Research Summary

Unused Opioids Remain in Patients’ Homes After ED Discharge

Edited by:
Brian McCurdy

Key Highlights

  • At 2 weeks, 84% of assessed participants reported unused opioids, and only 6.7% of respondents to storage questions reported keeping opioids in a locked place.
  • At 3 months, 61.9% still had unused opioids; possible future pain was the most common reason for retaining them.
  • Only 33.5% would voluntarily return opioids to a pharmacy if prompted, while 26.1% would refuse regardless of incentives.
  • The authors supported individualized prescribing, stronger take-back networks, and education on safe opioid use, storage, and disposal.

Unused prescription opioids frequently remained in patients’ homes months after emergency department (ED) discharge for acute pain, according to a study published in JAMA Network Open. The Canadian multicenter cohort also identified infrequent locked storage and limited willingness to return leftover medication.

The investigation was a preplanned substudy of the Quantity of Opioids for Acute Pain and Limit Unused Medication Group study. Researchers enrolled adults discharged with opioid prescriptions from 7 EDs in Québec and Ontario. Recruitment began in May 2019, and follow-up ended in January 2024. Eligible patients had pain lasting less than 2 weeks; exclusions included prior opioid use and cancer or chronic pain requiring treatment.

Of 2,590 enrolled participants, 2,047 completed the 2-week follow-up, and 1,835 completed the 3-month follow-up. Investigators assessed unused medication at both intervals, storage practices at 2 weeks, and disposal practices and motivations at 3 months. Among 3-month respondents, mean age was 51.3 years and 51.6% were male.

Study Findings

At 2 weeks, 1,521 of 1,811 participants assessed for unused medication reported leftover opioids (84.0%; 95% CI, 82.2%-85.6%). Among 1,525 respondents to storage questions, 102 reported locked storage (6.7%; 95% CI, 5.5%-8.1%), and 393 reported storage out of children’s or teenagers’ reach (25.8%; 95% CI, 23.6%-28%).

At 3 months, 926 of 1,495 assessed participants still had unused opioids (61.9%; 95% CI, 59.4%-64.4%). Among these participants, 57.7% retained them for possible future pain, while 28.3% had forgotten or lacked time to return them. Among all 1,835 respondents at this follow-up, 614 would voluntarily return opioids to a pharmacy if prompted (33.5%; 95% CI, 31.3%-35.7%), whereas 479 would not return them regardless of the incentive offered (26.1%; 95% CI, 24.1%-28.2%).

Clinical Implications

According to the authors, retaining opioids for months and storing them unsafely may contribute to misuse. They supported tailoring prescriptions to individual needs, strengthening medication take-back networks, and improving education on opioid use, storage, and disposal.

The authors noted that missed enrollment and follow-up losses could limit representativeness, while the predominantly Québec sample and differences in take-back systems could affect applicability elsewhere. Self-reported outcomes were susceptible to recall and social desirability bias, potentially overestimating safe storage and disposal.

Expert Commentary

“These findings support tailoring opioid prescriptions to individual patient needs to reduce unused medication, alongside strengthening take-back networks and enhancing patient education on safe use, storage, and disposal of opioids,” the researchers concluded.

Reference

Daoust R, Williamson D, Huard V, et al. Storage and disposal of unused prescription opioids for acute pain after emergency department discharge. JAMA Netw Open. 2026;9(10):e2639607. doi:10.1001/jamanetworkopen.2026.39607