Home Disposal Kits for Leftover Opioid Medications After Surgery: Do They Work?

Stokes, Sean M.; Kim, Rebecca Y.; Jacobs, A.; Esplin, Jordan; Kwok, Alvin C.; Varghese, Thomas K.; Glasgow, Robert E.; Brooke, Benjamin S.; Finlayson, Samuel R.G.; Huang, Lyen C.

doi:10.1016/j.jss.2019.07.034

Cited by 34 publications

(64 citation statements)

References 22 publications

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“…Baseline disposal rates of surplus opioids are relatively low. The use of an opioid disposal kit or bag appears to consistently increase the rate of safe opioid disposal across multiple studies [6,23,34]. While some studies suggest that patient education on proper disposal of excess opioids alone increases the rate of disposal [17,18,28], other studies suggest that patient education alone may not significantly improve these rates [6,7,20,32].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have shown that providing a drug disposal bag consistently increases the rate of proper disposal postoperatively compared with education alone [6,23,34]. These products contain compounds that irreversibly bind to medications, thereby deactivating them and preventing the possibility of retrieval and diversion [23].…”

Section: Discussionmentioning

confidence: 99%

“…Among studies with no intervention, the rate of opioid disposal was 4.9% to 46.5% [1,2,4,9,11,16,29]. There was an intervention group in 9 (56%) studies, with rate of opioid disposal ranging from 22% to 87% [6,7,17,18,20,23,28,32,34]. In 3 studies, the intervention was an opioid disposal kit or bag [6,23,34].…”

Section: Opioid Disposal Ratesmentioning

confidence: 99%

“…There was an intervention group in 9 (56%) studies, with rate of opioid disposal ranging from 22% to 87% [6,7,17,18,20,23,28,32,34]. In 3 studies, the intervention was an opioid disposal kit or bag [6,23,34]. In 7 studies, the intervention was instruction/education on proper opioid disposal [6,7,17,18,20,28,32].…”

Section: Opioid Disposal Ratesmentioning

confidence: 99%

“…Of the 3 studies that used an opioid disposal kit or bag, each demonstrated a significant increase in opioid disposal when compared with the non-intervention group [6,23,34]. Brummett et al [6] randomized patients undergoing any outpatient surgery to usual care, to receive an educational pamphlet with detailed instructions for locating Drug Enforcement Administration (DEA)-registered disposal locations or to an activated charcoal bag for opioid deactivation, finding a significantly higher rate of disposal among those receiving an activated charcoal bag compared with usual care or an educational pamphlet (57.1% vs 28.6% and 33.3%, respectively; P = .001).…”

Section: Opioid Disposal Kitsmentioning

confidence: 99%

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Postoperative Disposal of Unused Opioids: A Systematic Review

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Premkumar

James

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Introduction: Opioid misuse and overprescription have contributed to a national public health crisis in the United States. Postoperatively, patients are often left with unused opioids, which pose a risk for diversion if not appropriately disposed of. Patients are infrequently provided instructions on safe disposal methods of surplus opioids. Purpose: We sought to determine the current rates of disposal of unused opioids and the reported disposal mechanisms for unused opioids that were prescribed for acute postoperative pain control. Methods: A systematic review was performed of the PubMed, Cochrane, and Embase databases for relevant articles from their earliest entries through October 2, 2019. We used the search terms “opioid” or “narcotic” and “disposal” and “surgery.” Studies were considered for inclusion if they reported the rate of disposal of unused opioids following surgery. A screening strategy was used to identify relevant articles using Covidence. For studies meeting inclusion criteria, relevant information was extracted. Results: Sixteen studies met inclusion criteria. We found that surplus opioid disposal rates varied widely, from 4.9% to 87.0%. Among studies with no intervention (opioid disposal education or drug disposal kit/bag), rates of opioid disposal ranged from 4.9% to 46.5%. While 7 studies used opioid disposal education as an intervention, only 3 showed a significant increase in surplus opioid disposal compared with standard care. All 3 studies that used an opioid disposal kit or bag as an intervention demonstrated significant increases in opioid disposal. Conclusions: Baseline rates of surplus opioid disposal are relatively low in the postoperative setting. Our findings suggest that opioid disposal kits significantly increase rates of surplus opioid disposal postoperatively. Further research, including a large-scale cost-benefit analysis, will be necessary prior to recommending widespread implementation of drug disposal kits or bags.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Opioid Disposal Ratesmentioning

confidence: 99%

Section: Opioid Disposal Ratesmentioning

confidence: 99%

Section: Opioid Disposal Kitsmentioning

confidence: 99%

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Postoperative Disposal of Unused Opioids: A Systematic Review

Lamplot

Premkumar

James

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Efficacy of a password‐protected, pill‐dispensing device with mail return capacity to enhance disposal of unused opioids after cancer surgery

Cogan

Accordino

Beauchemin

et al. 2022

Cancer

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Background Opioid misuse is a public health crisis, and unused postoperative opioids are an important source. Although 70% of pills prescribed go unused, only 9% are discarded. This study evaluated whether an inexpensive pill‐dispensing device with mail return capacity could enhance disposal of unused opioids after cancer surgery. Methods A prospective pilot study was conducted among adult patients who underwent major cancer‐related surgery. Patients received opioid prescriptions in a mechanical device (Addinex) linked to a smartphone application (app). The app provided passwords on a prescriber‐defined schedule. Patients could enter a password into the device and receive a pill if the prescribed time had elapsed. Patients were instructed to return the device and any unused pills in a disposal mailer. The primary end point was feasibility of device return, defined as ≥50% of patients returning the device within 6 weeks of surgery. Also explored was total pill use and return as well as patient satisfaction. Results Among 30 patients enrolled, the majority (n = 24, 80%) returned the device, and 17 (57%) returned it within 6 weeks of surgery. In total, 567 opioid pills were prescribed and 170 (30%) were used. Of 397 excess pills, 332 (84% of unused pills, 59% of all pills prescribed) were disposed of by mail. Among 19 patients who obtained opioids from the device, most (n = 14, 74%) felt the benefits of the device justified the added steps involved. Conclusions Use of an inexpensive pill‐dispensing device with mail return capacity is a feasible strategy to enhance disposal of unused postoperative opioids.

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