Reduce Non-Medical Access to Prescription Drugs
It is essential that people who have prescription medications in their homes store them safely. When people begin to misuse prescription drugs, they often acquire them by stealing them from family, relatives, friends or from homes that they enter for other reasons (work, open houses, breaking and entering). If prescription drugs are safely stored, misuse can be stopped earlier, because people who have not yet developed a dependence on opioids usually do not go directly to illegal opioids like heroin or fentanyl. Prescription drugs that are not safely stored can also be accidentally taken by young children or by curious pre-teens.
Safe storage of prescription drugs within the home has been identified as key priority strategy by many organizations and coalitions. Even if a community does an excellent job of reducing prescriptions and taking back or disposing of unused opioids, there will still be a lot of opioids in communities. Thirty-two percent of American adults received a prescription for opioids in the two years preceding 2018In 2019, 22.1% of U.S. adults with chronic pain used a prescription opioid in the past 3 months.  Many others are legitimately being prescribed opioids for short-term pain management that can be misused, stolen or accidentally consumed by children. Failure to securely store prescription drugs contributes to the opioid epidemic and other health hazards in several ways.
- Easy access to prescription drugs can lead to initial experimentation, especially by teens.
- Stealing prescription drugs, which is much easier when they are commonly available in unlocked medicine cabinets, is often a step toward more destructive misuse.
- Easy access to unsecured opioids or other prescription drugs contributes to theft by people who sell them or give them away.
- Children who access unsecured drugs sometimes take them, thinking they are candy.
- Only 2 in 10 who have dangerous medications—such as opioid pain pills, stimulants used to treat ADHD, and sedatives—lock them up Nearly 70% of prescription opioid medications kept in homes with children are not stored safely
- A recent study of adults living in households with children, prescription opioids were stored in a locked or latched place in only 32.6% of households with young children and 11.7% with older children.
- More than 1,600 teens begin abusing prescription drugs each day.
- 1 in every 4 teens in America say they have misused or abused a prescription drug at least once.
- 60,000 kids under the age of 5 accidentally ingest these dangerous drugs every year and wind up in emergency rooms, according to data from the CDC
- 12-17 year old abuse prescription drugs more than ecstasy, heroin, crack/cocaine and methamphetamines combined.
- In one study, only 8.6% of the respondents reported locking up their opioid medication and only 20.9% reported using a latched location.
- The National Drug Intelligence Center reported that $184 million in prescription drug thefts occurred in 2010 — a 350 percent increase since 2007. They note that older people are especially vulnerable to theft of prescription drugs. They also indicate that over half of teens, ages 12 and up, obtained prescription drugs from a friend or family member "for free."
There are four primary successful strategies for communities to consider. The four strategies are conducive for implementation in conjunction with each other, but are covered separately below:
- Campaigns - An information campaign enables a variety of sectors in the community to collaborate. For example, an awareness campaign could engage law enforcement in a drug take-backs and in hosting drop-off locations that are advanced by the campaign and that, in turn, promote the overall campaign. Health department staff could disseminate information and schools could provide an avenue for reaching parents and for providing the location of take-back events. Pharmacies and of the businesses could be engaged in sponsoring the campaign. A few models of national campaigns are provided in the “Promising Practices” section below.
- Proper Disposal — In addition to take-backs and promotion of drop-off locations, there are medication neutralization kits that are available. These provide an appealing way to engage people to take action in a one-off event that increases their readiness to take more routine medication safety actions.
- Safe Storage — Increasing awareness about the importance of safe storage often goes hand-in-hand with providing members of the community with free or affordable storage options. A variety of vendors associated with both safe storage and disposal products are listed in the “Available Tools and Resources”section below.
- Education— Families are generally more receptive to tips for medication safety than they might be for information about other forms of prevention. While any of the statistics above can be used in education campaigns, some basic ideas can get people thinking about their own practices in a new way. For example, most people have not considered that it makes sense to keep a medication log or an inventory of all their medication types and amounts. Updating this inventory every six to twelve months keeps medication safety in their awareness. Likewise, people are ready to recall that the medicine cabinet in a bathroom is often not the best place to store prescriptions, since they should be stored in a cool, dry place. Humidity, heat, and the change in temperatures in the bathroom can alter the potency of some medications, and some storage devices can help protect medications from humidity, even if they are stored in bathrooms. This is a good lead-in to building a desire to obtain a lock-box.
This report highlights survey results that reveal the disconnect between parent knowledge and behavior regarding safe storage of medicine.
Impactful Federal, State, and Local Policies
HHS 5-Point Plan HHS developed a comprehensive strategy to improve access to prevention, treatment, and recovery support services to prevent the health, social, and economic consequences associated with opioid misuse and addiction, and to enable individuals to achieve long-term recovery: 
- Better Addiction Prevention, Treatment, and Recovery Services  This involves working across the continuum of care and has evolved to explicitly include harm reduction.
- Better Data Strengthen public health data reporting and collection to improve the timeliness and specificity of data, and to inform a real-time public health response as the epidemic evolves.
- Better Pain Management Advance the practice of pain management to enable access to high-quality, evidence-based pain care that reduces the burden of pain for individuals, families, and society while also reducing the inappropriate use of opioids and opioid-related harms.
- Better Targeting of Overdose Reversing Drugs Target the availability and distribution of overdose-reversing medications to ensure the broad provision of these drugs to people likely to experience or respond to an overdose, with a particular focus on targeting high-risk populations.
- Better Research Support cutting-edge research that advances our understanding of pain, overdose and addiction, leads to the development of new treatments, and identifies effective public health interventions to reduce opioid-related health harms.
Available Tools and Resources
Here is a small sample of products that can either be distributed within your community or advertised by community coalitions for families to purchase. Some of these are low-cost items, useful as give-ways at community events. Some of the items could have logos of local business sponsors or coalition branding added to the items:
- IKeyp Provides a safe that offers storage for personal items that need to be securely stored yet regularly accessed. It is linked to an app on a smart phone.
- Pack4U Provides pharmacies with single-dose packaging. Using blister packs instead of having an entire bottle filled with prescription pills has been shown to help prevent accident poisonings in children
- Safer Lock Provides 4-digit combination lock boxes and locking caps 
- TimerCaps A TimerCap has a built-in LCD stopwatch timer that displays how long it has been since the cap was last replaced. Timer caps come in different sizes, and they can replace an existing medicine bottle cap (or you can get a cap and bottle combination). TimerCaps are easy to use and don't require a change in patient behavior. They are also useful to track the timing since the last dosage -- helping seniors avoid accidental overdoses and emergency room visits due to accidentally taking medications multiple times. 
Many communities have done some education and awareness efforts to increase prescription drug disposal and safe storage, but there is potential to reach significantly more people by engaging a diverse group of cross-sector partners in a campaign. The CDC promotes three different national campaigns: 
- The National Action Plan for Adverse Drug Event Prevention- (ADE Action Plan) identifies common, preventable, and measurable adverse drug events and aligns the efforts of Federal health agencies to reduce patient harms from these ADEs nationwide.
- The PROTECT Initiative is an innovative collaboration led by CDC. PROTECT unites public health agencies, private sector companies, professional organizations, consumer/patient advocates, and academic experts to keep children safe from unintended medication overdoses. 
- Up and Away Campaign -- "Put your medicines up and away and out of sight." This campaign is designed to remind families about the importance of safe medicine storage.
There are numerous examples of campaigns that were started by local communities. One example is the partnership between the South Kingstown Partnership for Prevention in Rhode Island with Rebels Inspiring Positive Lifestyles. Their medication safety campaign held community awareness events and garnered local news publicity for their cause and were able to raise funds to send youth leaders to CADCA training.
- Kennedy-Hendricks A, et al. “Medication sharing, storage and disposal practices for opioid medications among US adults.” JAMA Intern Med 2016; 176:1027-29.