By William M. Simpson, President & CEO, DisposeRx, Inc.
Editor’s note: This is the third of a three-part op-ed series exploring how simple, affordable prevention could change the trajectory of the opioid epidemic — if we have the will to act.
Introduction: The Flawed Choice Between Compassion and Cost
Too often in healthcare, prevention is dismissed as “too expensive.” We saw this argument against child-resistant packaging in the 1970s, against seat belts in the 1980s, and against helmets for motorcyclists and bicyclists for decades. Every time, the skeptics were wrong. Each of those reforms saved millions of lives and billions of dollars.
In-home drug disposal belongs on that same list. It is one of the simplest, cheapest, and most effective tools we have to prevent opioid misuse, diversion, and accidental poisoning. Yet our ‘system’ continues to treat disposal as optional, even though economics are undeniable: prevention is pennies, addiction is trillions. We’ve learned this lesson before. A generation ago, old tires were piled in vacant lots, dumped in rivers, or burned, creating breeding grounds for disease and long-term environmental damage. Today, tire recycling is mandated, standardized, and accepted as the responsible norm. In-home drug disposal deserves the same status: a universal, commonsense safeguard that protects families and communities by preventing harm before it starts.
The Staggering Cost of Inaction
The scale of the opioid epidemic is almost impossible to overstate, and yet its consequences are felt daily in American homes. In 2023, an average of 217 Americans died every single day from opioid overdoses, according to CDC data. That is the equivalent of a large passenger jet crashing every day — and yet the nation has come to accept it as a grim routine. Nearly seven in ten overdose deaths involve opioids, showing just how deeply these drugs fuel the crisis.
The financial toll mirrors the human one. The Council of Economic Advisers (CEA) once placed the annual cost of the epidemic at $696 billion; more recent estimates put the burden at $2.7 trillion — nearly 10% of U.S. GDP. These numbers capture not only healthcare costs, but also the ripple effects across criminal justice, workforce participation, child welfare, and social services. Addiction is not only a human tragedy; it is a structural drag on our economy and our communities.
But behind the macro numbers of costs and deaths, are our families and households. Research published in JAMA Internal Medicine found that 12% of patients prescribed opioids still had leftover pills, and 60–70% never disposed of them properly. Each of those forgotten bottles is not just a small nuisance; it is a spark waiting to ignite. Even if just 0.5% of the 42 million leftover prescriptions annually contribute to new cases of opioid use disorder, that translates into 210,000 new addictions every year and 4,200 preventable deaths.
Every leftover prescription that lingers in a medicine cabinet is more than a handful of pills. It represents the risk of a child accidentally ingesting, a teenager experimenting, or a vulnerable adult spiraling into dependency. It represents preventable costs measured in lives, in futures, and in billions of taxpayer dollars.
And yet, our system continues to treat disposal as optional, an afterthought rather than a front-line defense. This is not the first time America has faced such a blind spot. A generation ago, old tires were routinely piled in vacant lots, dumped in rivers, or burned. They became breeding grounds for mosquitoes and disease, fire hazards for neighborhoods, and long-term sources of environmental damage. Today, tire recycling is mandated, standardized, and accepted as the responsible norm. We would never consider returning to the days of casual dumping, so why do we except such casual practices around our medication education and drug disposal?
In-home drug disposal must be treated with the same universal acceptance as other public safety norms, seatbelts, child car seats, and smoke detectors. It is one of the simplest, cheapest, and most effective tools we have to prevent misuse, diversion, and accidental poisoning. Just as tire recycling was elevated from an afterthought to a national standard, in-home disposal must move from “optional” to “expected.” The economics are undeniable: prevention costs pennies, while addiction drains trillions. The moral case is even stronger: prevention spares lives that cannot be replaced.
The ROI of In-Home Disposal
The economics of in-home disposal are as compelling as the moral case. A single disposal packet costs roughly $1.50, about the price of a cup of coffee (before Starbucks). By contrast, the lifetime cost of treating a single case of opioid use disorder is estimated between $150,000 and $250,000, according to the Council of Economic Advisers and the CDC. That means for every case of addiction prevented, the return on investment is more than one hundred-fold.
Our internal cost-avoidance modeling reinforces this point. If disposal packets were distributed with three out of every four opioid prescriptions nationwide, the system could save between $1.6 and $2.7 billion annually, even under conservative assumptions that only 2.5 percent of potential misuse is actually prevented. In a crisis where even small percentages translate into tens of thousands of lives and billions of dollars, that is not just an attractive investment; it is fiscal common sense.
The contrast with other interventions is striking. Naloxone, while vital, costs between $30 and $150 per dose, and it must be administered after an overdose has already occurred, when tragedy is already unfolding. Addiction treatment ranges from $6,000 to $20,000 per patient each year, with relapse rates as high as 60 percent. Incarceration averages $30,000 annually per inmate, draining state budgets while failing to address the root cause.
In-home disposal, by comparison, is a one-time preventive measure that neutralizes risk before it begins. It spares families the trauma of addiction, prevents the need for emergency interventions, and reduces the burden on treatment systems and correctional facilities. In public health, we rarely encounter an intervention that is this inexpensive, this effective, and this scalable. In-home disposal is exactly that — pennies invested upfront that avert tragedies and costs measured in the hundreds of thousands of dollars.
Now consider the economics of disposal:
1. Cost per packet: ~$1.50 (Wholesale Acquisition Cost).
2. Lifetime cost per OUD case: $150,000–$250,000 (CEA, CDC).
3. Return on investment: >100x for every case prevented.
Our internal cost avoidance models show that scaling disposal to 75% of opioid prescriptions could save $1.6–$2.7 billion annually, even at conservative estimates of just a 2.5% reduction in misuse.
By contrast, disposal is a one-time preventive measure that neutralizes risk at the source.
A Household-Level Investment
The math becomes even clearer when framed at the family level.
1. For $1.50, a household can safely eliminate leftover opioids.
2. That $1.50 potentially prevents: 1. An ER visit for accidental ingestion (average cost: $3,500).
2. A new opioid dependency ($150,000 lifetime cost).
3. A fatal overdose (immeasurable in human terms, but also costly in lost productivity and social burden).
Families don’t need to be convinced by abstract numbers. They simply need tools. And when provided, as in an example of DisposeRx, it is our experience that 92% of families use them (Shriners, 2021).
Medicare and Medicaid: “Reasonable and Necessary”
Under Section 1861 of the Social Security Act, Medicare covers services that are “reasonable and necessary” for the diagnosis or treatment of illness. By any definition, safe disposal qualifies. It directly prevents OUD, reduces accidental poisonings, and lowers healthcare utilization.
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Medicaid, meanwhile, bears a disproportionate share of the opioid burden, covering nearly 40% of nonelderly adults with OUD. With addiction treatment costs growing at a CAGR of 8.6% in Medicaid (2019–2020), prevention is the only fiscally sustainable path.
Yet disposal remains outside formularies and reimbursement structures. That must change. Recognizing disposal as “reasonable and necessary” and allowing reimbursement through existing pharmacy benefit structures would align incentives across Medicare, Medicaid, and commercial payors. This is not a question for debate, it is a call to action.
Prevention and Payer Responsibility
For too long, investments in the opioid crisis have been reactive — pouring money into treatment beds, law enforcement, and litigation after the damage is already done. What remains underfunded is prevention: the one strategy proven to reduce harm before it takes root.
Prevention is where our community and national return is highest. Distributing disposal packets alongside medication education through pharmacies, hospitals, and community programs directly addresses the leading source of misuse and accidental poisoning — leftover medications in the home.
Private insurers have a clear stake as well. Addiction treatment spending in the private sector grew from $5.1 billion to $8.56 billion between 2019 and 2020, a CAGR of 5.3%. Covering in-home disposal at the point of dispensing costs pennies compared to the six-figure downstream cost of treating addiction.
Prevention and Public Responsibility
Government spending on the opioid crisis has followed the same pattern as the private sector: billions directed downstream to cover the costs of addiction, ER visits, and long-term care, while prevention remains an afterthought. Medicaid alone bears a disproportionate share of these costs, with opioid-related hospitalizations and treatment consuming growing portions of state budgets.
Yet prevention offers the strongest fiscal and public health return. Providing in-home disposal kits at the point of dispensing, supported by brief pharmacist counseling directly eliminates the reservoir of unused medications that fuels diversion, accidental poisonings, and misuse.
For Medicaid and Medicare, the math is simple: pennies invested in prevention avert six-figure costs in treatment. By reimbursing pharmacists for counseling and disposal kits, public payors can reduce avoidable spending while protecting families in every community.
Prevention as Fiscal Responsibility
Prevention is not only a moral argument; it is a fiscal one. Every policymaker, payor, and taxpayer should be asking a simple question: why are we pouring billions into downstream treatment when the cost of prevention is measured in pennies? The disparity is stark. Treating a single case of opioid use disorder burdens the healthcare system with costs between $150,000 and $250,000 over a lifetime. Each overdose death robs families of loved ones and the economy of decades of productivity; a loss measured not just in grief but in millions of dollars. Even a single emergency room visit for a child who has accidentally ingested unsecured medication can run into the thousands — costs that ripple through families, insurers, and state budgets alike.
And yet, for roughly the cost of a cup of gas station coffee, a household can prevent these tragedies before they ever occur. For the cost of a modest line item in a state’s public health budget, entire populations can be protected from the cascade of harm that flows from leftover medications. Prevention at this scale is not aspirational; it is achievable, affordable, and long overdue.
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The Broader Economic Ripple
The cost of inaction cannot be confined to hospital bills or addiction treatment budgets as it reverberates through every corner of our society. When safe disposal is absent, leftover medications drive misuse, and those costs cascade:
• Workforce productivity: Opioid use disorder (OUD) pulls people out of the labor market, reduces participation, and increases disability claims. Employers lose skilled workers, while states lose tax revenue.
• Criminal justice: Every diverted pill risks fueling arrests, prosecutions, and incarcerations — costs borne by courts, law enforcement, and communities.
• Child welfare: Parental addiction is now one of the leading drivers of foster care placements, straining state systems and fracturing families.
• Education: Adolescent misuse derails human capital before it has a chance to grow, lowering graduation rates and lifetime earnings.
But when disposal is present, the ripple is reversed: prevention compounds savings across society. For the cost of a packet — less than a cup of coffee — families can eliminate risk at the source. For the cost of a modest budget line, states can protect their workforce, their classrooms, their courts, and their future.
Some states, however, have turned prevention into a revenue scheme. Oregon requires a $75,000 review fee just to submit a disposal program plan to its Department of Environmental Quality. I am not trying to put Oregon on the spot but this “pay-to-play” barrier doesn’t foster innovation, it blocks it. Meanwhile, Oregon lost ~1,100 residents to overdoses in 2023. Using the Council of Economic Advisers’ value of statistical life ($10.1 million per fatality), that represents ~$11.1 billion in societal loss. Add an estimated 16,500 nonfatal overdoses (based on the 1:15 fatal-to-nonfatal ratio), each costing an average $17,000 in acute medical care, and the toll climbs another ~$280 million. In round numbers, Oregon’s 2023 overdose burden was ~$11.4 billion. Against that bill, a $75,000 DEQ “review fee” amounts to just 0.0006% of one year’s losses. Charging innovators to apply for prevention while the state absorbs billion-dollar costs is not policy — it is arrogance dressed as regulation.
Policy Pathways
The alternative is simple: clear, targeted action that unlocks the ROI of prevention. Policymakers should:
1. Make disposal a covered service under Medicare and Medicaid — because prevention saves taxpayers downstream costs.
2. Integrate in-home disposal technologies into OA REMS programs as Congress intended in the SUPPORT Act — closing the seven-year gap in FDA enforcement.
3. Require manufacturers to fund disposal as part of their statutory duty — the same principle that governs REMS.
4. Recognize pharmacists as providers, enabling them to bill for counseling and disposal distribution — unleashing the workforce already trusted by patients.
5. Direct settlement funds upstream into prevention, not just downstream into treatment and litigation — ensuring every community can invest where the risk begins: the home.
The pathway is not complicated. The tools exist, the costs are minimal, and the savings are undeniable. What remains is the will to act.
Families Will Use It
The final proof lies in behavior: families use disposal when they have it. At Shriners, compliance was 92%, and at Penn, disposal rates rose dramatically. Across studies, families consistently prefer in-home disposal to mail-back or take-back options.
This should come as no surprise. Families do not want the risk of opioids, benzodiazepines, or stimulants sitting in their medicine cabinets. What they want is a solution that is immediate, private, and safe — one they can use at the kitchen counter without driving to a police station or mailing narcotics through the postal service.
The stakes could not be clearer:
• Child safety: Every year, more than 50,000 children under six in the U.S. are taken to the emergency room for accidental medication ingestion. Each visit costs on average $1,500–$2,000, and severe cases requiring hospitalization can exceed $20,000.
• Seniors: Polypharmacy and leftover medications are a leading driver of falls and adverse drug events, costing the healthcare system an estimated $3.8 billion annually.
• Overdose risk: For everyone fatal overdose, there are at least 15 nonfatal overdoses — each bringing trauma to families and an average $17,000 in immediate medical costs.
In-home disposal eliminates those risks at the source, before they turn into tragedies. Preventing just a handful of cases saves more than the cost of distributing disposal to entire communities.
As I have said: leading the next generation of medication safety means empowering households to eliminate leftover drugs before they cause harm. This isn’t about convenience — it’s about prevention. The data is clear, the public demand is clear, and the tools already exist. The only question is whether we will act with the urgency families deserve.
Conclusion: The Smartest Dollar We Can Spend
We spend billions every year on treatment, emergency response, and criminal justice. For pennies, we could prevent a measurable portion of that suffering and cost. Inaction is not just negligent — it is wasteful.
Prevention is not a luxury. It is the most affordable, effective, and urgent step we can take. Recognizing pharmacists, closing the medicine cabinet gap, and funding in-home disposal are not just public health imperatives — they are fiscal imperatives.
The smartest dollar we can spend in healthcare today is the one that prevents a leftover prescription from becoming a tragedy tomorrow. That is how we honor the families who have already borne the cost of inaction, and how we secure a safer future for those who come after us.
This concludes the series. Thank you for your attention, your engagement, and your willingness to confront these hard truths. My hope is simple: that by shedding light on these failures and solutions, we can move from words to action — and that real, measurable change will come soon.
For more data and resources, visit medicationsafetymadesimple.com.
