Toss them on the rare occasion I see them. I prefer giardiniera on pizza.
I like Star Pizza–a local chain with* two* restaurants. Usually, they don’t include condiments unless you ask. If they add red pepper, I’ll use it on the pizza; otherwise, use some from my kitchen. If they include parmesan, I save it; it’s freshly ground stuff in aluminum foil. If I don’t save it too long, it’s great on a plate of pasta…
Meh, I use them if I’m actually at a restaurant but in order to feel the heat I’d have to open like 3 packets per slice, and it’s not worth the time. Those flakes are pretty tame.
I do however love me some Papa John’s garlic sauce. And their Buffalo sauce is perhaps the most delicious hot sauce I’ve ever had (even if it’s also not very hot.)
Never used them. The idea of actually liking to sprinkle hot stuff on food only came to me recently–my parents never even kept black pepper on the table. And I haven’t seen those packets in years, maybe over a decade.
We always get them, too. I save them Just in Case. And sometimes use them in recipes.
The “cheese drawer?” in our refrigerator is stuffed with Taco Bell sauce, sweet & sour packets that come with egg rolls, Ranch dressing (it’s there because I never use it) and “butter” spreads. Good for if we ever run out of butter.
Huh. Another case of Ignorance Fought. I had to look this up, and now I know that you can put this on pizza and sandwiches, which sounds awesome, whereas before I only ate it as a side with some cheese.
Oh, and I’ve had delivery pizza from PA, VA, ME, CA, FL, MS, LA and WA, and never once did I get a packet of red pepper with it.
I forgot, it’s a semi-regional thing, where there are a lot of Italian-Americans. 
Chicago has it all over the place. The local pizza place offers it as a topping, but they make it so freaking hot that I don’t always get it on the pizza. I prefer the milder variety so you can put more on. 
Pizza, sandwiches, and part of an antipasto platter (and occasionally in an antipasto-style salad) are pretty much the only ways I eat it.
They’re more like the packets that sanitizer wipes come in.
They look like this.
Hmmm…I don’t ever recall seeing such a thing with my pizza order. Were I to get such an item, I would put it on top of the pizza, of course.
I can’t remember ever getting them with a pizza. If I did, I’d just toss them in a drawer with the soy and hot sauce from take-out chinese, salt and pepper packets and wrapped plastic forks. Everything except duck sauce, that stuff is nasty.
I’d then use my own, good quality red pepper flakes.
I tell the deliveryman I don’t want them (nor the parmesan packets) so he just takes them back.
When available, I’ll use the Parmesan on a couple of slices, but never feel like it has materially affected my enjoyment of the pizza. I had no idea the stuff was controversial. Gee-whillikers, people, get a religion already.
I don’t recall seeing them. My wife likes pepper flakes on her pizza, but I don’t: for some reason I’m not crazy about chile-heat in Italian food. Great in Chinese, Mexican, Indian, Thai, etc., but don’t much like it in Italian. (Spicy sausage excepted).
I’ve definitely never encountered them. Grew up in NYS, now live in New England. I like putting red pepper on my pepperoni or plain cheese pizza (but not on pizza with other toppings). I’ve always had to use my own jar.
I use 'em on the pizza. I can’t tell them apart in taste from the ones in the plastic container I bought at the grocery store (which is what I use when the pepper packets aren’t available).
They’re pretty common here in Southern California, and typically look exactly like the packet silenus linked to. The last time we ordered take-out from East Side Mario’s, an astonishing number of pepper and cheese packets were included in our (non-pizza) order, as well.
You left off “other” from your poll.
I sprinkle them out in the garden to keep the squirrels from digging. 
:::Hijack::: . So I was in Cleveland at a bowling alley and ordered some Buffalo wings. I’d never jumped straight into a “nuclear” wing hotness since I never know when it would be too too hot, but I did go right for the “nuclear” this time.
Their “hot” level was straight up Frank’s – I could even see them pouring it from the can (ETA: which is good and exactly what I would expect on a “hot” level of wings). Their “nuclear” level was Frank’s – with pepper flakes . Which wasn’t horrible tasting, just weird.
Douse my pizza with them, then take the leftovers and save them in the pepper spice bottle. A combination of 1 and 3, then.
I use them on the pizza.
I’ve thought about grinding them to a fine powder and adulterating someone’s cocaine.