“Where do you keep your medicines?” pain care activist Teresa Shaffer asked an audience of 40 people last year in West Virginia.
The answers came quickly: the kitchen table, above the kitchen sink, the medicine chest in the bathroom, on my desk, on my night table…
These were typical responses to the questions Shaffer asked dozens of community groups as part of her volunteer work for the American Pain Foundation’s PainSafe program.
“How easy do you think it is for a teenager to get hold of your prescription medicines?” she would ask next.
“None of the adults could, in their wildest dreams, believe that their kids or their kids’ friends would steal from them — especially medicines that their kids knew that they relied upon,” Shaffer recalls. “But teens tell me it’s really easy to take medicines from their parents and grandparents.”
Shaffer would then explain that a near majority of teens abusing prescription drugs obtain them illicitly from family and friends. She reminded her audience that teens are always experimenting and that many simply make bad decisions. Easy access to drugs at home is a huge factor in the diversion of these medicines and their illicit use — sometimes leading to accidental overdose and death.
“Not an answer they wanted to hear,” Shaffer laughed, “but you have to get in their faces if they’re going to hear you.”
The most vulnerable to having their drugs pilfered are patients over 65-years-old. The main reason is that elderly people accumulate medical problems over the years that necessitate taking more prescriptions. Cognitive and memory problems also develop, making the elderly less likely to notice that one or two pills are missing.
Shaffer says medicines lying around the house are especially dangerous to small children, who see adults swallowing brightly colored tablets that look like candy. Naturally, they want to have some candy, too.
Safe Storage of Medication
Many parents and grandparents say that they watch their children and grandchildren like hawks. But Shaffer asks who is watching when they slip into the kitchen to get a drink for a small child? Or when the phone rings? Who is watching when they go to the bathroom?
At this point, Shaffer brings up the use of lock boxes.
“The best way to protect your medicines,” she says, “is to lock them away so small children or older kids cannot gain access to them.”
Shaffer is blunt with her audience. “It comes down to the person being responsible. If the prescription bottle has your name on it, you’re responsible for keeping that medicine safe,”she says.
During informal chats after her presentation, Shaffer hears from one person after another who never thought of the safety of their medicines in quite that way before. Many say they’ll get a lock box.
Lock boxes and small safes can be purchased almost anywhere, and Shaffer urges people to go on line to look for the best deals. She also urges them to obtain a box or safe that will accommodate all their medications, with room to spare as more are prescribed. Shaffer believes that more than half the people she talks to will get a box.
This begs the question: What about the other half?
Shaffer believes education should and will play an important role. She says it should begin with prescribers emphasizing the potential for diversion and abuse. It’s also paramount that patients take responsibility for the storage and safety of their medicines.
The Risk Evaluation and Mitigation (REMS) strategy just released by the FDA for opioid medicines includes safe storage as part of its guide for patients. But it would be helpful if physicians were also educated about the importance of telling patients about lock boxes and safes to protect their medicines. It might be a financial burden to those who can hardly afford their medicines, but partnerships with philanthropic organizations could supply these items at a reduced price.
This educational effort should also be extended into schools. Even at the youngest ages, children should be taught about the dangers of taking opioid analgesics and other medicines not prescribed for them. This education should be available at all levels through the 12th grade.
Shaffer believes that “the more people you get to secure their meds, the less diversion and addiction there will be.”
A significant flow of diversion, addiction and accidental death could be stanched by this one step. Everyone — manufacturers, distributors, pharmacies, providers and patients — needs to be involved in making sure these medicines are as secure as possible.
“It’s really got to be a conscious choice.” Shaffer insists, “If you don’t secure your meds, then you’re a part of the problem.”
Mark Maginn lives in the east bay of San Francisco where he is a poet, writer and social justice activist. Mark suffers from chronic pain and was a longtime volunteer with the American Pain Foundation. His blog can be found here.
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