26 10. Make provisions for safe disposal of unused opioids Two-thirds of teenagers who have misused prescription drugs get them from their family and friends, according to a report from SAMHSA.86 The conclusion reached by many practitioners is that it is important to clear out medicine cabinets at home that contain unused drugs, particularly opioids. Doing so is not as simple as might be expected, however, as regulations require that law enforcement take custody of discarded controlled substances (rather than, for example, making it easy to just return the drugs to a pharmacy). Many communities have organized annual drives during which people can give their unused controlled substances to the police, who then dispose of them in approved ways. Studies evaluating such take-back programs generally show a positive outcome for removing drugs from broad availability. Recent research shows a more-positive impact for programs that allow drugs to be turned in at any time, rather than just once or twice a year.87 Task-based programs need a methodology for collection and disposal, as well as a marketing/awareness effort to persuade citizens to participate. Goals and Objectives The goal of drug take-back programs is simply to reduce the amount of controlled substances that are contained in readily openable places, such as home medicine cabinets. Objectives in many programs are stated in the specific amounts of drugs that are turned in. Theory of Change By reducing the amount of controlled substances that are easily obtained from friends and family, this program will prevent the development of substance use disorders by those who have ready access to these medicines without a prescription. Examples The sweeping Massachusetts law (Chapter 52) that addresses the opioid crisis calls for the establishment of a drug stewardship program, to be paid for by pharmaceutical companies, that makes it easier for patients to safety dispose of unwanted and unused medications. The law became effective Jan. 1, 2017 (Section 31). In June 2007, the La Crosse County, WI, Solid Waste Department became the first permanent collection site in the state. The county developed a unique strategy for disposing of unwanted pharmaceuticals, specifically controlled substances. Employees from the department are conditionally deputized by the county sheriff to receive controlled substances. County residents are allowed to drop off any unused medications at the hazardous waste facility. Under supervision by the deputized staff, residents drop off their drugs through a funnel into a gallon drum of solvent that dissolves them. The program is funded through a tax levy, grants and fees charged to non-area residents and businesses.88 The San Diego Police Department has set up boxes at two of its locations where citizens can just drop off expired or unused prescriptions.89 Resources The U.S. Drug Enforcement Administration works with state and local agencies to create national drug take-back programs, which have been successful in removing significant amounts of controlled substances from the streets. At its most-recent take-back event, the DEA set a record, collecting about 447 tons at almost 5,400 sites in all 50 states (US DEA Public Affairs, 2016). What Works for Health includes references and resources for Wisconsin’s program.