Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients

Garren, Brandon; Lawrence, Marley B; McNaull, Peggy; Sutherland, Richard W.; Bukowski, Timothy P.; Nielsen, Matthew E.; Woody, Nathan; McCall, Max; Ricketts, Karene; Chidgey, Brooke; Ross, Scott E.

doi:10.1016/j.jpurol.2019.02.009

Cited by 48 publications

(27 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…199,200,210 Data from other surgical subspecialties reveal that perioperative counseling on appropriate storage and disposal of opioids is surprisingly rare, occurring for only 8% to 22% of patients. 211,212 When patients are educated on opioid storage and disposal, they improve their practices. 213 Some states now require that clinicians provide such counseling whenever prescribing opioids.…”

Section: Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Anne¹,

Mims

Tunkel

et al. 2021

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

Objective Opioid use disorder (OUD), which includes the morbidity of dependence and mortality of overdose, has reached epidemic proportions in the United States. Overprescription of opioids can lead to chronic use and misuse, and unused narcotics after surgery can lead to their diversion. Research supports that most patients do not take all the prescribed opioids after surgery and that surgeons are the second largest prescribers of opioids in the United States. The introduction of opioids in those with OUD often begins with prescription opioids. Reducing the number of extra opioids available after surgery through smaller prescriptions, safe storage, and disposal should reduce the risk of opioid use disorder in otolaryngology patients and their families. Purpose The purpose of this specialty-specific guideline is to identify quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. Employing these action statements should reduce the variation in care across the specialty and improve postoperative pain control while reducing risk of OUD. The target patients for the guideline are any patients treated for anticipated or reported pain within the first 30 days after undergoing common otolaryngologic procedures. The target audience of the guideline is otolaryngologists who perform surgery and clinicians who manage pain after surgical procedures. Outcomes to be considered include whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan. The guideline addresses assessment of the patient for OUD risk factors, counseling on pain expectations, and identifying factors that can affect pain duration and/or severity. It also discusses the use of multimodal analgesia as first-line treatment and the responsible use of opioids. Last, safe disposal of unused opioids is discussed. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not a comprehensive guide on pain management in otolaryngologic procedures. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experiences and assessments of individual patients. Action Statements The guideline development group made strong recommendations for the following key action statements: (3A) prior to surgery, clinicians should identify risk factors for opioid use disorder when analgesia using opioids is anticipated; (6) clinicians should advocate for nonopioid medications as first-line management of pain after otolaryngologic surgery; (9) clinicians should recommend that patients (or their caregivers) store prescribed opioids securely and dispose of unused opioids through take-back programs or another accepted method. The guideline development group made recommendations for the following key action statements: (1) prior to surgery, clinicians should advise patients and others involved in the postoperative care about the expected duration and severity of pain; (2) prior to surgery, clinicians should gather information specific to the patient that modifies severity and/or duration of pain; (3B) in patients at risk for OUD, clinicians should evaluate the need to modify the analgesia plan; (4) clinicians should promote shared decision making by informing patients of the benefits and risks of postoperative pain treatments that include nonopioid analgesics, opioid analgesics, and nonpharmacologic interventions; (5) clinicians should develop a multimodal treatment plan for managing postoperative pain; (7) when treating postoperative pain with opioids, clinicians should limit therapy to the lowest effective dose and the shortest duration; (8A) clinicians should instruct patients and caregivers how to communicate if pain is not controlled or if medication side effects occur; (8B) clinicians should educate patients to stop opioids when pain is controlled with nonopioids and stop all analgesics when pain has resolved; (10) clinicians should inquire, within 30 days of surgery, whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan.

show abstract

Section: Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Anne¹,

Mims

Tunkel

et al. 2021

Otolaryngol.--head neck surg.

View full text Add to dashboard Cite

show abstract

“…Among all studies included, opioid disposal rate varied from 4.9% to 87%. 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].…”

Section: Resultsmentioning

confidence: 99%

“…While prescription handouts from pharmacies often do contain some information on safe drug disposal, patients are often unaware of or do not read these instructions [2]. One study in a pediatric population found that most guardians who did report disposal of surplus opioids were not familiar with proper disposal methods [16]. Studies in adult populations have reported that 75% of patients are unaware of proper opioid disposal methods [3,27].…”

Section: Discussionmentioning

confidence: 99%

“…In a prospective cohort study of patients undergoing inpatient orthopedic joint or spine surgery, Bicket et al [4] reported a high prevalence of patients with unused opioids and unsecure storage, with nearly 75% reporting unused opioids, most lacking knowledge of safe storage and disposal practices, and nearly all failing to safely dispose of unused pills. Together, these findings suggest that patient and caregiver education is inadequate, and their understanding of the potential consequences is insufficient [16].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Postoperative Disposal of Unused Opioids: A Systematic Review

Lamplot

Premkumar

James

et al. 2021

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

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.

show abstract

“…In general, opioid disposal rates are less than 10% in adult and pediatric patients with leftover opioid supply with no education or encouraged disposal. 2 , 7 , 8 , 9 Studies evaluating the impact on a specific intervention have yielded a wide variation in opioid disposal rates, ranging from 18% to 57%. 5 , 10 , 11 Differences in patient assessment design, patient population, and dispensed opioid quantities likely contribute to this variation.…”

Section: Discussionmentioning

confidence: 99%

Provision of a Drug Deactivation System for Unused Opioid Disposal at Surgical Dismissal

Ramel

Habermann

Thiels

et al. 2020

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

View full text Add to dashboard Cite

Objective: To determine the impact of a drug deactivation system to post-surgical patients on the rate of opioid prescription disposal. Patients and Methods: Two hundred post-operative patients discharged after inpatient surgery at a large academic medical center. This study was conducted August 20, 2018, through November 30, 2018. Patients were provided with a drug deactivation system (DDS) and instruction sheet along with their opioid prescription. Three to 4 weeks after dismissal, patients were surveyed about quantity of opioids remaining, use of DDS or other disposal methods, and satisfaction with DDS if used. Results: One hundred forty-nine of 200 (74.5%) patients were surveyed. One hundred six reported leftover opioids and 29 (27.3%) had disposed of these medications. By the time of survey, 23 (21.2%) participants with leftover opioids had used the DDS to destroy their remaining supply and an additional 33 (31.1%) participants reported plans to use the disposal bag on a future date. Of the 23 participants who used the DDS, 22 (96.0%) reported that they were very satisfied with the disposal process. Conclusion: Participants are willing to use a DDS and are satisfied with the process; however, additional education is needed to ensure timely disposal.

show abstract

Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients

Cited by 48 publications

References 23 publications

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Postoperative Disposal of Unused Opioids: A Systematic Review

Provision of a Drug Deactivation System for Unused Opioid Disposal at Surgical Dismissal

Contact Info

Product

Resources

About