Mark C Bicket1, Jane J Long1, Peter J Pronovost1,2, G Caleb Alexander2,3, Christopher L Wu1. 1. Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 3. Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
IMPORTANCE: Prescription opioid analgesics play an important role in the treatment of postoperative pain; however, unused opioids may be diverted for nonmedical use and contribute to opioid-related injuries and deaths. OBJECTIVE: To quantify how commonly postoperative prescription opioids are unused, why they remain unused, and what practices are followed regarding their storage and disposal. EVIDENCE REVIEW: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from database inception to October 18, 2016, for studies describing opioid oversupply for adults after a surgical procedure. The primary outcome-opioid oversupply-was defined as the number of patients with either filled but unused opioid prescriptions or unfilled opioid prescriptions. Two reviewers independently screened studies for inclusion, extracted data, and assessed the study quality. FINDINGS: Six eligible studies reported on a total of 810 unique patients (range, 30-250 patients) who underwent 7 different types of surgical procedures. Across the 6 studies, 67% to 92% of patients reported unused opioids. Of all the opioid tablets obtained by surgical patients, 42% to 71% went unused. Most patients stopped or used no opioids owing to adequate pain control, and 16% to 29% of patients reported opioid-induced adverse effects. In 2 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, but no study reported US Food and Drug Administration-recommended disposal methods in more than 9% of patients. CONCLUSIONS AND RELEVANCE: Postoperative prescription opioids often go unused, unlocked, and undisposed, suggesting an important reservoir of opioids contributing to nonmedical use of these products, which could cause injuries or even deaths.
IMPORTANCE: Prescription opioid analgesics play an important role in the treatment of postoperative pain; however, unused opioids may be diverted for nonmedical use and contribute to opioid-related injuries and deaths. OBJECTIVE: To quantify how commonly postoperative prescription opioids are unused, why they remain unused, and what practices are followed regarding their storage and disposal. EVIDENCE REVIEW: MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from database inception to October 18, 2016, for studies describing opioid oversupply for adults after a surgical procedure. The primary outcome-opioid oversupply-was defined as the number of patients with either filled but unused opioid prescriptions or unfilled opioid prescriptions. Two reviewers independently screened studies for inclusion, extracted data, and assessed the study quality. FINDINGS: Six eligible studies reported on a total of 810 unique patients (range, 30-250 patients) who underwent 7 different types of surgical procedures. Across the 6 studies, 67% to 92% of patients reported unused opioids. Of all the opioid tablets obtained by surgical patients, 42% to 71% went unused. Most patients stopped or used no opioids owing to adequate pain control, and 16% to 29% of patients reported opioid-induced adverse effects. In 2 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, but no study reported US Food and Drug Administration-recommended disposal methods in more than 9% of patients. CONCLUSIONS AND RELEVANCE: Postoperative prescription opioids often go unused, unlocked, and undisposed, suggesting an important reservoir of opioids contributing to nonmedical use of these products, which could cause injuries or even deaths.
Authors: Sean Esteban McCabe; Brady T West; James A Cranford; Paula Ross-Durow; Amy Young; Christian J Teter; Carol J Boyd Journal: Arch Pediatr Adolesc Med Date: 2011-08
Authors: J Thomazeau; A Rouquette; V Martinez; C Rabuel; N Prince; J L Laplanche; R Nizard; J F Bergmann; S Perrot; C Lloret-Linares Journal: Eur J Pain Date: 2015-10-30 Impact factor: 3.931
Authors: Raúl Herzog; María José Álvarez-Pasquin; Camino Díaz; José Luis Del Barrio; José Manuel Estrada; Ángel Gil Journal: BMC Public Health Date: 2013-02-19 Impact factor: 3.295
Authors: Tracy-Ann Moo; Kate R Pawloski; Varadan Sevilimedu; Jillian Charyn; Brett A Simon; Lisa M Sclafani; George Plitas; Andrea V Barrio; Laurie J Kirstein; Kimberly J Van Zee; Monica Morrow Journal: Ann Surg Oncol Date: 2020-07-30 Impact factor: 5.344
Authors: Sara J Hyland; Kara K Brockhaus; William R Vincent; Nicole Z Spence; Michelle M Lucki; Michael J Howkins; Robert K Cleary Journal: Healthcare (Basel) Date: 2021-03-16
Authors: Margaret E Smith; Jay S Lee; Aaron Bonham; Oliver A Varban; Jonathan F Finks; Arthur M Carlin; Amir A Ghaferi Journal: Surg Endosc Date: 2018-10-23 Impact factor: 4.584
Authors: Joe Habbouche; Jay Lee; Rena Steiger; James M Dupree; Caitlin Khalsa; Michael Englesbe; Chad Brummett; Jennifer Waljee Journal: JAMA Surg Date: 2018-12-01 Impact factor: 14.766