Reminder cards increased the return of unused prescription opioids

Pill container

Pill container

What was the challenge?

Unused prescription opioid pills stored in the home can contribute to opioid abuse. It’s estimated that between one quarter and three quarters of patients prescribed opioids either misplace unused pills or store them for future use, presenting a risk to those who may later find them. In an effort to encourage proper disposal, the White River Junction Veterans Affairs Medical Center implemented a cash buyback program, called “Cash for Your Stash,” in which patients who return unused opioid pills to the VA pharmacy can receive $5 per returned pill, up to $50. The program is offered to patients who receive one-time, short-term prescriptions for opioids to manage pain following outpatient surgery.

What was the program change?

We designed a treatment involving two reminder cards — one given to the patient when they receive their prescription opioid pills, and another mailed to the patient approximately one week later. The cards were designed to make information available to the patient at a time when they can take action, and to motivate action by framing the incentive as money waiting to be claimed.

Figure 1. Card mailed to treatment patients a week after surgery Reminder: Time to return unused opioid pills for cash! After your recent surgery, you received opioid pills to help manage any pain. You have 60 days from your surgery to return opioid pills for cash! You have up to $50 waiting for you. All you need to do is return your unused opioid pills. Count any unused opooid pills you might have. Keep opioid pills in the original prescription bottle. Make a plan for returning them to the outpatient pharmacy window at your VAMC. Many patients return unused opioid pills when they have a follow-up appointment at the VA - or you can come anytime the pharmacy is open (Monday - Friday 9AM-3:30PM). For more information, see the pink letter you received on the day of your surgery or call 802-291-6255.

How did the evaluation work?

Patients in a treatment condition received the cards in addition to the standard information about the buyback program. Patients in a control condition received the standard information only. Patients were randomly assigned to treatment and control conditions by the week of their surgery; within each two-week interval during the field period, one week was randomly assigned to treatment, and the other to control.

What was the impact?

The intervention increased the likelihood that a patient would return unused pills by 7.0 percentage points over a baseline of 24.8% in the control group (p = 0.043).

Figure 2. Treatments increase the likelihood that patients return unused pills by 7.0 percentage points The Y axis title is Pill Return Likelihood (90% Confidence Interval) on a scale of 0 to 1.00. The X axis shows the control and treatment groups in a bar chart. The control group returned pills at 0.248 percentage points. The treatment group returned pills at 0.318 percentage points, which has one star of statistical significance at the 90th percentile.

Additional cost effectiveness analysis indicated that the reminder cards reduced the cost per pill returned.

  • When using reminder cards, the cost per pill returned was $12.57.
  • When no reminder cards were used, the cost per pill returned was $15.66.

Read the blog: Incorporating costing information

Verify the upload date of our Analysis Plan on GitHub.





Project Type

Impact evaluation of program change


Veterans Affairs




View Analysis Plan (PDF) View Abstract (PDF) View Intervention Pack (PDF)