and his colleagues found that over two-thirds of those interviewed (66.7%) first abused a prescription opioid that was given, bought or stolen from a friend or family member. Another 7% purchased the drugs from a stranger or dealer. Only one in four (26%) started by abusing opioid medication that was prescribed to them by a doctor.

“We found that most people initiated through a pattern of recreational use because of people around them. They got them from either siblings, friends or romantic partners," said Verdery. “Participants repeatedly reported having a peer or caregiver in their childhood who had a substance use problem. Stories from childhood of witnessing one of these people selling, preparing, or using drugs were very common. Being exposed to others’ substance use at an early age was often cited as a turning point for OMI (opioid misuse) and of drug use in general.”

And prescription opioids were not the gateway drugs they are often portrayed to be. Polysubstance abuse was common and usually began with drugs such as alcohol, marijuana, cocaine, methamphetamine, prescription sedatives and prescription stimulants.

“It is important to note that interviewees universally reported initiating OMI only after previously starting their substance use career with another drug (e.g., alcohol, marijuana, cocaine). Opioids were never the first drug used, suggesting that OMI is likely associated with being further along in one’s drug using career,” Verdery reported in the Journal of Addictive Studies.

Verdery says additional studies are needed on the origins of drug abuse and that researchers should focus on the role that other substances play in opioid addiction. Only then can proper steps be taken to prevent abuse and addiction before they start.

"We think that understanding this mechanism as a potential pathway is worth further consideration," said Verdery. "It's not just that people were prescribed painkillers from a doctor for a legitimate reason and, if we just crack down on the doctors who are prescribing in these borderline cases we can reduce the epidemic.”