The DEA held its eighth national prescription drug takeback event at the end of April and pulled in hundreds of tons of pills.
Non-medical use of prescription drugs is undeniably the fastest growing drug problem in the U.S. (the only substance with a higher rate of new users is cannabis) and since over half of users are getting the drugs from friends or family, it makes sense that the DEA has focused on diverting that supply at the medicine cabinet before it changes hands.
It seems like the DEA would like us to think that the risk of holding on to old medication is that someone could take them without our consent. A 2012 Carnevale Associates policy brief on the efficacy of drug takebacks reports that users get drugs from friends or family without permission (steal them) only about 5% of the time—keeping our meds away from sneaky cohabitants is hardly the problem. If the DEA’s drug take back program is effective in curbing non-medical prescription drug use, it won’t be because fewer opioids will be available for theft, it will be effective because we will have fewer opioids on hand give to our friends. We are who cannot be trusted with our own drugs.
There are a number of ways we get it wrong with our old medication and a few different campaigns educating people on how to dispose of their medicine in appropriate ways. Each is more or less focused on a different harmful outcome of inappropriate disposal. The water table people would rather you not throw your drugs in the trash, but as long as you don’t flush them down the toilet they’re counting it as a win. The FDA would rather you not flush your drugs, but when it comes to certain more dangerous opioids they would rather you flush them than throw them in the trash. (Just a note: people tend to think the toilet is a magical bye-bye portal and if it fits down you’re good to go. There are lots of reasons why that isn’t true, least of which is that water treatment plants can’t really get antibiotics or antidepressants or Claritin or anything much more complicated than poop out of the water. Don’t flush any of that noise because it is ending up in the water supply and that’s very gross. )
Recently, a close friend of mine was dealing with the sleep problems that go along with getting on top of a long-term alcohol addiction. She told me that her friend, Justin*, had offered to keep an eye out for something that might help her. Justin spends a lot of time at a waste transfer station and is, it turns out, one of the reasons they tell you to mix your medication into a bag of kitty litter if you must throw it in the trash.
Justin does what just about anyone does at the dump—find stuff people trashed that could still have value. He says he doesn’t normally sell the drugs he finds; drugs aren’t his focus for salvage when he’s at the dump. When he does happen upon them he prefers a mutually beneficial trade, but he estimates that if he focused on selling what he found in orange prescriptions bottles he would only earn about a quarter of what he makes now.
He mostly finds heart medication and drugs for acid reflux.
“I’m learning a lot about what is what,” he says. If he doesn’t know what the drug treats by its generic name, he’ll often recognize the trade name from advertising; doctor’s instructions can also help. When all else fails he takes the stuff home and looks it up on the Internet.
“I have a huge bag of pills that I took home of drugs that didn’t turn out to be of any use to me.” He can’t bring himself to put them in the trash and must eventually take his haul of duds to the drop-off box at the library.
Justin says that people don’t give him lists or requests—if it’s for recreation people aren’t picky—but mostly what people want is Vicodin, which they know to ask for because it’s the opioid he finds most often.
“There’s no resolution to the moral quandary around possibly enabling someone’s addiction problem. I try to keep an eye on the people I’m supplying because they’re my community, they’re my friends.”
Sometimes he’ll come across specific drugs to treat what ails his friends—he once found the medication his roommate takes for a thyroid disorder. Whether for recreation or treatment, salvaging drugs for Justin is motivated by the sense that they still have a use. I’m not sure where Justin falls in different ways prescription drugs get diverted—he is certainly taking these meds without the patient’s permission, but the people who get drugs from him are receiving drugs from a friend.
“No matter what economic textbooks say, people are happy to give stuff to each other,” he says. The Carnevale policy brief points out that a large percentage of people who share their prescription drugs get them from a single doctor, pointing up the supply line to the main reason people have so much of these potentially dangerous substances lying around in the first place. Doctors give us too much so we’re left in a place where prescription opioids have value but are not precious.
We hold on to them because we don’t really know how to toss them, but we give them away for the same reason we give anything away—we just have so much.
*name has been changed