For Doctors, a Growing Awareness of the Dangers Posed By the Pills That Get Left Over
Dr. Scott Kurtzman
Take a look inside your cupboard or medicine cabinet and you're likely to find pills from prior visits to the doctor.
Some of those could be opioid painkillers, which can be dangerous if used improperly. So where should all that old medicine go?
In the first of a two-part series, WNPR begins exploring that question by looking at how doctors prescribe and how much thought is given to the pills that get left over.
A typical scenario goes like this. You get a surgery or medical procedure, and afterward -- a doctor prescribes you a bottle of pills to relieve your pain. Sometimes, they're opioids, which was the case for Julie Spencer, who got Vicodin.
"I didn't take all of it," she said. "The prescription I have at home is from 2007, so you can see I actually don't do much with it, but I don't know how to dispose of them."
Spencer said it's not just leftover opioids in her Bloomfield house, either. Stowed away in a nightstand next to her bed are unused pills prescribed to treat her osteopenia.
"I tried 'em," Spencer said. "Didn't like them, didn't like the side effects. So, I have a 90-day prescription at home of that, which is no good to me. Then he prescribed something else. Did the same thing -- gave me a 90-day prescription of that, which I paid for. Didn't like that one, either."
In other words, she's paying for lots of drugs that she isn't using. "That's costly for the insurance company. It's costly for you," said Spencer. "Now I've got all these pills in my cabinet that I don't know what to do with."
It's not just patients who are unwittingly stockpiling leftover pills. "I personally had an operation. I got 30 Percocet. I used one. And the other 29 sat under my counter for a long time. I never thought about it," said Scott Kurtzman, a surgeon who runs the residency program at Waterbury Hospital.
"But then I noticed that patients come in with bags of medication and they may not even be pain medicines. It may be they got switched to a different Statin or a different blood pressure medication," Kurtzman said. "Probably everybody's got a closet full of these pills, and they don't know what to do with it."
That's a problem. Especially when those stockpiled pills don't stay packed away in the closet.
According to the Office of Connecticut's Chief Medical Examiner, accidental intoxication deaths have doubled in the state over the past four years. And opioid-based prescriptions like fentanyl or oxycodone, which can cause respiratory failure in high doses, have contributed to that rise.
Daniel Tobin is a primary care physician who also instructs students at the Yale School of Medicine.
"It’s so, just, awful to see how patients who start with pain can lose control and transition into prescription drug use and misuse," said Tobin. "Where do people get the supply of medications that are used without a prescription? It turns out in the vast majority of cases it's not a drug dealer. It's not even really the doctor or multiple doctors," he continued. "It's the medicine cabinet of family and friends."
When an abuser runs through that medicine cabinet, Tobin said they can sometimes turn to heroin -- combining that street drug with leftover prescription medicines.
In 2012, for example, Connecticut recorded one overdose death due to a combination of prescription fentanyl and heroin.
"Having all of those medications there is very dangerous and confusing to patients," said Shawn Cole, medical director for the Chase Outpatient Center at Waterbury Hospital. "But I'll be 100 percent honest: as a provider, what I try to do is judiciously decide how many pills I believe are appropriate for a specific episode of pain," he said. "This is where the art of medicine comes in."
Waterbury Hospital surgeon Scott Kurtzman said most patients aren't looking to abuse pills, but they are in pain -- and doctors want to help a patient feel better, which can leave prescribers in a tricky spot when it comes to deciding the right amount of medication.
"So it's a judgment call," Kurtzman said. "We don't want to have too many pills left over at the end of the operation, yet we don't want the patient to be stranded, and not be able to get a renewal if they have a genuine need."
Yale's Daniel Tobin said sometimes, however, writing that pain prescription in the near term can cause a physician to lose sight of long-term health consequences. Both for a patient at risk for becoming addicted -- and for society, as leftover pills make their way out of the nightstand and onto the street.
"The way you address that? I don't know, except maybe to point it out to doctors. That, sometimes, what seems like helping may, in fact, be enabling," Tobin said. "You need to pause and just take a moment and figure out, in this circumstance, is this the right next step, or not?"
As for Bloomfield resident Julie Spencer, she got tired of multiple prescriptions from her doctor. So, after 30 years, she left him. "It was tough! It was kind of like getting a divorce," Spencer said. "But I just think it's time to move on."
Eventually, she found a new doctor -- one who prescribed her osteopenia drugs in ten-day increments, until she found the right one that worked for her.
In our next story, we look at what you can do with old pills, and examine the confusing variety of choices out there for leftover pill disposal.