Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department

Silvestre, Julio; Reddy, Akhila; Cruz, Maxine de la; Wu, Jimin; Liu, Diane; Bruera, Éduardo; Todd, Knox H.

doi:10.1017/s1478951516000158

Cited by 38 publications

(63 citation statements)

References 26 publications

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“…The public, including our patients, are often unaware of the connection between the opioid epidemic and their own safe storage of medications. One study of cancer patients seen in the emergency department found that by self‐report, 36% admitted to storing their opioids in plain sight, 53% hid the medications but not in a locked box or cabinet, and only 15% reported that they locked up the opioids . Most in this study were unaware of proper disposal methods.…”

Section: Strategies For Optimal Pain Management Using Opioids In the mentioning

confidence: 69%

Cancer pain management and the opioid crisis in America: How to preserve hard‐earned gains in improving the quality of cancer pain management

Paice

2018

Cancer

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Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief. Oncologists and other professionals treating those with cancer pain will require new knowledge and tools to provide safe and effective pain control while preventing additional cases of substance use disorders (SUDs), helping patients in recovery to maintain sobriety, and guiding those not yet in recovery to seek treatment. How do these 2 serious epidemics intersect and affect oncology practice? First, oncology professionals will need to adopt practices to prevent SUDs by assessing risk and providing safe pain care. Second, oncology practices are likely to see an increased number of patients with a current or past SUD, including opioid misuse. Few guidelines exist for the direct management of pain when opioids may be indicated in these individuals. Third, modified prescribing practices along with the education of patients and families are warranted to prevent the exposure of these medications to unintended persons. Finally, advocacy on behalf of those with cancer pain is imperative to avoid losing access to essential therapies, including opioids, for those who might benefit. Cancer 2018;124:2491-7. © 2018 American Cancer Society.

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Section: Strategies For Optimal Pain Management Using Opioids In the mentioning

confidence: 69%

Cancer pain management and the opioid crisis in America: How to preserve hard‐earned gains in improving the quality of cancer pain management

Paice

2018

Cancer

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“…However, despite the recent increase in and reported efficacy of drug take-back programs, recent studies suggest that the mere presence of such programs is not sufficient. Many individuals continue to employ incorrect drug disposal methods, which can largely be attributed to a lack of education on safe disposal practices [44][45][46]. Overall, we propose that reduced prescription and OTC drug abuse hinges on a combined effort that integrates education, growth and expansion of drug disposal programs, and elimination of environmental stressors (refer to and OTC drugs as well as safe methods of drug disposal.…”

Section: Discussionmentioning

confidence: 96%

“…74% of patients were not aware of correct drug disposal methods and 46% of patients had unused drugs in their home. Silvestre et al [45] also surveyed patients receiving opioids and found that only 13% had received education on safe opioid disposal and 77% indicated the presence and improper storage of unused opioids at home. Maeng et al [46] conducted a telephone survey of 721 Medicare adults in central Pennsylvania on their unused medication disposal patterns.…”

Section: Proper Drug Disposal As a Mechanism For Changementioning

confidence: 99%

Proper Drug Disposal: Studying a Solution to Household Prescription and Over-the- Counter Drug Abuse

Kinrys¹,

Gold²,

Nierenberg³

2016

J Drug Abuse (edi(n))

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For the average American, prescription and over-the-counter drugs are a standard component of a daily health regimen with 35% of American adults consuming over-the-counter (OTC) medicines on a daily basis [1] and 48.7% of Americans reporting use of at least one prescription drug in a 30 day period [2]. Data indicate that OTC medications serve a crucial role in helping treat a host of common health problems such as pains, aches, sprains, and rashes [1,3] with 81% of adults utilizing OTC medications as a first response treatment for common medical symptoms [4]. With OTC sales at approximately 31 billion dollars in 2014, OTC drugs importantly provide low-cost treatments to individuals in underserved communities [4].In a thirteen-year span from 1999 to 2012, prescription drug use in the United States demonstrated a notable increase [5]. Using data from the National Health and Nutrition Examination Survey, Kantor et al. [5]. found that 51% of US adults reported use of any prescription drug from 1999 to 2000 while 59% reported use of any prescription drug from 2011-2012. A recent Mayo Clinic study estimated that 70% of Americans are on at least one prescription drug [6].Widespread prescription and OTC medication use in the United States has produced an environment in which drugs are highly present and, thus, readily accessible to any given individual [7]. This ease of access is reflected in many areas. First, OTC drugs can be easily purchased in pharmacies and drug stores. Further, many individuals have access to expired or unused drugs in their home cabinets [8,9]. These avenues create opportunities for individuals to share excess drugs with friends and family members or to consume the drugs themselves. In many cases, these medications are not consumed as prescribed -specifically, they are consumed at higher doses or by non-intended recipients [10,11]. Thus, high accessibility can, in turn, contribute to misuse and abuse of prescription and OTC drugs [12]. Proper Drug Disposal: Studying a Solution to Household Prescription and Over-theCounter Drug Abuse AbstractWith 6.5 million Americans misusing a prescription drug in 2014 and 12% of American teenagers indicating lifetime use of over-the-counter cold medicine or cough syrup for getting high, misuse and abuse of prescription and over-thecounter drugs remains a major problem in the United States. Prescription and over-the-counter drug abuse often results from unused or unwanted medications remaining in the household cabinet. A potential solution to this problem lies in drug take-back programs which allow individuals to bring unused medications back to designated facilities for safe and proper disposal. In this commentary, we discuss the current state of drug take-back programs and their relevance to prescription and over-the-counter drug abuse. We conclude with suggestions on future directions in drug disposal that can help fight against prescription and overthe-counter drug abuse.

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“…Components may include storage, appropriate use of opioids and controlled substances, and disposal strategies once these agents are no longer indicated. Despite nonstop media attention to the opioid epidemic, patients are often stunned when advised to lock up their medications . Optimally, agreements provide an educational opportunity to emphasize our partnership in ensuring safe opioid management.…”

Section: Risk Assessment and Monitoringmentioning

confidence: 99%

Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy

Paice

2019

The Oncologist

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The primary objective of this article is to assist oncologists and advanced practice prescribers to safely and effectively minimize risk when providing opioids for cancer pain relief. The majority of people with cancer are unlikely to misuse or divert opioid medications, yet the prescriber is often unaware of those who are at risk for these behaviors. To provide skillful pain management to each patient in the oncology setting, while limiting harm to the community, all prescribers must consider the potential for risk of misuse, addiction, or diversion. To minimize this risk to the greatest degree possible, it is imperative to include a thorough risk assessment when conducting a comprehensive pain evaluation. This information is then used to triage pain relief interventions based upon the degree of risk, including whether or not to incorporate opioids into the plan of care. Risk mitigation strategies, incorporating universal precautions, are implemented to assess, monitor, and reduce the potential for opioid misuse. Universal precautions include strategies such as the use of urine toxicology, state prescription drug monitoring programs, and agreements. Ongoing monitoring is conducted with the goal being to identify aberrant behaviors early so that they can be addressed and managed appropriately. Referral to addiction specialists may be warranted when substance use disorder precludes safe use of opioids. Implications for Practice Throughout the trajectory of cancer care, opioid use is often indicated, and, in fact, it may be unethical to limit or prohibit the use of opioids when pain is severe. Oncologists face the significant challenge of providing cancer pain control that is safe and effective, while limiting individual risk for abuse or overdose and keeping the community free of diverted substances. Most oncology providers report inadequate training in chronic pain principles and in managing addiction. Risk assessment and mitigation measures can be incorporated within oncology care to enhance effective pain management while reducing the potential for harm.

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Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department

Abstract: Many cancer patients presenting to the ED improperly and unsafely store, use, or dispose of opioids, thus highlighting a need to investigate the impact of patient education on such practices.

Cited by 38 publications

References 26 publications

Cancer pain management and the opioid crisis in America: How to preserve hard‐earned gains in improving the quality of cancer pain management

Cancer pain management and the opioid crisis in America: How to preserve hard‐earned gains in improving the quality of cancer pain management

Proper Drug Disposal: Studying a Solution to Household Prescription and Over-the- Counter Drug Abuse

Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy

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