On locating prescription drug collection boxes

Optimizing return and secure disposal of prescription opioids to reduce the diversion to secondary users and black market

Objective. To implement an opioid buyback program after ambulatory surgery.Methods. We performed a prospective cohort study of 578 opioid-naïve patients prescribed opioids after ambulatory surgery at a rural US Veterans Affairs (VA) hospital from 2017 to 2018. We reimbursed $5 per unused opioid pill ($50 limit) returned to our VA for proper disposal. We tracked the number of participants, number of unused opioid pills returned, surgeon prescribing, and refill requests.Results. Out of 578 eligible patients, 171 (29.6%) returned 2136.5 unused opioid pills. Information shared with surgeons after 6 months led to a 27% decrease in opioid prescribing without an increase in refills.Conclusions. With this opioid buyback program, rural patients had a safe and convenient place to dispose of unused opioids. Surgeons used information about returns to adjust opioid prescribing after common ambulatory surgeries without an increase in refill requests.Public Health Implications. Although providers prescribe within state opioid guidelines, there will be variations in patient use after ambulatory surgery. An opioid buyback program helped our patients and surgeons decrease unused prescription opioids available for diversion in our rural communities.

The amount of municipal solid waste (MSW) has been increasing rapidly in the urban centres of developing countries during the last few decades; however, municipal solid waste management (MSWM) remains inadequate. One of the largest aspects of cost of the MSWM system is the collection of waste. This paper describes a methodology that combines geographic information systems (GIS), hesitant fuzzy linguistic term set (HFLTS), and the full multiplicative form of multi-objective optimization by ratio analysis (MULTIMOORA), to determine suitable locations for waste collection boxes (named AYPIKUT), which have been designed specifically for collection of domestic waste vegetable oil and waste batteries. It takes as case study, Atakum, a district of Samsun city, Turkey. As a solution to the problem, first, a total of 88 items have been identified for consideration by seven criteria elicited from the insights of experts, and spatial analyses were performed. Multi-criteria HFLTS was then used to determine weights of the criteria. Population density was the most significant criterion affecting the selection process, and proximity to housing complexes with more than 150 dwellings was the least important. According to the weights of the seven criteria, and three rules determined by the experts, 15 AYPIKUT locations were identified using GIS. As a final step, the alternative locations (A1-A15) were ranked with the MULTIMOORA method. A5 was the most suitable site, and A6 was the least suitable site for an AYPIKUT. The results indicated the ability of the proposed model to select the suitable locations for waste collection box.

The study aims to analyze the feasibility of implementing a dry weather collection system as a technical solution to the challenges related to sewage collection and treatment in unitary systems in Brazil. The proposal seeks to minimize the impacts on Effluent Treatment Plants and protect water bodies, contributing to the fulfillment of the goals of the legal framework for basic sanitation and the Sustainable Development Goals. The methodology adopted involved a literature review, document analysis and a case study. The data were collected from scientific databases, such as Scielo and Scopus, and from official sources. The information was critically analyzed regarding the technical feasibility of capturing in dry weather, and sizing calculations were performed in Excel spreadsheets to simulate the operation of the system in different scenarios. The proposed model considered parameters such as sewage flow, rainfall intensity and operational capacity of the Effluent Treatment Plants. The results of the study included the development of a conceptual design for the dry weather catchment system, with detailed calculations of pure and combined sewage flow. Specific interception points and sizing were defined, such as collection boxes, pumps and operational configurations based on a set point of 190 mg/L of Chemical Oxygen Demand - COD. The system had the potential to reduce the overload in the Effluent Treatment Plants, ensuring a maximum flow of 5452 m³/day and compliance with the parameters of the Resolution of the National Council for the Environment - CONAMA and environmental standards. The study points out that the dry weather collection system is a viable technical solution to improve the efficiency of biological treatment and reduce environmental impacts from the discharge of untreated sewage. However, it is recommended that future research be carried out to prepare a detailed executive project and evaluate the technical, economic and socio-environmental feasibility of the proposed model.

IntroductionDiversion of unused prescription opioids is a common source of opioid sensitization in the community. Educating patients about safe opioid use has been shown to be effective in decreasing opioid use. However, decreasing diversion will also require educating patients on proper opioid disposal. A survey was administered to better understand patients’ habits with opioid disposal for opioids prescribed after orthopedic surgery.MethodsA cross-sectional survey study of 469 patients who had undergone orthopedic surgery was conducted to learn their preferences and habits regarding the disposal of unused prescription opioids received after orthopedic surgery.ResultsThe survey respondents consisted of 48.8% female and 51.2% male patients. Ninety-four point two percent (94.2%) of those receiving opioid prescriptions reported having leftover unused opioids. In terms of voluntary disposal, 68.8% claimed to dispose of their prescription opioids while 31.2% did not. Gender, but not age, had a significant effect on plans for opioid disposal and how seriously respondents viewed issues of opioid misuse. When asked their preferred location for prescription opioid disposal, the most common preference was a local pharmacy.DiscussionThis survey identified that most patients do not store their prescription opioids in a locked location, claim to dispose of their unused prescription opioids, and would prefer to dispose of them at a pharmacy if possible. This information points to the need for close prescriber-to-pharmacy collaboration to promote the safe disposal of prescription opioids and mitigate drug diversion.

Perianesthesia Patient Education for the Promotion of Opioid Stewardship

To recycle or reuse used containers, it is necessary first to collect them. One way to do this is to give rewards to persons who return used packaging and containers to designated places. Many Japanese university cooperatives use recyclable lunch boxes for take-out food, and they collect used boxes in a variety of ways, including such reward giving. By analyzing the responses of university cooperatives to questionnaires on the ways that they collect used recyclable lunch boxes, this study examines the effect of this reward giving on the collection rate. The study results suggest that cash rewards are more effective in increasing the rate of return of used containers than setting up collection boxes that offer no rewards upon return, or giving point-based rewards.

Patient utilization of prescription opioids after discharge from the emergency department

Excessive opioid prescribing following surgery creates a reservoir of unused medications available for diversion and abuse. We conducted a cohort study examining the impact of clinic-based, surgeon-initiated strategies using an activated charcoal bag (ACB) system on disposal of unused opioids. Among patients undergoing a variety of general surgery procedures, 67% of those with unused opioids disposed of them using the ACB. Our findings demonstrate practical ways to incorporate opioid disposal into surgical practice as a complement to judicious opioid prescribing.

A two-stage procedure to optimally allocate limited resources for the dual purpose of purchasing new transit buses and rebuilding existing buses is presented in this paper. In stage 1, estimates are derived for the maximum investment that can be justified for rebuilding buses that have fulfilled their service life expectations. In stage 2, optimization by linear programming is used to estimate the number of buses in each category. Two optimization approaches are presented. In approach 1, the objective is to maximize the weighted fleet life, subject to budgetary and demand constraints. In approach 2, the objective is to minimize the total capital investment in the fleet, subject to minimum fleet life and demand constraints. Case studies are presented to demonstrate the application of two approaches. The proposed procedure can be used by state Departments of Transportation to allocate capital dollars among various transit agencies for the dual purpose of purchasing new buses and rebuilding older buses. While it is desirable to replace all the old buses with new ones, budgetary constraints often make it impossible to fund the purchase of all new buses. The proposed approach provides a tool to identify the “next best solution,” a solution that will result in an optimum combination of new and rebuilt buses that will satisfy the requirements of the minimum fleet size as well as the budgetary constraints.

Developing a health communication campaign for disposal of unused opioid medications

INTRODUCTION: Most women have unused opioids after cesarean, a source of opioid misuse and diversion. This study examined whether customized prescribing can reduce unused opioids after cesarean. METHODS: Between 6/14/2017 and 8/25/2017, all English- and Spanish-speaking women >18 years undergoing a cesarean were considered for eligibility. Women with complicated cesarean or chronic opioid use were excluded. Eligible women were approached postoperative day 1 and informed consent was obtained. Enrolled women were randomized to standard post-discharge opioid prescription (30 tablets of 5mg oxycodone) or customized prescription (formula derived from a prior study, and based on inpatient opioid use). Subjects were contacted on postoperative day 14 to assess opioid tablets used and pain. The Tennessee Controlled Substance Monitoring Database was accessed to confirm dispensed opioids. The primary outcome was unused opioid tablets. RESULTS: Of 323 cesarean deliveries, 34 declined participation and 99 were excluded, leaving 190 (84%) for randomization. Of 172 in final analysis (18, 9.5% lost to follow-up), the proportions reporting unused opioids were 65/87 (74.7%) in customized group, 60/85 (70.6%) in standard group (p=0.74). The customized prescription group received half the opioid tablets (14 [IQR 12-16]) compared to standard group (30), used less opioids (8 [IQR 4-14] vs 15 [IQR 6-30], p<0.001), and had less unused (5 [IQR 1-8] vs 10 [IQR 0-22], p<0.001) tablets. Reported pain outcomes and analgesic satisfaction with analgesia were not statistically significant. CONCLUSION: Customized opioid prescribing was associated with reduced opioid use and fewer unused opioids after cesarean, without affecting pain management.

BackgroundSurgery is a risk factor for opioid initiation, persistent use, and subsequent misuse in pediatric patients. The objective of this study was to assess the rate of postoperative opioid prescribing and extent of unused opioid prescriptions on the first postoperative day after pediatric ambulatory surgery.MethodsA telephone survey was administered on postoperative day 1 (POD1) to guardians of all pediatric patients who underwent ambulatory surgery at a single medical center. Participants were asked whether postoperative opioids were prescribed, and, if yes, whether they were currently taking them. Multivariable logistic regression was used to assess factors associated with postoperative opioid prescribing and unused opioids on POD1.ResultsOf 1344 pediatric patients who underwent ambulatory surgical procedures, 849 (63.1%) guardians responded to the survey. 275 (32.4%) were prescribed postoperative opioids, and 164 (59.6%) reported not taking opioids on POD1. The highest rates of unused opioid prescriptions were from orthopedic and plastic surgery services (28% and 29%, respectively). Governmental insurance status predicted having unused opioids (OR 0.59, CI 0.35–0.97).ConclusionsUnused opioid prescriptions were prevalent in this pediatric ambulatory surgical population. Opportunities remain to streamline opioid prescribing in pediatric patients undergoing ambulatory surgical procedures.

Surgery is a risk factor for opioid initiation and subsequent abuse. Discharge opioid prescription patterns after surgery are often varied and not evidence based, which may lead to unnecessary prescription of opioids. We aimed to assess opioid prescribing and unused opioid prescriptions in ambulatory surgery patients at our academic hospital. We conducted a retrospective observational study based on phone survey and electronic medical records. Adult patients who underwent ambulatory surgery at our large, multisite, tertiary-care hospital system were asked whether they were using the opioids that were prescribed at discharge. Our main outcomes were opioid prescription (defined as being prescribed an opioid on discharge) and unused opioid prescription (defined as being prescribed an opioid but not taking any opioids on postoperative day 1). We evaluated predictors of opioid prescription and unused opioid prescription through univariable and multivariable analyses. We also stratified outcomes by surgical service. Of 4248 adult patients who underwent ambulatory surgical procedures, 3279 (77.2%) responded to the survey. Of all responders, 2146 (65.4%) were prescribed postoperative opioids, and 1240 (57.8%) reported not taking them on postoperative day 1. The highest rates of unused opioid prescriptions were for patients whose primary service were orthopedic surgery (65%) and plastic surgery (62%). Opioid prescribing and unused opioid prescriptions are prevalent in our hospital's ambulatory surgical population. Patients undergoing selected ambulatory surgical procedures may not require as much opioid as is currently being prescribed.

A paucity of literature exists regarding current opioid prescribing and use following bariatric surgery. We aimed to characterize opioid prescribing practices and use following bariatric surgery to inform future studies and optimized prescribing practices. We performed a systematic review of Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, and Cochrane Library (via WILEY) on August 20, 2021. Two reviewers reviewed and extracted data independently. Studies evaluating adult patients undergoing bariatric surgery that reported opioid prescriptions at discharge were included. Abstracts, non-English studies, and those with n < 5 were excluded. Primary outcomes assessed the amount of morphine milligram equivalents (MMEs) prescribed at discharge. Secondary outcomes evaluated opioids used following discharge, proportion of patients with unused opioid, and if unused opioids were properly discarded. We evaluated 2113 studies, with 18 undergoing full-text review, and 5 meeting inclusion criteria. Overall, 847 patients were included, with 450 (53%) undergoing sleeve gastrectomy and 393 (46%) receiving Roux-en-Y gastric bypass. Most patients were female (n = 484/589, 82.2%), and the average age and BMI were 44.6 (± 11.8) years and 48.1kg/m2 (± 8.4kg/m2), respectively. On average, 348.4 MMEs were prescribed to patients undergoing bariatric surgery. Patients used only 84.7 MMEs, with 87.0% (95% CI 66.0-99.0%) having unused opioid, and 41/120 (34.2%) retaining these excess opioids. Nearly 90% of all bariatric patients evaluated in our systematic review are prescribed excessive opioids at discharge. Further work characterizing current opioid prescribing practices and use may help guide development of standardized post-bariatric surgery prescription guidelines.