Education Increases Disposal of Unused Opioids After Total Joint Arthroplasty

Abstract

Background: Unused opioid pills are a danger to patients and their loved ones as they may be diverted for abuse or misuse. The purpose of this study was to determine the baseline rate of proper disposal of unused opioids among patients undergoing total joint arthroplasty and to determine how education impacts disposal rates. Methods: In this study, 563 patients undergoing primary total joint arthroplasty (183 patients undergoing total hip arthroplasty, 293 patients undergoing total knee arthroplasty, and 87 patients undergoing unicompartmental knee arthroplasty) were cluster-randomized to groups that received no education, educational pamphlets, or educational pamphlets plus text messages. Patients were randomized by education class and were blinded to participation to avoid behavioral modifications. Patients were surveyed at 6 weeks postoperatively to determine if they disposed of their unused opioid pills using a U.S. Food and Drug Administration-recommended method, which was the primary outcome. Assuming a 15% difference in opioid disposal rates as clinically relevant, power analysis determined that 76 patients with unused opioids were required per group (228 total). An as-treated analysis was conducted with the Fisher exact text and analysis of variance with alpha = 0.05. Results: A total of 539 patients (95.7%) completed the survey, and 342 patients (63.5%) had unused opioid pills at 6 weeks postoperatively: 89 patients in the no education group, 128 patients in the pamphlet group, and 125 patients in the pamphlet and text message group. Of these 342 patients, 9.0% of patients in the no education group, 32.8% of patients in the pamphlet group, and 38.4% of patients in the pamphlet and text message group properly disposed of their unused opioids (p = 0.001 for each educational intervention compared with no education). Unused opioid pills were kept by 82.0% of patients in the no education group, 64.1% of patients in the pamphlet group, and 54.4% of patients in the pamphlet and text message group (p < 0.001 for the no education group compared with either educational strategy group). Patients who underwent total hip arthroplasty were more likely to properly dispose of their unused opioids compared with those who underwent total knee arthroplasty (odds ratio, 2.1; p = 0.005). There were no demographic differences between groups, including inpatient opioid use, refills, and preoperative opioid use, other than sex (41.5% male patients in the no education group, 55.0% male patients in the pamphlet group, and 37.4% male patients in the pamphlet and text message group; p = 0.001), suggesting appropriate randomization. Conclusions: The rate of opioid disposal is very low after total joint arthroplasty. Education on opioid disposal more than triples opioid disposal rates compared with no education. To help to prevent diversion of unused opioid pills, all patients who undergo total joint arthroplasty should be educated on the proper disposal of unused opioids.

The potential for diversion of prescribed opioids among orthopaedic patients: Results of an anonymous patient survey

“…In fact, 70%-75% of abusers obtained opioids through methods of diversion and only 5% from drug dealers or strangers [ 46 – 51 ]. Consistent with our findings, recent studies have demonstrated that prior instruction in safe opioid handling practices was highly associated with returning medications to a pharmacy, and was the factor most strongly associated with returning medications to a clinician [ 52 – 57 ]. Consequently, it is essential that orthopaedic surgeons, as well as other hospital and community HCPs allocate sufficient time toward educating patients on safe opioid handling practices and the potential danger of opioid diversion.…”

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“…In fact, 70%-75% of abusers obtained opioids through methods of diversion and only 5% from drug dealers or strangers [46][47][48][49][50][51]. Consistent with our findings, recent studies have demonstrated that prior instruction in safe opioid handling practices was highly associated with returning medications to a pharmacy, and was the factor most strongly associated with returning medications to a clinician [52][53][54][55][56][57]. Consequently, it is essential that orthopaedic surgeons, as well as other hospital and community HCPs allocate sufficient time toward educating patients on safe opioid handling practices and the potential danger of opioid diversion.…”

Perioperative dexamethasone administration reduces ‘on-demand’ opioid requirements in bilateral total hip arthroplasty

“…International experience would also suggest that the use of perioperative opioids increases the rate of hospital readmission post lower limb arthroplasty and the length of stay in hospital after these procedures [6,7]. Numerous efforts have been made to both understand and mitigate the factors contributing to opioid abuse in the context of lower limb arthroplasty [8,9]. We have demonstrated that the 'on-demand' opioid requirements for bilateral THA patients are significantly reduced with the use of perioperative steroids.…”