Prescription Opioid Analgesics Commonly Unused After Surgery

Abstract

Importance Prescription opioids play an important role in the treatment of post-operative pain, yet unused opioids may be diverted for non-medical use and contribute to opioid-related injuries and deaths. Objective To quantify how commonly post-operative opioids are unused, why they remain unused, and practices regarding their storage and disposal after surgery. Evidence Review We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from inception to 18 October 2016 for studies describing opioid over-supply for adults after any surgery or procedure. We defined our primary outcome, opioid over-supply, as the number of patients with either filled prescriptions with unused opioids or unfilled opioid prescriptions. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality. Findings Six eligible studies reported on a total of 810 patients (range 30–250) undergoing seven different procedure types. Across the six studies, between two-thirds (67%) to nine-tenths (92%) of patients reported unused opioids. Among opioids obtained by surgical patients, 42% to 71% of all tablets went unused. A majority of patients stopped or used no opioids due to adequate pain control, while 16% to 29% of patients reported opioid-induced side effects. In two studies examining storage safety, 73% to 77% of patients reported that their prescription opioids were not stored in locked containers. All studies reported low rates of anticipated or actual disposal, while no study reported FDA-recommended disposal methods in more than 9% of patients. Conclusions & Relevance Post-operative prescription opioids often go unused, unlocked, and undisposed, suggesting an important reservoir of opioids contributing to non-medical use of these products.

Postoperative pain and analgesic requirements after septoplasty and rhinoplasty

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Role of regional anesthesia and analgesia in the opioid epidemic

“…A colorectal ERP intervention which included epidural analgesia resulted in an increase in the use of opioid-free anesthesia and multimodal analgesia but did not decrease discharge opioid prescriptions 27. It is well recognized that opioid over-prescription occurs regularly after surgery among almost all surgical specialties and opioids are not regularly prescribed in a patient-specific manner to postoperative patients28–30 and up to 71% of these opioid pills go unused 30. Though the use of regional techniques may reduce perioperative opioid use, it cannot be utilized in isolation.…”

Perioperative Esmolol and Opioids

“…A recent study in ERAS for colorectal surgery showed that despite a reduction in inpatient postoperative opioids as a result of consistent compliance with multimodal and regional analgesia, patients were just as likely to be prescribed opioids at hospital discharge. 18 These findings, described by others as well, were primarily attributed to systems-level failures in time-of-discharge communication, prescription practices, 4,19 and patient follow-up coordination.…”