Please please PLEASE, patients on opioid treatment programs, store your medication safely.
Of course, the vast majority of patients in opioid treatment programs, dosing with methadone or buprenorphine, store their medication safely and never have any medication storage issues.
The public never hears about these people, who calmly go about their daily lives as productive members of society.
But one incident of a pediatric overdose on medication prescribed for a patient in an opioid treatment program threatens the reputations of treatment programs and their patients. Each time a pediatric overdose occurs due to improper storage of medication, people who oppose opioid treatment programs get new ammunition to say patients should never be allowed any take home doses.
By the way, this information about safe storage of medication applies to opioids prescribed for pain and other controlled substances. Anyone prescribed any medication should store it safely.
So let’s review what should be done to keep medication safe and out of the hands of people for whom it isn’t prescribed, including children.
1. Store your medication in a lock box that is locked. It does no good to have a lock box if you leave the key in the lock. The key must be stored in another place. Otherwise, it’s just a box.
2. Unless you’ve been directed to split your dose, take your medication all at one time. The seal on the bottle is there for a reason. Once the seal is broken, all of the medication is meant to be taken at once. This gives less chance for part of your dose to be ingested by accident or on purpose by another person.
I know patients like to take a little bit of their dose at a time, multiple times during the day. That’s a pattern leftover from active addiction with short-acting opioids. Each time an addict takes something, it gives a feeling of benefit.
But the unique pharmacology of both methadone and buprenorphine means patients can take the entire dose once daily and feel the same as if they take multiple doses. In fact, with buprenorphine, some people in the early studies did OK with every other day dosing.
Some patients are fast metabolizers of methadone and have to have split dosing. We can determine who needs split dosing with careful dose titration and peak and trough blood levels when needed. Then the dose can be split precisely, in individual bottles.
3. Plan for the unexpected. People who don’t have children living in the home often get complacent about medication storage. But what about when friends or family visit? You may not remember to remove your medication bottles or unlocked box from plain site. It’s best to stay in the habit of storing your medication, in a locked box, out of sight and reach.
4. Children are driven by curiosity. If medication is stored where kids can get into it, overdose is more likely. Don’t underestimate a child’s capacity to get into things.
5. Be careful with your empty bottles. Patients are instructed to drink their methadone dose, and then put a little water in it to rinse any residual and drink that too. It’s possible a small amount of medication could still be in the bottle. That’s one reason we ask you to store empties in the lock box, too.
6. Don’t let your child be any part of your daily medication administration. Kids naturally like to imitate their parents. Take doses of all medications in private, out of their view. Of course, don’t let your kids play with or handle your empty bottles.
7. Your take home bottles should spend all their time in the lock box. That’s their home. That’s where they live. The only time they leave the lock box is for the few moments it takes to consume your day’s dose, and afterward the bottle goes right back in to the lockbox. It makes me nuts to see patients transporting empty bottles in their coat pockets and purses.
8. Don’t tell other people what medications you are on. Addicts in active addiction can do desperate things like break into your house and steal medication.
9. If your medication does get stolen, call the police right away. That way, if someone overdoses and dies from the medication dispensed to you, you have a record of doing all you can to report that it’s fallen into the wrong hands.
10. If the worse thing happens and a child or other person takes your medication, call 911 right away. You will lose take home medications, but it’s still the right thing to do. Remember that methadone and buprenorphine cause a peak effect anywhere from two to five hours later. Just because you don’t see any problems in the child for the first hour does NOT mean the child is safe. Don’t take any chances.
11. If you or a member of your household takes opioids either by prescription or illicitly, get a naloxone kit. Keep it in your house so that if an overdose happens, it can be reversed quickly. You can read more about naloxone kits on my blog post on April 27, 2013. You still need to call 911, because naloxone’s effects wear off much faster than methadone or buprenorphine.
Lastly, and it’s self-serving for me to say so, but store your take home doses safely for your doctor’s sake. That take home dose with my name on it is a vote of confidence that you will be careful about how you store your medication. It’s always a judgment call, and sometimes I get it wrong. I am affected when bad things happen with diverted or improperly stored take home doses that I’ve prescribed. Plus, I become more cautious when considering patients for take home doses. Medication-assisted patients complain about overly restrictive regulations around take home doses of medication, particularly methadone, but cases of pediatric overdose make those regulations necessary.
However, I try to remember that the vast majority of medication-assisted patients store their medication correctly and never have any incidents of accidental pediatric ingestion or any other misuse of medication. They’re responsible and careful. For every episode of carelessness leading to a pediatric overdose, hundreds of patients never have an episode with improper storage. It’s not fair to paint them with the same brush.