Most ER Patients Keep Leftover Opioids at Home

By Crystal Lindell

Most of the patients who have leftover or unused opioids after visiting an emergency department for acute pain keep them at home for future use, according to a new study that also found those excess pills are rarely diverted.

Researchers in Canada asked over 2,000 patients what happened to opioid prescriptions they were given at discharge after being treated in the ER’s of 7 hospitals in Quebec and Ontario. Most were treated for acute pain episodes such as fractures, renal colic, musculoskeletal pain, and back pain. Patients who were already taking opioids were excluded from the study.

The research findings, published in JAMA, found that many patients wound up having an excess number of pills prescribed to them.

Two weeks after discharge, 92% reported filling their opioid prescription, and 84% said they still had some unused opioids at home. 

Most patients (60%) stopped taking opioids because they were no longer in pain or their pain was tolerable. About one in six (17.3%) stopped taking them due to side effects or because they were afraid of becoming dependent.

Three months after discharge, nearly two-thirds (61.9%) of patients still had unused opioids at home. Most were unwilling to part with them because they wanted to keep them “in case it still hurts.”

Notably, less than 1 percent said they had given their leftover opioids to another person or sold them. 

While the low rate of diversion is encouraging, researchers are concerned about the high number of leftover pills and the unwillingness of many patients to dispose of them. More than one-fourth (26.1%) said they would not consider returning the opioids, even if they were offered a cash refund. 

“A considerable proportion of participants reported still having unused prescription opioids at home, most of which were stored in unlocked locations and potentially within reach of children and adolescents,” wrote lead author Raoul Daoust, MD, a Clinical Professor in the Department of Family Medicine and Emergency Medicine at the University of Montreal.

“Unsafe storage practices and the tendency to retain opioids for months following an ED visit for acute pain may contribute to opioid misuse.”

At a time when many patients in Canada and the U.S. have reduced access to opioid medication, it’s not surprising that many patients are stockpiling their unused pills for future use.

An interesting finding from the study is that patients who retained their unused opioids were significantly more likely to have higher education. Among those who kept their opioids, 73.6% attended a college or university, compared to just 58.5% of patients who disposed of their opioids.

The researchers said their findings support tailoring opioid prescriptions to individual patient needs to reduce unused medication, as well as take-back programs and patient education on safe use, storage, and disposal of opioids.