Health Care

Prescription opioids often go unused after surgery

Prescription opioids often go unused after surgery”

Most patients don't use all of the pills in their opioid prescriptions, but they also don't often dispose of their leftovers properly, according to a new study.

"Unused opioids that have been prescribed for pain after surgery serve as an important reservoir for potential opioid misuse, and this very likely contributes to the ongoing opioid crisis", said Dr. Mark Bicket, a professor at Johns Hopkins University School of Medicine in Baltimore who led the research.

Bicket also noted that the research is not meant to encourage withholding opioids from people in pain, but instead to better understand patients' pain experiences in order to optimize opioid prescribing patterns after surgery. Instead of a one-size-fits-all approach, Bicket says, clinicians need to do a better job of personalizing prescriptions and dosing for each patient.

Surgeons have no guidelines for how much pain medication to dispense to patients when they leave the hospital, and there is no data or research to draw on for direction, Bicket said.

Researchers performed a systematic review and searched Medline, Embase and the Cochrane Center Register of Controlled Trials to identify studies that detailed opioid oversupply for adults following surgery.

Of the 2,419 studies screened, the research team identified six that met all eligibility criteria, with a combined total enrollment of 810 patients. Surgeries included operations on the skin, lungs, shoulder and hands, cesarean sections and dental work.

The CDC previous year released guidelines urging primary-care physicians to dramatically curtail prescribing opioids for chronic pain. Among those who had outpatient procedures, 77% to 92% had surplus opioids, the researchers found. "We have evidence that there are patients who legitimately need these medications, and sometimes pain after surgery has been undertreated". Moreover, 42 percent to 71 percent of the pills prescribed weren't taken, according to the patient reports.

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In an interview with MedPage Today, he expressed surprise at the high rates of unused opioids, noting that "at least two out of every three patients reported leftover pills, a finding that was consistently high even among different types of surgery". A majority of patients reported they stopped or used no opioids due to adequate pain control, while 16 to 29 percent of patients reported they stopped because of opioid-induced side effects, such as nausea, vomiting or constipation.

In two studies that looked at how unused painkillers were stored, 73 percent to 77 percent of the participants said their prescription opioids were not kept in locked containers, which is recommended by the U.S.

All studies reported low rates of anticipated or actual disposal, but none found that disposal methods recommended by the FDA occurred in more than 9% of patients. Additionally, data on usage and disposal was self-reported and the studies did not use pill counts to independently verify unused tablets.

Deutsch said, "We need to reflect on our practices".

For more on how to store and dispose of unused opioids, visit the American Academy of Family Physicians.

Bicket cautions that his research is not meant to encourage withholding opioids from people in pain, and says he and his team are conducting research to better understand patients' pain experiences in a bid to someday identify better ways to optimize the way in which opioid are prescribed after surgery.

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