Unused opioid analgesics and drug disposal following outpatient dental surgery: A randomized controlled trial

Maughan, Brandon C.; Hersh, Elliot V.; Shofer, Frances S.; Wanner, Kathryn J.; Archer, Elizabeth; Carrasco, Lee; Rhodes, Karin V.

doi:10.1016/j.drugalcdep.2016.08.016

Cited by 183 publications

(137 citation statements)

References 37 publications

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“…34 A study of urology patients showed that 92 percent of patients received no instructions on how to dispose of leftover opioids after surgery, 67 percent had leftover opioids, and 91 percent of the patients with leftovers went on to keep them in an unlocked medicine cabinet. 35 Similar results were found with oral surgery 36 and pediatric surgery. 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.…”

Section: Opioid Risk and Surgerysupporting

confidence: 74%

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

Demsey

Carr

Clarke

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Summary Opioid addiction is a public health crisis that affects all areas of medicine. Large numbers of the population across all racial and economic demographics misuse prescription opioids and use illicit opioids. The current understanding is that opioid misuse is a disease that requires treatment, and is not an issue of choice or character. Use of opioid medication is a necessary part of postoperative analgesia, but many physicians are unsure of how to do this safely given the risk of patients developing an opioid misuse disorder. This review gives an update of the current state of the opioid crisis, explains how current surgeons prescribing practices are contributing to it, and gives recommendations on how to use opioid medication safely in the perioperative period.

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Section: Opioid Risk and Surgerysupporting

confidence: 74%

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

Demsey

Carr

Clarke

et al. 2017

Plastic &Amp; Reconstructive Surgery

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“…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.…”

Section: Resultsmentioning

confidence: 99%

Prescription Opioid Analgesics Commonly Unused After Surgery

et al. 2017

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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.

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“…The point at which most of our patients completely stopped taking opioid analgesics following fracture—96 hours—is far shorter than the week-long duration of opioid analgesia for the management of acute pain often prescribed by physicians. 5,6 In addition, we observed that the majority of participants, whether they had operative and non-operative fractures, tapered (increasing the length of intervals in their dosing schedule) the dose of opioid analgesic. These findings therefore may be used to improve the precision with which physicians prescribe opioids.…”

Section: Discussionmentioning

confidence: 80%

“…23 Our data regarding actual opioid utilization is consistent with other studies demonstrating that physicians significantly overprescribe opioids in response to acute pain. 1,5,28 …”

Section: Discussionmentioning

confidence: 99%

Oxycodone Ingestion Patterns in Acute Fracture Pain With Digital Pills

Chai

Carreiro

Innes

et al. 2017

Anesthesia &Amp; Analgesia

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BACKGROUND Opioid analgesics are commonly prescribed on an as needed (PRN) basis for acute painful conditions. Uncertainty of how patients actually take PRN opioids, coupled with a desire to completely cover pain, leads to variable and overly generous opioid prescribing practices, resulting in a surplus of opioids. This opioid surplus becomes a source for diversion and nonmedical opioid use. Understanding patterns of actual opioid ingestion after acute painful conditions can help clinicians counsel patients on safe opioid use, and allow timely recognition and intervention when escalating opioid self-dosing occurs, to prevent tolerance and addiction. METHODS We used a novel oxycodone digital pill system (ingestible biosensor within a standard gelatin capsule combined with 5mg oxycodone) that when ingested, is activated by the chloride ion gradient in the stomach thereby emitting a radiofrequency signal captured by a wearable Reader. The Reader relays ingestion data to a cloud-based server that displays ingestion events to the study team. We deployed the oxycodone digital pill among opioid naïve individuals discharged from the emergency department (ED) with acute fracture pain. Participants were trained on digital pill operation and discharged with 21 5mg oxycodone digital pills. They were instructed to take digital pills PRN for pain upon discharge. We conducted a brief interview 7 days after study enrollment, at which point participants returned the digital pill system. We identified oxycodone ingestion events in real time by data from the digital pill system, and performed pill counts at return visit to validate digital pill reporting of medication ingestion. RESULTS In this study, 26 individuals were approached; 16 enrolled with 15 completing the study. Participants ingested a median of 6 (3–9.5) oxycodone digital pills over the course of 7 days, with 82% of the oxycodone dose ingested in the first 3 days. In individuals who required operative repair, 86% (N=6) continued to ingest opioids at 1 week. There was substantial variability in ingestion patterns between individuals. CONCLUSIONS The utilization patterns of individuals with acute fracture pain could be captured using a digital pill system and revealed a median opioid ingestion of 45mg morphine equivalents for acute pain over 7 days. Seven participants ceased using opioids within 4 days following discharge from the emergency department, although operative repair was associated with longer use. This digital pill system was able to measure changes in and patterns of opioid self-dosing, which varied between patients.

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Unused opioid analgesics and drug disposal following outpatient dental surgery: A randomized controlled trial

Cited by 183 publications

References 37 publications

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

Prescription Opioid Analgesics Commonly Unused After Surgery

Oxycodone Ingestion Patterns in Acute Fracture Pain With Digital Pills

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