Medication disposal within reach: Assessing implementation of permanent disposal receptacles in community pharmacies

Background: Availability of medication disposal receptacles is critical to curbing nonmedical opioid use and diversion; however, availability in community pharmacies is sparse. The objective of this study was to describe implementation of the community pharmacy medication disposal program offered by the HEALing Communities Study in Kentucky (HCS-KY) using the EPIS (Exploration, Preparation, Implementation, and Sustainment) framework. Methods: Sixteen counties participated in the HCS-KY from 1/1/2020–12/31/2023. Exploration and Preparation included gathering and review of evidence-based literature, state/community data, and key opinion leader input to develop a detailed implementation plan. Implementation and Sustainment were assessed using implementation outcome data collected (e.g., number of receptacles placed, amount of drug returned) and semi-structured qualitative interviews to evaluate common themes, including barriers and facilitators related to implementation and sustainment. Results: Disposal receptacles were placed in 59 pharmacies within the 16 HCS-KY counties. Following implementation, the median number of receptacles per participating county increased significantly from 2.5 to 4.5 (p<0.001). A total of 8019.9 pounds of drug were returned during the study period, with a median per-county return rate of 230.5 pounds per year. Twenty-one pharmacy representatives participated in qualitative interviews. Most (70.0 %) reported weekly receptacle usage; however, few (35.0 %) reported routinely discussing disposal with patients. While 42.9 % reported no barriers, the most frequently reported barrier (33.3 %) was receptacle limitations (e.g., only available during business hours, dosage form restrictions). Conclusions: Implementation of the HCS-KY community pharmacy medication disposal program led to notable increases in disposal locations that were highly utilized by communities.