In most developed countries, governments require that opioid manufacturers and distributors fund widely available medication disposal programs at convenient locations, such as community pharmacies. The USA in contrast tightly regulates drop off procedures and does not ask the private sector to absorb the costs its products generate. For the first 15 years of the opioid crisis, this meant that efforts to reduce the prevalence of unused pills were limited to “prescription drug take back days” operated once or twice a year by law enforcement. These efforts are valuable but insufficient as a national policy response because opioids constitute only a tiny proportion of what is returned during such events. In 2010, the U.S. Congress expanded the number and types of organizations (e.g., pharmacies, hospitals) that can be licensed to collect and destroy unused controlled drugs. But seven years later, only 2.5% of eligible sites operated such take-back programs.
The Commission recommends that the USA follow the example of countries (including Canada) that operate more effective drug takeback programs by mandating that accepting unused medications be a required activity for hospital-based and community pharmacies. As in other countries, the cost of these programs should be borne by pharmaceutical manufacturers and distributors. As with the early days of glass recycling, a financial incentive may initially be needed for the public to adopt the habit of returning unused medications until the behavior becomes widespread and routinized. Policymakers should consider experimenting with requiring opioid manufacturers to fund a program that would reward pharmacy customers returning the unused portion of controlled-substance prescriptions, for example a discount coupon for in-store purchases.