Modifiable risk factors associated with disposal of unused prescription drugs by parents of adolescents

The safe disposal of unused medications is one primary prevention strategy to reduce nonmedical prescription drug use among adolescents. We sought to identify modifiable risk factors associated with disposal of unused prescription drugs by parents of adolescents residing in ten south central Kentucky counties with disposal programs. In the fall of 2017, 4148 parents of adolescents participated in an anonymous, paper-based survey. We conducted generalized logit mixed models adjusted for within-school clustering to assess the relationship between disposal behaviors and modifiable risk factors while controlling for respondents’ sociodemographic characteristics. The analytic sample consisted of parents in households in which someone had been prescribed an opioid medication within the past 12 months (N = 627). Our findings indicated that almost 42% of parents reported disposing of unused prescription medication within the past 12 months, and the majority disposed of medications at home rather than using a disposal program. Parents who perceived that any, compared to none, of their child’s close friends engaged in nonmedical prescription opioid use had higher odds of reporting use of a disposal program. Parents who were aware of disposal programs, compared to those who were not aware, had greater odds of using them, rather than not disposing at all or disposing unused prescription medications at home. Compared to parents who perceived prescription drugs to be hard for adolescents to obtain for nonmedical use, parents who believed that prescription drugs were easily accessible to adolescents for nonmedical use had lower odds of using disposal programs than disposing of medications at home. Collectively, our findings suggest that enhancing awareness of disposal programs, while addressing parents’ perceptions of their children’s peers’ use of nonmedical prescription opioids, should be considered to facilitate the disposal of unused medications and optimize current public health prevention efforts related to adolescent nonmedical use of these drugs.NI

Implementation and use of community-based prescription drug disposal programs

Encouraging disposal of unused prescription medications through the establishment of community-based prescription drug disposal programs is one prevention strategy that has been used by local communities to combat nonmedical prescription drug use (NMPDU) and associated consequences. The premise is that disposal programs (i.e., drop-boxes and take-back events) provide opportunities for community members to dispose of their unused or expired prescription drugs, ultimately reducing their availability for nonmedical use. While drop-boxes have been growing in popularity since their introduction in the early 2010s, the extent of their implementation and associated community characteristics had not been assessed. The first objective of this dissertation was to address this gap in knowledge by examining the diffusion of drop-boxes and community characteristics associated with drop-box implementation. Between 2007 and 2016, 311 drop-boxes had been implemented in North Carolina (NC), and 91 out of 100 NC counties had at least one drop-box. The majority of drop-boxes were located at law enforcement agencies but the number of drop-boxes installed in pharmacies had increased in recent years. Counties with a higher percentage of whites and college educated residents, a substance abuse prevention coalition, higher rates of controlled medications (i.e., prescription drugs with abuse potential) dispensed, higher prescription opioid overdose rates, and counties considered to be Appalachian were more likely to be early implementers of drop-boxes. Prescription drug disposal programs are primary prevention strategies intended to prevent initiation of NMPDU among adolescents by reducing the availability of prescription drugs in the home. While several studies have examined self-reported disposal of unused prescription drugs, none have specifically examined disposal of unused medications by parents of adolescents. The second objective of this dissertation was to examine prescription drug disposal by parents of adolescents. Among 2,300 parents residing in a household prescribed a controlled medication in the past year, only 33.9% disposed of unused medications. Of these, 9.8% used a take-back event, 10.0% a drop-box, 12.8% flushed the medication in a toilet, and 15.0% threw the medication in the trash within the past year (disposal practices were not mutually exclusive). Use of prescription drug disposal programs was associated with awareness of these programs, receiving a prescription for Attention Deficit Hyperactivity Disorder (ADHD), and permissiveness of underage drinking parties. Being a grandparent raising a grandchild, permissiveness of underage drinking parties, and being prescribed pain relievers or medications for ADHD were associated with awareness of prescription drug disposal programs. Additional research is needed as disposal programs continue to be implemented, especially drop-boxes at pharmacies. It will be important to study the diffusion of drop-boxes at pharmacies, motivations for- and barriers to implementation, and utilization (e.g., quantity of controlled medications disposed) in order to assess the impact of location on the effectiveness of prescription drug disposal programs. Given that awareness of disposal programs is related to utilization, developing and implementing effective awareness campaigns should be a priority of both research and practice. Despite being implemented in practice for at least 10 years (according to my findings) the research on prescription drug disposal programs is limited but increasing. It is imperative that researchers and practitioners work together to improve, implement, and evaluate this strategy within the context of a comprehensive approach to address NMPDU and associated consequences