Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery

Abstract

IntroductionOpioid-based analgesic therapy represents a cornerstone of pain management after surgery. The recent rise in opioid sales and opioid overdoses suggests it is important to maximize the safety of opioid prescribing after surgery. Given that patients may live with other family members in the home, safe storage and appropriate disposal of excess opioids after hospital discharge are necessary to prevent unintended secondary exposures. Identifying characteristics of patients who are likely to be prescribed excess opioids after surgery may enable more targeted prescription practices and safety interventions. Our study aimed to elucidate patient-reported opioid use patterns and modes of home storage of opioids among patients discharged home after Cesarean section (C-section) and thoracic surgery. Specifically, we sought to identify characteristics of patients who reported using about half or more versus less of the opioids prescribed to them for use after hospital discharge.MethodsFor this cohort study, we developed a survey on quality of analgesia following hospital discharge, amounts of opioids taken relative to the amount prescribed, reasons for not taking all prescribed medications, and storage and disposal methods for leftover opioids. Adult patients, who had C-section or thoracic surgery at a tertiary academic medical center, were given a web-based self-administered survey after discharge. Descriptive statistics (means and standard deviations, proportions) were used to describe the study sample and survey results. Comparisons between patients who reported taking about half or more versus less of the opioids prescribed to them for use after hospital discharge were made using unpaired t-tests, Mann-Whitney tests, and Chi-square tests as appropriate.ResultsThe majority (53%) of respondents after C-section (N = 30) reported taking either no or very few (less than 5) prescribed opioid pills; 83% reported taking half or less; and 17% of women, reported taking all or nearly all (5 or fewer pills left over) of their opioid prescription. In a cohort of patients after thoracic surgery (n = 31) 45% reported taking either no or very few (5 or less) prescribed opioid pills; 71% reported taking half or less; and 29% of patients reported taking all or nearly all (5 or fewer pills left over) of their opioid prescription. In both cohorts, use of opioids while hospitalized was higher in the group reporting using about half or more of prescribed opioids after discharge. Leftover opioids were stored in an unlocked location in 77% and 73% of cases following C-section and thoracic surgery, respectively.ConclusionOur findings from surveys in two distinct patient populations at a single academic medical center suggest that current opioid prescribing practices for pain management at hospital discharge following Cesarean section and thoracic surgery may not account for individual patients’ analgesic requirements. Excess opioid pills are commonly stored in unsecured locations and represent a potential source for non-medical opioi...

Opioid use following gynecologic and pelvic reconstructive surgery

“…Bates et al, surveyed adult patients who underwent surgery in a urology practice and showed that only 58.0% of the prescribed pain medication was used and 67.0% of participants had excess medication [5] . In a cohort study by Bartels and colleagues, 53.0% of participants reported taking fewer than five opioid tablets following a cesarean delivery and 45.0% reported the same following thoracic surgery [9]. Based on these studies and our own findings, surgeons in a variety of specialties appear to be overprescribing opioid analgesia, leading to an excess of medication in the home.…”

Prescription Opioid Analgesics Commonly Unused After Surgery

“…10–15 Among the prospective studies considered for this review, we identified duplicate reports for one study 15, 16 and excluded three others 17–19 because of an inability to distinguish surgical from non-surgical reports of unused opioid medications.…”

“…Only one study examined patients’ concern about addiction, with 8% of thoracic surgery patients avoiding opioids for this reason. 10 …”

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

“…37 A study including thoracic and gynecologic surgery patients showed that 83 percent had leftover opioid medication and 71 to 73 percent stored the leftovers unsafely. 38 This unsafe handling of opioids is not unique to surgical patients—a large proportion of oncology patients 39 and those receiving opioids in the emergency room 40 did not dispose of or store their medications properly. Because most people with prescription opioid use disorder get them from friends and family, it is reasonable to conclude that our postoperative analgesia prescription practices are making a significant contribution to the supply of illicit opioids.…”