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Many Surgical Opioid Drugs Go Unused, Not Disposed

Pills in blister packs

(PublicDomainPictures, Pixabay)

3 August 2017. A review of studies that track the use and disposition of opioid pain drugs following surgery shows a large percentage of the pills go unused and few are stored properly. The findings appear in a report by researchers at Johns Hopkins University in Baltimore published in yesterday’s issue of the journal JAMA Surgery (paid subscription required).

The team led by Mark Bicket, professor of anesthesiology and critical care medicine, sought to better track the disposition of opioid pain medications prescribed to patients following surgery. The ongoing problem of opioid addiction is intertwined with relief and management of pain, for which opioid drugs are usually prescribed. Opioids work by reducing the intensity of pain signals to the brain, particularly regions of the brain controlling emotion, which reduces effects of the pain stimulus.

The scale of the opioid abuse problem is huge. As of 2015, some 2 million Americans age 12 and older are addicted prescription opioid drugs, while 600,000 are addicted to heroin. Drug overdose, mainly by opioids, is now the leading cause of death from unintentional injury in the U.S. Today, about 90 Americans die each day from opioid overdoses.

Bicket and colleagues reviewed 3 medical databases for research on opioid prescriptions following surgery, which also describe the extent to which patients took their pain drugs and the disposition of those drugs. The database review turned up 6 published studies meeting those criteria with a total of 810 patients who had seven types of surgical procedures. Some 30 patients were women giving birth through Cesarean section and about two-thirds (65%) of the surgeries were outpatient procedures.

The researchers found patients in the vast majority of cases did not use all of their pain pills. From two-thirds (67%) to 92 percent of patients in the studies reported leftover pills from their opioid prescriptions. Of the pills prescribed to patients, between 4 and 7 in 10 (42% to 72%) remained unused. The patients largely attribute the unused pills to achieving satisfactory pain relief, but up to 3 in 10 (29%) patients also reported adverse side effects as the reason for not taking the drugs.

The results also show few patients took adequate steps to store or dispose of the drugs in ways that prevent diversion into non-medical uses. Two of the studies reported on storage methods for drugs, showing about three-quarters of patients (73% to 77%) did not store their pills in locked containers.

Five of the papers discussed disposal practices, and in those studies no more than 30 percent of patients disposed of their drugs, or planned to do so. In addition, no more than 9 percent used procedures recommended by FDA to dispose of their drugs, such as taking them back to a pharmacy.

Bicket notes that despite the lack of iron-clad ways to verify pain levels or determine them in advance, the results suggest doctors can probably prescribe fewer pain drugs in many cases. “Perhaps there are some characteristics in a patient,” says Bicket, “such as whether he or she is on opioids before the surgery or has certain genetic markers, that can let me determine that one needs more pain medication than another.” His team is conducting further research into patients’ pain experiences to find better ways of calibrating prescriptions to their precise needs.

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