Opioid Medication Disposal Among Patients Following Hand Surgery

Background: Despite increased public awareness to dispose of unused narcotics, opioids prescribed postoperatively are retained, which may lead to drug diversion and abuse. This study assessed retention of unused opioids among hand surgery patients and describes disposal methods and barriers. Methods: Participants undergoing hand surgery were given an opioid disposal information sheet preoperatively (N = 222) and surveyed postoperatively to assess disposal or retention of unused opioids, disposal methods, and barriers to disposal. A binomial logistic regression was conducted to assess whether age, sex, pain intensity, and/or the type of procedure were predictors of opioid disposal. Results: There were 171 patients included in the analysis (n = 51 excluded; finished prescription or continued opioid use for pain control). Unused opioids were retained by 134 patients (78%) and disposal was reported by 37 patients (22%). Common disposal methods included returning opioids to a pharmacy (49%) or mixing them with an unwanted substance (24%). Reasons for retention included potential future use (54%), inconvenient disposal methods (21%), or keeping an unfilled prescription (9%). None of the patient factors analyzed (age, sex, type of procedure performed, or pain score) were predictors of disposal of unused narcotics ( P > .05). Conclusions: Most patients undergoing hand surgery retained prescribed opioids for future use or due to impractical disposal methods. The most common disposal methods included returning narcotics to a pharmacy or mixing opioids with unwanted substances. Identifying predictors of disposal may provide important information when developing strategies to increase opioid disposal.

Review on Drug Waste Management

Drug waste management is the alarming issue nowadays so provide more awareness from healthcare professionals and drug receiver. The pharmacist are in the admirable position to aware people about safe medication disposal. The safe medication disposal awareness in society leads to the sufficient good differences in public health and surroundings. the knowledge of the safe drug disposal is equally important that consumption of the medicines. The easiest solution to the drug pollution is to disposal of medicines properly. The aim of this review is the government have to maintain the drug disposal methods on the label of drugs and dosage forms. The collection of the drug is easier and they can authorize the collection in the take back program. The Indian government have to authorized the drug collection sites and registered business or various authorization for the collection of the drug safely, they also have to organize the various types of events like drug take back awareness events, awareness programs on the need of proper drug disposal and its conditions. The drug waste contains the expired and non-expired drugs.

The contribution of the clinical pharmacist in palliative care

Pharmacists are exceptionally positioned to deliver expert medication consultation and teaching, thus creating a specialized role within the palliative care team to optimize and rationalize medication use. The role pharmacists play varies among different palliative care practice settings; however, all pharmacists participate in providing pharmaceutical care. Activities of pharmacists can include identifying and resolving adverse drug-related problems, reconciling medication, developing medication guidelines, helping patients and families with medication disposal, and providing medication counselling as well as patient psychological support. Pharmacy organizations support pharmacists as key members of interdisciplinary care, and there is growing recognition of the value of their contribution. This chapter reviews the role of clinical pharmacists and is based mainly on the situation in the US with additional information from other parts of the world. It highlights the positive impact of pharmacy practice through improved symptom control, identifying, preventing, and resolving medication-related problems.

Engaging the opioid epidemic head on: Improving proper disposal of unused opioid medications after surgery

Background: Currently, in the United States, there is an epidemic of opioid abuse. While this problem is well known to the public due to significant media and political attention, patients are poorly educated on the proper handling and disposal of unused opioids. Instead, the onus has fallen on the healthcare provider to minimize the number of opioids prescribed.Study objective: To improve proper opioid disposal rates after gynecologic surgery by providing educational materials along with a disposal bag.Study design: We performed a prospective study evaluating baseline understanding of medication disposal using a questionnaire given to the patients during their preoperative visit. Subsequently, patients were provided written information on proper disposal of their medications and an activated charcoal medication disposal bag. Study patients completed a survey about disposal of their unused opioids at their last post-operative visit. The success of education and proper disposal of opioid medications were evaluated.Results: Thirty-five patients, average age of 45 (range 20-77), were enrolled, and 31 patients successfully completed both surveys. The surgeries performed included hysterectomy 23 percent (n = 7), laparoscopic excision of endometriosis 32 percent (n = 10), laparoscopic ovarian cystectomy 23 percent (n = 7), prolapse repair 3 percent (n = 1), and midurethral sling procedures 19 percent (n = 6). Chronic pelvic pain was identified in 39 percent (n = 12) of our patient population. Prior to education, 52 percent (n = 16) of patients did not dispose of their opioids. Furthermore, 71 percent (n = 22) of patients stated they had never been educated by a medical provider regarding appropriate disposal. Nineteen percent (n = 6) confirmed they have used an opioid medication prescribed to someone else. Demographic data show 65 percent (n = 20) of these patients had completed a college degree or greater. After education and being given a reliable option for medication disposal with the Deterra® bag, 94 percent (n = 29) of patients properly disposed of their opioids after surgery, demonstrating a 45 percent (p 0.001) increase in proper disposal. In our study alone, 491 tablets of 5mg oxycodone were properly disposed. The majority of patients, 77 percent (n = 24) used the drug disposal bag, and when queried, stated they would be willing to pay on average $7.70 (range 0-20) per bag. Without education and a simple option for disposal, 422 tablets prescribed may have been subject to inappropriate diversion.Conclusion: This study clearly shows that patient education, coupled with a reliable option for opioid disposal, is effective. We strongly encourage other surgical institutions to implement similar practices not only for our surgical patients’ safety, but also for the tens of thousands of patients who died of opioid abuse in the last year.

Community Pharmacists’ Practice, Awareness, and Beliefs about Drug Disposal in Saudi Arabia

The awareness among Saudi people regarding the good and safe practice of drug disposal is fairly low. Community pharmacists’ potential toward drugs disposal directions and practice are not emphasized enough. Therefore, a cross sectional study was conducted in Riyadh, Saudi Arabia, to evaluate the practice, awareness and beliefs of community pharmacists about disposal of unused drugs. Out of 360 subjects who participated in the study, more than 70% returned the unused drugs to the pharmaceutical distributors. Around 80% of the participants confirmed the risk of environmental damage due to the inappropriate disposal of drugs, and 87.5% of them held themselves responsible for preventing such risk. Approximately 85% of surveyed pharmacists believed community pharmacies to be an appropriate location for the collection of unused drugs. There was no significant association between the community pharmacists’ age group and years of practice as community pharmacists with either the awareness of unused medication disposal on environmental hazards, or the beliefs about the appropriate location for collecting unused drugs (p > 0.05). The awareness and proactive accountable responsibility, along with community pharmacists’ belief of appointing pharmacies to collect unused drugs, strongly support the institution of drug take-back programs.

ASSESSMENT ON KNOWLEDGE, ATTITUDE AND PRACTICE OF PATIENTS IN HOSPITAL TAPAH REGARDING DISPOSAL OF UNUSED AND EXPIRED MEDICINES

According to the World Health Organization (WHO), more than half of dispensed medications were inappropriately prescribed, which causes a build-up of unused medications and increasing medication disposal. The aim of this study is to assess the level of knowledge, attitude and current practice of patients in Hospital Tapah, Perak, Malaysia towards this issue. A cross-sectional study was conducted by using a self- administered questionnaire adapted from Su Lan et al. (2018). Patients aged more than 17 years old who visited outpatient pharmacy and who admitted into medical ward; the caregivers of children who admitted into paediatric ward, Hospital Tapah were enrolled in this study, selected through convenience sampling. Logistic regression analysis was performed to determine significant association between independent and dependent parameters. The significance level was set at p < 0.1. Total of 344 valid questionnaires were returned in which 34.9% (n = 120) men and 65.1% (n = 224) women participated. The majority of the participants has general knowledge of the correct way of disposing medicines. Although 57.3% of the participants have heard about ‘Return Your Medicines Programme’ (RMP) implemented by the Ministry of Health Malaysia, only 38.1% returned their unused or expired medication to the nearby hospital/clinic. Most of them were found to have a positive attitude regarding this issue, nevertheless only 24.7% practiced a proper medication disposal. The utilisation of RMP could be improved by increasing the awareness of safe medication disposal, as significant association has been found between the level of knowledge and attitude with current disposal practice of patients in Hospital Tapah.

Lack of Awareness of the Impact of Improperly Disposed Of Medications and Associated Factors: A Cross-Sectional Survey in Indonesian Households

Introduction: Disposal of unused medications through environmentally unsafe routes is common in Indonesia. The lack of awareness of the impact of improperly disposed of medications is a significant contributing factor. The objectives of this study were to identify factors associated with lack of awareness of the impact of improperly disposed of unused medications and to assess the associations of awareness with medication disposal practices among the general population in Indonesia.Patients and methods: An observational cross-sectional survey was conducted using nonprobability sampling in Bandung, Indonesia, from November 2017 to January 2018 among respondents who were older than 18 years, had used any medication in the past, were literate, and had signed an informed consent document. Disposal practices and awareness regarding the impact of improperly disposed of unused medications were collected using an online- and a paper-based pre-validated questionnaire. The paper-based questionnaires were distributed to respondents in public places such as city center, markets, and religious places. Binary logistic regression was performed to assess associations of sociodemographic and other related factors with a lack of awareness. Odds ratios (ORs) with 95% confidence intervals (CIs) are reported.Results: Of 497 participating respondents, 433 and 64 respondents filled an online- or a paper-based questionnaire, respectively. Most respondents were female, aged between 18 and 30 years, and students/university students. Of 497 respondents, more than half (53.1%) were not aware that improper medication disposal could harm the environment and population health. Most respondents (79.5%) had never received information about proper medication disposal practices. The education level, the number of stored medications at home, and previous education about medication disposal practices were significantly associated with awareness of proper practices. In the multivariate analysis, only those with previous education about medication disposal practices were less likely to report a lack of awareness (OR: 0.043; 95% CI: 0.02–0.09). Respondents with a lack of awareness tended to dispose of their unused medications in the garbage or shared them with friends or relatives.Conclusion: There is a clear need to increase awareness of the importance of proper medication disposal practices, in particular among the student population of Bandung city, Indonesia. Healthcare providers can play an important role by educating this specific population on the proper disposal of unused medications.