The potential for diversion of prescribed opioids among orthopaedic patients: Results of an anonymous patient survey

Abstract

Introduction Diversion of prescription opioid medication is a contributor to the opioid epidemic. Safe handling practices can reduce the risk of diversion. We aimed to understand: 1) if orthopaedic patients received instructions on how to safely handle opioids, 2) their typical storage/disposal practices, and 3) their willingness to participate in an opioid disposal program (ODP). Methods Cross-sectional study of adult orthopaedic patients who completed an anonymous survey on current or past prescription opioid use, instruction on handling, storage and disposal practices, presence of children in the household, and willingness to participate in an ODP. Frequencies and percentages of responses were computed, both overall and stratified by possession of unused opioids. Results 569 respondents who reported either current or past prescription opioid use were analyzed. 44% reported receiving storage instructions and 56% reported receiving disposal instructions from a health care provider. Many respondents indicated unsafe handling practices: possessing unused opioids (34%), using unsafe storage methods (90%), and using unsafe disposal methods (34%). Respondents with unused opioids were less likely to report receiving handling instructions or using safe handling methods, and 47% of this group reported having minors or young adults in the household. Respondents who received storage and disposal instructions were more likely to report safe storage and disposal methods. Seventy-four percent of respondents reported that they would participate in an ODP. Conclusion While many orthopaedic patients report inadequate education on safe opioid handling and using unsafe handling practices, findings suggest targeted education is associated with better behaviours. However, patients are willing to safely dispose of unused medication if provided a convenient option. These findings suggest a need to address patient knowledge and behavior regarding opioid handling to reduce the risk of opioid diversion.

The impact of the Florida law HB21 on opioid prescribing patterns after spine surgery

“…Studies have also shown that patients do not receive adequate education in regards to opioids. Sundararajan et al [ 28 ] surveyed 569 patients who received an opioid script and found that just 44% received storage instructions, just 56% received disposal instructions, and a high percentage reported having unused opioids that were not properly disposed of. These numbers indicate a need for improved provider and patient education with regards to opioid medications.…”

Time trends and patterns in opioid prescription use following orthopaedic surgery in Ontario, Canada, from 2004/2005 to 2017/2018: a population-based study

“…However, opioids are associated with potential harms, including risks of long-term use, negative surgical outcomes and potential diversion. [17][18][19][20][21] US and Canadian studies have reported that about 10% of patients undergoing surgery are persistent opioid users within 1 year of surgery 18 22 and that surgical patients generally use less opioids than prescribed, with the potential for diversion for non-medical use. 23 Recognising these potential harms, initiatives and interventions to address the opioid crisis have mainly focused on regulatory changes for prescription opioids for chronic pain, with less clear guidelines/recommendations for postoperative opioid therapy.…”

Evidence-Based Orthopaedic Post-Operative Opioid Prescribing Recommendations Following Shoulder Surgery

“…47,48 Additionally, patients should be educated on safe storage and disposal practices to avoid potential narcotic diversion and abuse. 49 Finally, a key component of preoperative counseling is setting reasonable patient expectations regarding analgesia. While we strive to provide the safest and most effective pain management strategies, pain is a "normal" aspect of recovery from shoulder surgery.…”