Promoting Responsible Disposal of Opioids : A Randomized Evaluation of Behaviorally Informed Messaging Combined with a Financial Incentive

The opioid epidemic is a major public health problem that affects millions of people around the world. This paper addresses one challenge identified on the demand side of the epidemic: A large proportion of patients prescribed opioids lose track of their unused pills or save them for future use. Here, we report the results of a randomized controlled trial investigating an intervention aimed at encouraging patients to return unused opioid pills to the dispensing pharmacy. The intervention featured two reminder cards to increase the efficacy of a cash incentive for the return of unused pills. Messages on the cards incorporated several behavioral insights, including timely delivery of information, clear action steps, and a loss framing designed to activate the endowment effect. We find that after receiving the reminders, patients are more likely to return unused opioid pills, both at the extensive margin (likelihood of return) and the intensive margin (number returned). As an additional benefit, our intervention reduces the per-person and per-pill-returned costs of this program by 5% and almost 25%, respectively. Low-cost reminders may significantly enhance the effectiveness of overt financial incentives, and behaviorally informed interventions may be a cost-effective strategy for improving responsible opioid disposal