Unused Opioids Research Articles

Evaluation of a drug deactivation system for safe disposal of opioids after ambulatory surgery

BackgroundPrescription opioids are commonly prescribed postoperatively and increase the risk of diversion or misuse when left unused and accessible. Despite awareness of the risks associated with unused opioids, harm reduction strategies like safe storage and drug take-back events may be limited by inconvenience and patient-specific barriers to access. ObjectiveTo evaluate a quality improvement project designed to facilitate at-home disposal of unused opioids after day surgery. MethodsAn observational, prospective quality improvement project was conducted in patients undergoing elective outpatient surgery at Newton-Wellesley Hospital from December 2019 to June 2020. Upon discharge, eligible patients received a Deterra drug disposal packet which deactivates unused medication. Follow-up surveys assessed packet use and reasons for nonuse 1 to 2 weeks after surgery. ResultsOne hundred six participants received a disposal packet and responded to the survey. Among the 67 respondents with unused medication, 30% used the packet. Women were more likely to use the packet than men (predicted probability 30.2% vs. 10.4%, P = 0.033), and patients aged 18–25 were more likely to use the packet than those aged 26–40 (40.0% vs. 9.5%, P = 0.049). The most common reasons for packet nonuse included procrastination, holding onto prescriptions in case of future pain, and waiting to dispose of multiple medications. ConclusionThe majority of patients surveyed had unused opioids 1 to 2 weeks after surgery, and approximately 1 in 3 patients with unused doses utilized the disposal packet. Common reasons for nonuse included procrastination and concerns about needing future medication for pain. Going forward, safe drug disposal efforts may emphasize improved patient education, partial prescription fill options, or alert systems to remind patients to safely dispose of unused medication.

Perceptions of disposal options for unused opioid analgesics among people who have been prescribed an opioid analgesic in North Carolina

ABSTRACT Background: Medication disposal programs have been promoted as one solution to the opioid crisis, but uptake by community members has been minimal. Objectives: To clarify perceptions of medication disposal options among people who have been prescribed an opioid analgesic in North Carolina to inform interventions that can facilitate the disposal of unused opioids. Methods: In 2022, we conducted focus groups with participants who received an opioid medication in the past year to gain information to develop an intervention related to the disposal of unused opioid medication (12 focus group discussions (FGDs); total N = 37; 30 identified as female, 6 as male, and 1 as another gender). Participants were shown a slide with the Food and Drug Administration’s recommended disposal options and asked about their perceptions of each option. Themes were derived using an inductive, thematic, qualitative approach. Results: Seven themes about perceptions of medication disposal programs emerged from the data. Four of the themes reflect potential barriers to medication disposal: failed disposal attempts, lack of sufficient education on proper disposal, unclear meaning of specific disposal language, and concerns about existing disposal options. Three of the themes provide insight on potential facilitators of medication disposal: preference of low-cost disposal options, ease and accessibility among disposal methods, and preferred disposal methods. Conclusion: Patients should be provided clear and consistent guidance from prescribers and dispensing pharmacists on when and how to dispose of unused medications and opportunities to dispose of medications at no cost to the patient.

Prediction Model for Outpatient Opioid Use Following the Minimally Invasive Repair of Pectus Excavatum

IntroductionTo minimize unused outpatient opioids while providing adequate pain control, we sought to create a model to predict outpatient opioid use following the minimally invasive repair of pectus excavatum with cryoablation MIRPE-C. MethodsA retrospective review was conducted at a single center from May 2023 to January 2024 among patients <21 years who underwent MIPRE-C. Demographic and clinical data, including inpatient and outpatient opioid use were reviewed. Patients completed opioid use questionnaires at their first postoperative visit. Simple linear regression was employed to create a model for outpatient opioid use. ResultsSixty-eight patients underwent MIRPE-C: 84% were male (mean age of 15.2 ± 1.7 years, and median Haller index 4.2[IQR:3.7–5.7]). Daily mean inpatient opioid requirement and daily opioid doses were 0.3 ± 0.2 OME/day/kg and 2 ± 1.2 opioid doses/day. At the first outpatient follow-up visit, patients reported using a median of five 5-mg oxycodone tablets [IQR:1.6–10] for 5 days [IQR:2–7] with 22% of patients needing an opioid refill. On linear regression, inpatient opioid use had a significant relationship with the number of outpatient doses taken, while patient factors were not associated with outpatient opioid use. A simple equation for predicting opioid need based on best fit (R2 = 0.211) was developed:#OUTPATIENT OPIOID TABLETS = 3 TABLETS + (0.82 x #INPATIENT OPIOID RECIEVED). ConclusionThe proposed outpatient opioid prescription model is simple to calculate and tailors the prescription to individual patient need. This model has the potential to provide effective pain control and avoid prescription refills, while minimizing over-prescription of opioids. Level of EvidenceTreatment study Level III.

Opioid prescribing requirements to minimize unused medications after an emergency department visit for acute pain: a prospective cohort study.

Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids. In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription. Participants completed a pain medication diary for real-time recording of quantity, doses, and names of all analgesics consumed during a 14-day follow-up period. We included 2240 participants, who had a mean age of 51 years; 48% were female. Over 14 days, participants consumed a median of 5 (quartiles, 1-14) morphine 5 mg tablet equivalents, with significant variation across pain conditions (p < 0.001). Most opioid tablets prescribed (63%) were unused. To meet the opioid need of 80% of patients for 2 weeks, we found that those experiencing renal colic or abdominal pain required fewer opioid tablets (8 morphine 5 mg tablet equivalents) than patients who had fractures (24 tablets), back pain (21 tablets), neck pain (17 tablets), or other musculoskeletal pain (16 tablets). Two-thirds of opioid tablets prescribed at emergency department discharge for acute pain were unused, whereas opioid requirements varied significantly based on the cause of acute pain. Smaller, cause-specific opioid prescriptions could provide adequate pain management while reducing the risk of opioid misuse. ClinicalTrials.gov, no. NCT03953534.

Opioid consumption before discharge predicts outpatient opioid use in adolescents undergoing surgery

BackgroundThe majority of adolescents undergoing surgery report unused prescription opioids after surgery, increasing the risk of diversion, misuse, and addiction. Adult studies have demonstrated that opioid use 24 hours before discharge corresponds with opioid use at home. We hypothesized that inpatient opioid consumption is associated with outpatient opioid use in adolescents. MethodsAdolescents aged 13-20 years undergoing elective surgery associated with an opioid prescription were prospectively recruited. Parent-adolescent dyads were surveyed preoperatively to assess sociodemographics, health literacy, and baseline substance use, and opioid use was measured at 30- and 90-days postoperatively. Medical records were reviewed to calculate cumulative opioid use during hospitalization. Inpatient and postoperative opioid use was converted to oral morphine equivalents. Adjusting for age, sex, race, health literacy, alcohol use, pain score, and surgery, multivariable linear regression identified factors associated with outpatient oral morphine equivalent use 90 days postoperatively. ResultsOverall, 103 adolescents were enrolled. Median oral morphine equivalents used from 24 and 48 hours before discharge and throughout the hospitalization were 30.8 (interquartile range:11.7–45.0), 67.5 (interquartile range:37.5–94.3), and 97.5 (interquartile range:18.0–152.7), respectively. Regression analysis demonstrated that adolescent-reported pain at discharge (P = .028) and cumulative oral morphine equivalents used 24 hours (P < .001) and 48 hours (P = .003) before discharge were significantly associated with postoperative oral morphine equivalents use at home. Oral morphine equivalents consumption 24 hours before discharge estimated cumulative oral morphine equivalents use 90 days postoperatively at a 1-to-5 ratio in 94.1% of patients. ConclusionFor adolescents undergoing surgery, patient-reported pain at discharge and oral morphine equivalents administered 24 hours before discharge are associated with cumulative outpatient opioid use. Tailoring outpatient prescriptions to total oral morphine equivalent consumption 24 hours before discharge could reduce excess opioid prescribing.

Postoperative Opioid Usage and Disposal Strategies After Arthroscopic Procedures in a Young Cohort: A Prospective Observational Study.

Although several studies have noted that patients are routinely overprescribed opioids, few have reported usage after arthroscopic surgery. To determine opioid consumption and allocation for unused opioids after common arthroscopic surgeries. Case series; Level of evidence, 4. Patients between the ages of 15 and 40 years who were scheduled to undergo anterior cruciate ligament reconstruction (ACLR), labral repair of the hip or shoulder, meniscectomy, or meniscal repair were prospectively enrolled. Patients were prescribed either 5 mg hydrocodone-325 mg acetaminophen or 5 mg oxycodone-325 mg acetaminophen based on surgeon preference. Patients completed a daily opioid usage survey during the 2-week postoperative period. In addition, patients completed a survey on postoperative day 21 inquiring about continued opioid use and medication disposal, if applicable. Opioid medication consumption was converted to morphine milligram equivalents (MMEs). Of the 200 patients who were enrolled in the study, 176 patients had sufficient follow-up after undergoing 85 (48%) ACLR, 26 (14.8%) hip labral repair, 34 (19.3%) shoulder labral repair, 18 (10.2%) meniscectomy, and 13 (7.4%) meniscal repair procedures. Mean age was 26.1 years (SD, 7.38); surgeons prescribed a mean of 26.6 pills whereas patients reported consuming a mean of 15.5 pills. The mean MME consumption in the 14 days after each procedure was calculated: ACLR (95.7; 44% of prescription), hip labral repair (84.8; 37%), shoulder labral repair (57.2; 35%), meniscectomy (18.4; 27%), and meniscal repair (32.1; 42%). This corresponded to approximately 39% of the total opioid prescription being utilized across all procedures. Mean MME consumption was greatest on postoperative day 1 in hip, shoulder, and meniscal procedures and on postoperative day 2 in ACLR. Only 7.04% of patients reported continued opioid use in the third postoperative week. Patients had a mean of 11 unused pills or 77.7 MMEs remaining. Of the patients with remaining medication, 24.7% intended to keep their medication for future use. The results of our study indicate that patients who undergo the aforementioned arthroscopic procedures consume <75 MMEs in the 2-week postoperative period, translating into a mean of 10 to 15 pills consumed. Approximately 60% of total opioids prescribed went unused, and one-fourth of patients intended to keep their remaining medication for future usage. We have provided general prescribing guidelines and recommend that surgeons carefully consider customizing their opioid prescriptions on the basis of procedure site to balance optimal postoperative analgesia with avoidance of dissemination of excess opioids.

Use-Based Opioid Prescribing Protocol Reduces Opioid Prescriptions After Cesarean Section [ID 2683514

INTRODUCTION: Up to 75% of post-cesarean patients report having up to 50% of their discharge opioid prescription left over. We assessed an institutional standardized post-cesarean section pain management and opioid prescribing protocol implemented to decrease unused opioids entering the community while still adequately managing pain. METHODS: This was an IRB-approved single-center retrospective comparative cohort study in patients aged 18 years or older, who underwent cesarean section before or after implementation of standardized pain management and opioid prescribing protocol. The intervention group received scheduled acetaminophen and NSAIDs with oxycodone 5 to 10 mg as needed postoperatively. Opioid consumption during the 24 hours prior to discharge was used with set ranges determine the quantity of opioid to prescribe for discharge. Outcomes included opioid prescription receipt, quantity of opioid prescribed, and supplementary opioid prescription within 30 days of discharge. RESULTS: Four hundred thirty-three patients were included, with 255 in the intervention group and 208 in the control group. The intervention group used less oxycodone postoperatively (75.1%, 17.8%, and 7.1% of patients using 45 mg, respectively, versus 52.4%, 30.3%, and 17.3%; P&lt;.001), received fewer opioid prescriptions (79.1% versus 89.4%; P=.041), and fewer oxycodone tablets if prescribed (median [interquartile range]: 15 [5–20] versus 30 [20–30]; P&lt;.001). There was no significant difference in number of supplemental post-discharge opioid prescriptions received. CONCLUSION: A standardized post-cesarean section pain management and opioid prescribing protocol significantly reduced the number of both opioid prescriptions written and number of tablets prescribed without increasing patients seeking opioid refills in the 30 days following discharge.

Opioid use and disposal at 2 weeks post-surgery: Brief communication regarding excess opioids and disposal habits.

To measure the number of unused prescription opioids and disposal habits of patients following orthopedic shoulder surgery. A prospective observational study. Academic orthopedic sports medicine department. Sixty-seven patients undergoing shoulder surgery. Nine-question opioid use questionnaire. Responses to an opioid use questionnaire were collected at 2 weeks post-surgery. Outcomes of interest included the amount of initial opioid prescription used and the disposal of excess opioids. Sixty-seven patients completed the opioid use questionnaire. Forty-six (68.7 percent) patients reported having excess opioids at 2 weeks. Of the 46 patients with excess opioids, 57 percent disposed of the excess, and 43 percent planned to keep their opioids. Two-thirds of the patients reported having excess opioids, highlighting the issue of an overabundance of unused prescription opioids in America. Utilization of opioid-free pain management strategies and drug disposal kits should be explored to reduce the number of unused and improperly disposed opioids.

Opioid prescription usage and disposal after provider education and SMS-based parent education

Adequate pain control after outpatient pediatric urologic surgery is important for both providers and caregivers; however, opioid pain medications are often prescribed in excess of utilization. The resultant excess opioid medication has potential to be diverted or misused. While families are instructed to dispose of leftover opioids, a significant proportion may not dispose of leftover medication. We performed a quality improvement (QI) initiative within a tertiary academic care center to examine opioid excess, opioid disposal, and whether a two-component QI intervention of provider education and family education via automated SMS messages on opioid disposal could improve excess opioid prescribing and leftover opioid disposal. Prospective parent surveys were performed on a baseline cohort of 73 patients undergoing outpatient pediatric urologic surgery between July 27 and September 4, 2020. Based on baseline data, a two-component quality improvement initiative was implemented. The first component was non-binding surgeon education regarding opioid prescribing versus opioid utilization. The second component was initiation of automated SMS messages to families after surgery with information on expected postoperative course and hyperlinked instructions for opioid disposal with GPS search for opioid disposal sites nearby. We then repeated the survey for a second cohort of patients between September 14 and October 29, 2021, including additional questions regarding SMS message utility. Of 73 patients in the baseline group, 46% were prescribed opioids (Summary Table). Of patients prescribed opioids, a median of 3 doses were used and 96% had leftover opioid medication. Seventeen percent of parents in the baseline group disposed of unused opioids prior to survey completion (1-4 weeks postop). After the intervention, 19 of 74 (26%) patients were prescribed opioids. In the group that received opioids, a median of 2 doses were used and 63% reported disposing of opioids. Ninety-six percent of parents reported satisfaction with SMS messages. Many competing priorities exist for surgical providers and parents of children undergoing outpatient pediatric urologic surgery. A passive program that delivers just-in-time information in the postoperative period has high utility for both parents and providers. Automated SMS messages and provider education about opioid utilization are associated with decreased excess opioid after outpatient pediatric urologic surgery and improved opioid disposal rates by parents. These interventions are easily implemented without significant manpower and should be considered by organizations interested in decreasing excess community opioids after outpatient pediatric urologic surgery.

Opioid Consumption After Discharge From Total Knee and Hip Arthroplasty: A Systematic Review and Meta-Analysis

BackgroundPain is challenging after recovery from total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures, and patients often receive prescription opioids. However, opioid consumption by patients remains unclear, and unused opioids may lead to risks including misuse and diversion. The objective of this systematic review and meta-analysis was to compare prescription size versus patient-reported consumption of opioids after discharge following TKA and THA. MethodsPubMed and Embase were systematically searched for publications published between 2015 and 2022 on patient-reported consumption of opioids after TKA and THA. The primary outcome was opioid use in oxycodone 5-mg equivalents. Team members independently reviewed studies for screening, inclusion, data extraction, and risk of bias. ResultsAmong the 17 included studies (15 TKA and 11 THA), discharge opioid prescribing exceeded consumption for both TKA (88.4 versus 65.0 pills at 6 weeks) and THA (64.0 versus 29.8 pills at 12 weeks). For both TKA and THA, the range of opioids prescribed varied significantly, by 1.6-fold for TKA and 2.8-fold for THA. Most studies reported pain outcomes (89%) and the use of nonopioid medications (72%). Of the 4 studies offering prescribing recommendations, the amounts ranged from 50 to 104 pills for TKA and 30 to 45 pills for THA. ConclusionsOpioid prescribing exceeds the amount consumed following TKA and THA. These findings serve as a call to action to tailor prescribing guidelines to how much patients actually consume while emphasizing the use of nonopioid medications to better optimize recovery from surgery.

Perioperative Opioid-Related Harms: Opportunities to Minimize Risk.

Although substantial attention has been given to opioid prescribing in the United States, opioid-related mortality continues to climb due to the rising incidence and prevalence of opioid use disorder. Perioperative care has an important role in the consideration of opioid prescribing and the care of individuals at risk for poor postoperative pain- and opioid-related outcomes. Opioids are effective for acute pain management and commonly prescribed for postoperative pain. However, failure to align prescribing with patient need can result in overprescribing and exacerbate the flow of unused opioids into communities. Conversely, underprescribing can result in the undertreatment of pain, complicating recovery and impairing well-being after surgery. Optimizing pain management can be particularly challenging for individuals who are previously exposed to opioids or have critical risk factors, including opioid use disorder. In this review, we will explore the role of perioperative care in the broader context of the opioid epidemic in the United States, and provide considerations for a multidisciplinary, comprehensive approach to perioperative pain management and optimal opioid stewardship.

Opioid Use Following Cesarean Delivery: A Pilot Study on Patterns of Use, Storage, and Disposal.

Objective The aim of this study was to describe various aspects related to opioid use and storage in the setting of at-home pain management after cesarean deliveries among an Appalachian population. Methods Women who underwent cesarean delivery (January-June 2019) at an Appalachian institution were prospectively enrolled and administered a telephone survey seven(± 3) days post-discharge. Results Of the 87 women enrolled, 40 (46%) completed the survey; 92.5% were prescribed an opioid medication, most commonly oxycodone/acetaminophen 5/325 mg. A Kruskal-Wallis H test revealed a significant association between the severity of pain that interfered with normal daily activities and the number of pills consumed [χ2(2)=6.75, p=0.034]. More than 70% of the participants (28/40) had not safely stored or disposed of their unused opioid medications. Conclusion Our findings highlight the need for interventions to educate patients on how to appropriately use, store, and dispose of unused opioids.

Factors Associated with Postoperative Opioid Use in Adolescents

BackgroundWe aimed to identify factors associated with postoperative prescription opioid use in adolescents. MethodsAdolescents aged 13–20 years undergoing surgery were prospectively recruited from a children's hospital. Adolescent-parent dyads completed a preoperative survey, measuring clinical and sociodemographic factors, and two postoperative surveys evaluating self-reported opioid use at 30- and 90-days. Poisson regression analysis identified factors associated with the number of pills used within 90-days, adjusting for age, gender, race/ethnicity, surgery type, and pain at discharge. ResultsWe enrolled 119 adolescents who reported postoperative opioid use following posterior spinal fusion (PSF) (50 %), arthroscopy (23 %), pectus excavatum repair (11 %), tonsillectomy (8 %), and hip reconstruction (7 %). Overall, 81 % of adolescents reported unused opioids. The median pain score at discharge was 7 (IQR:5–8). Adolescents reported using a median of 7 (IQR:2–15) opioid pills, with 20 (IQR:7–30) pills left unused. Compared to all other surgeries, adolescents undergoing PSF reported the highest median pill use (10, IQR:5–29; p = 0.004). Adolescents undergoing tonsillectomy reported the lowest median pill use (1, IQR:0–7; p = 0.03). On regression analysis, older patient age was associated with a 12 % increase in pill use (95 % CI:3%–23 %). Undergoing PSF was associated with a 63 % increase in pill use (95 % CI:15%–31 %). Each additional pain scale point reported at discharge was associated with a 13 % increase in pill use (95 % CI:5%–22 %). ConclusionsOlder age, surgery type, and patient-reported pain at discharge are associated with postoperative prescription opioid use in adolescents. Understanding patient and surgery-specific factors associated with opioid use may guide surgeons to minimize excess opioid prescribing. Level of evidenceII.

Elucidating determinants of medication disposal programs at retail pharmacies in North Carolina

BackgroundPharmacy-based medication disposal programs is one approach to prevent diversion of unused prescription opioids. Objective(s)The objective of this study was to assess the extent to which disposal programs have been implemented by retail pharmacies and identify determinants of implementation using the Consolidated Framework for Implementation Research. MethodsA sequential mixed-method design was used to examine implementation of medication disposal programs at pharmacies in Pitt County, NC. We conducted environmental scans of all retail pharmacies that served community members (N = 31) to assess the extent to which disposal programs had been implemented. Then, we conducted interviews with pharmacists (n = 15; 48.4%) to identify determinants of implementation. The following pharmacy types were represented in the completed interviews: corporate chain (n = 10), small chain (n = 1), independently owned and operated (n = 1), medical (n = 2), and government (n = 1). ResultsWe found that 32.3% of pharmacies (n = 10) had a medication disposal box and 12.9% (n = 4) had posted a flyer on medication disposal. Pharmacists perceived that patients benefit from disposal boxes and medication disposal is in their purview. Determinants of implementation included the cost of sustaining the intervention, polices of corporate and regional management, variable local control in the decision-making process to implement a disposal box, and experience with having a medication disposal box. ConclusionOur findings highlight one way in which pharmacists can have a vital role in preventing diversion of opioid analgesics and associated consequences. There is a need to expand disposal boxes at pharmacies to increase community member accessibility and use. Future research is needed to determine the cost-effectiveness of expanding the scale of disposal box implementation in community pharmacies.

Disposal of Unused Postoperative Opioids: A Real-World Demonstration of Surgeon-initiated Strategies Using an Activated Charcoal Bag System.

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.

Prescription Opioid Use for Adolescents With Neurocognitive Disability Undergoing Surgery: A Pilot Study

IntroductionParents frequently report retaining unused opioid pills following their child's surgery due to fear of untreated postoperative pain. Assessment of pain in adolescents with neurocognitive disability is challenging. We hypothesized that parents of adolescents with neurocognitive disability may report less opioid use and higher opioid pill retention. MethodsAdolescents (13-20 y) undergoing elective surgery (posterior spinal fusion, hip reconstruction, arthroscopy, tonsillectomy) were prospectively enrolled from a tertiary children's hospital from 2019 to 2020. Only adolescents prescribed opioids at discharge were included. Parents completed a preoperative survey collecting sociodemographic characteristics and two postoperative surveys at 30- and 90-d. Neurocognitive disability was determined at time of enrollment by caregiver report, and included adolescents with cerebral palsy, severe autism spectrum disorder, and discrete syndromes with severe neurocognitive disability. ResultsOf 125 parent-adolescent dyads enrolled, 14 had neurocognitive disability. The median number of opioid pills prescribed at discharge did not differ by neurocognitive disability (29, interquartile range {IQR}: 20.0-33.3 versus 30, IQR: 25.0-40.0, P = 0.180). Parents of both groups reported similar cumulative days of opioid use (7.0, IQR: 3.0-21.0 versus 6.0, IQR:3.0-10.0, P = 0.515) and similar number of opioid pills used (4, IQR: 2.0-4.5 versus 12, IQR: 3.5-22.5, P = 0.083). Parents of both groups reported similar numbers of unused opioid pills (17, IQR: 12.5-22.5 versus 19, IQR: 8.0-29.0, P = 0.905) and rates of retention of unused opioids (15.4% versus 23.8%, P = 0.730). ConclusionsThe number of opioid pills prescribed did not differ by neurocognitive disability and parents reported similar opioid use and retention of unused opioid pills. Larger studies are needed to identify opportunities to improve postoperative pain control for children with neurocognitive disability.

Paper 07: Postoperative Opioid Usage and Disposal Strategies Following Outpatient Arthroscopic Sports Medicine Procedures: A Prospective Observational Study

Objectives: While several studies have noted that patients are routinely over-prescribed opioids, few have reported usage following arthroscopic surgery. Nearly 2 million arthroscopic procedures are performed annually, and one study estimates that opioids are prescribed in excess in 88% of patients recovering from arthroscopic knee surgery. Such surplus of postoperative opioid prescription creates a conundrum, as many patients do not appropriately dispose of unused opioid pills, and the majority of recreational opioid users obtain these medications from friends or family. The objectives of this study were to determine opioid consumption, utilization of total prescription, and allocation for unused opioids following five common arthroscopic surgeries. Methods: This study is a prospective trial enrolling patients between the ages of 15-40 who were scheduled to undergo elective anterior cruciate ligament (ACL) reconstruction, labral repair of the hip or shoulder, meniscectomy, or meniscal repair. Patients were prescribed either 5-325 hydrocodone-acetaminophen or 5-325 oxycodone-acetaminophen based on surgeon preference. Patients completed a daily opioid usage survey during the 2-week postoperative period. In addition, patients completed a survey on postoperative day 21 inquiring about continued opioid use and medication disposal, if applicable. Opioid medication consumption was converted to morphine milliequivalents (MME) where one 5 mg oxycodone pill is equivalent to 7.5 MME and one 5 mg hydrocodone pill is equivalent to 5.0 MME. T-tests or Mann-Whitney U tests were used to calculate differences between continuous data. Chi-Square or Fisher’s Exact were used for categorical data. Results: Of the 200 patients enrolled in the study, 100 (50%) underwent ACL reconstruction, 26 (13%) underwent arthroscopic hip labral repair, 37 (19%) underwent arthroscopic shoulder labral repair, 23 (12%) underwent meniscectomy, and 14 (7%) underwent meniscal repair. The mean MME consumption in the 14 days following each procedure was calculated: ACL reconstruction (88.9), hip arthroscopy (84.8), shoulder arthroscopy (55.5), meniscectomy (24.3), and meniscal repair (31.2). This corresponded to a utilization rate of 40.4%, 36.5%, 40.7%, 37.4%, and 34.6% respectively (Table 1). Mean MME consumption was greatest on postoperative day 1 in all procedures, and only 6.6% of patients reported continued opioid use in the third postoperative week. Of the 141 patients available for follow up at 3 weeks, 113 reported having opioid medication remaining. Of the patients with remaining medication, 25.6% intended to keep their medication for future use (Figure 2). Conclusions: The results of our study indicate that patients who undergo the aforementioned arthroscopic procedures consume a mean of 70 MME in the 2-week postoperative period, translating into an average of 9-14 pills consumed, depending on medication prescribed. Few patients reported requiring opioid medication after 2 weeks postoperatively. Patients undergoing ACL reconstruction and hip labral repairs consumed the highest MME, followed by shoulder labral repair patients who consumed approximately 3 times more opioids than primary meniscal procedures. Approximately 65% of total opioids prescribed went unused, and over one fourth of patients intended to keep their remaining medication for future usage. [Table: see text]

Supply of opioids and information provided to patients after surgery in an Australian hospital: A cross-sectional study.

Opioids are commonly prescribed to manage pain after surgery. However, excessive supply on discharge can increase patients' risk of persistent opioid use and contribute to the reservoir of unused opioids in the community that may be misused. This study aimed to evaluate the use of opioids in Australian surgical patients after discharge and patient satisfaction with the provision of opioid information after discharge. This prospective cohort study was conducted at a tertiary referral and teaching hospital. Surgical patients were called 7-28 days after discharge to identify their opioid use and the information that they received after discharge. In total, 66 patients responded. Most patients underwent orthopaedic surgery (45.5%; 30/66). The median days of opioids supplied on discharge was 5 (IQR 3-5). In total, 40.9% (27/66) of patients had >50% of their opioids remaining. Patients undergoing orthopaedic surgery were less likely to have >50% of their opioids remaining (P = 0.045), whilst patients undergoing urological or renal surgeries were significantly more likely (P = 0.009). Most patients recalled receiving information about their opioids (89.4%; 59/66). However, the majority (51.5%; 34/66) did not recall receiving any information about the signs of opioid toxicity and interactions between opioids and alcohol. In conclusion, around 40% of patients had more than half of their opioid supply remaining after they ceased taking their opioid. Although most patients recalled receiving information about their opioids, more than half did not recall receiving any information about the signs of opioid toxicity or interactions between opioids and alcohol.

Excess Opioid Medication and Variation in Prescribing Patterns Following Common Breast Plastic Surgeries.

Purpose: Excess opioid prescribing has societal impacts including addiction, dependence, and misuse. This study aims to investigate prescribing patterns and self-reported patient experiences with opioid use, pain control, and disposal of unused medication following common breast surgeries. Methods: A total of 46 patients undergoing 5 breast procedures were identified during a predefined 14-week period. All procedures were carried out at a single tertiary care hospital by 9 plastic surgeons. Provincial narcotic monitoring program provided linked prescription information for identified patients. All patients were invited to participate in a telephone interview regarding postoperative opioid use. Results: A total of 41.6% of patients received and filled an opioid prescription following a breast procedure. Hydromorphone was the most commonly prescribed narcotic. The average number of opioid tablets dispensed following breast procedures was 31.9. Four percent of breast patients required an opioid refill. A total of 75% of breast patients used at least 1 over-the-counter analgesic, most commonly acetaminophen alone. Average self-reported pain score and total pain period were not significantly different between those using opioids and those not. A total of 6.7% and 23.1% of patients report returning excess narcotics to a pharmacy, while the majority report still having or self-disposing of excess tablets. Conclusions: Opioids are prescribed in excess for the breast procedures we analyzed. The majority of unused opioids were noted to still be at home or disposed of inappropriately. This suggests a role for reviewing opioid-prescribing patterns for common plastic surgery procedures to reduce the burden of the ongoing opioid epidemic.

Impact of Postsurgical Opioid Prescription Reduction in General Surgery Patients.

Purpose: Recent studies suggest a large percentage of post-surgical opioid prescriptions are not utilized. This surplus of opioids provides supply for diversion or entry into the waste cycle. Recommendations are available for general surgery procedures which may optimize prescribed quantity while maintaining patient satisfaction which this work was initiated to investigate. Methods: This retrospective patient survey was conducted with Institutional Review Committee approval following adjustments to discharge opioid prescription quantities in an individual General Surgeon practice. Patients were contacted via phone to assess the impact of the reduced opioid quantities. Patients were categorized based on whether they utilized the entire prescription or opioid remained. Data collected include baseline demographics, inpatient stay characteristics, opioid use patterns, and satisfaction with overall pain control. The primary endpoint was to determine if patients were satisfied with their pain control based on response. Secondary endpoints included if patient characteristics could be identified that signal larger opioid quantity use, and whether unused opioids were disposed. Results: Thirty patients utilized all opioid prescribed, 60 had some quantity remaining. Baseline data appear similar aside from age with younger patients using more opioid. Patients were satisfied with their overall pain control in 93% of respondents. A total of 960 opioid tablets (11.4 ± 4.8 tabs/patient) were not prescribed, 8% required refill. Opioid disposal yet to occur in 85% of patients. Conclusion: An evidence-based reduction in opioid discharge prescriptions following general surgery procedures resulted in nearly 1000 opioid tablets not being dispensed without having a negative impact on patient satisfaction.