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.

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Preoperative Opioid Use in Patients Undergoing Common Hand Surgeries

Hand ◽

10.1177/1558944720974122 ◽

2021 ◽

pp. 155894472097412

Author(s):

Ali Aneizi ◽

Dominique Gelmann ◽

Dominic J. Ventimiglia ◽

Patrick M. J. Sajak ◽

Vidushan Nadarajah ◽

...

Keyword(s):

Outcome Measures ◽

Hand Surgery ◽

Patient Characteristics ◽

Patient Reported Outcome Measures ◽

Pain Scale ◽

Patient Reported Outcome ◽

Measurement Information ◽

Opioid Use ◽

Patient Reported ◽

Opioid Users

Background: The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. Methods: Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. Results: After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. Conclusions: Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers.

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The Association between Implementation an Enhanced Recovery after Cesarean Pathway with Standardized Discharge Prescriptions and Opioid Use and Pain Experience after Cesarean Delivery

American Journal of Perinatology ◽

10.1055/s-0041-1732378 ◽

2021 ◽

Author(s):

Jennifer A. McCoy ◽

Sarah Gutman ◽

Rebecca F. Hamm ◽

Sindhu K. Srinivas

Keyword(s):

Cesarean Delivery ◽

Pain Control ◽

Enhanced Recovery ◽

Median Number ◽

Baseline Survey ◽

Quality Improvement Initiative ◽

Opioid Use ◽

Pain Scores ◽

Patient Reported ◽

Hospital Patients

Objective This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use. Study Design We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients' pain control and postoperative opioid use, both inpatient and postdischarge. Results Data were obtained from 152 women preimplementation (PRE) and 137 women post-implementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90–195] PRE to 114 [range: 45–168] POST (p = 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5–8] vs. POST 5 [range: 3–7], p < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16–30] vs. POST 17.5 [range: 4–25], p = 0.001). The number of pills consumed was significantly associated with number prescribed (p < 0.001). The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2–6] vs. POST 3[range: 1–5], p = 0.03). Conclusion Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients. Key Points

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A two-centre survey of caregiver perspectives on opioid use for children’s acute pain management

Paediatrics & Child Health ◽

10.1093/pch/pxz162 ◽

2019 ◽

Vol 26 (1) ◽

pp. 19-26

Author(s):

Esther Jun ◽

Samina Ali ◽

Maryna Yaskina ◽

Kathryn Dong ◽

Manasi Rajagopal ◽

...

Keyword(s):

Side Effects ◽

Willingness To Accept ◽

Moderate Pain ◽

Opioid Use ◽

Opioid Medication ◽

Electronic Survey ◽

Nonopioid Analgesics ◽

Ongoing Pain ◽

Past Experiences ◽

At Home

Abstract Background Given the current opioid crisis, caregivers have mounting fears regarding the use of opioid medication in their children. We aimed to determine caregivers’ a) willingness to accept, b) reasons for refusing, and c) past experiences with opioids. Methods A novel electronic survey of caregivers of children aged 4 to 16 years who had an acute musculoskeletal injury and presented to two Canadian paediatric emergency departments (ED) (March to November 2017). Primary outcome was caregiver willingness to accept opioids for moderate pain for their children. Results Five hundred and seventeen caregivers participated; mean age was 40.9 (SD 7.1) years with 70.0% (362/517) mothers. Children included 62.2% (321/516) males with a mean age of 10.0 (SD 3.6) years. 49.6% of caregivers (254/512) reported willingness to accept opioids for ongoing moderate pain in the ED, while 37.1% (190/512) were ‘unsure’; 33.2% (170/512) of caregivers would accept opioids for at-home use, but 45.5% (233/512) were ‘unsure’. Caregivers’ primary concerns were side effects, overdose, addiction, and masking of diagnosis. Caregiver fear of addiction (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.01 to 1.25) and side effects (OR 1.25, 95% CI 1.11 to 1.42) affected willingness to accept opioids in the emergency department; fears of addiction (OR 1.19, 95% CI 1.07 to 1.32), and overdose (OR 1.15, 95% CI 1.04 to 1.27) affected willingness to accept opioids for at-home use. Conclusions Only half of the caregivers would accept opioids for moderate pain, despite ongoing pain following nonopioid analgesics. Caregivers’ fears of addiction, side effects, overdose, and masking diagnosis may have influenced their responses. These findings are a first step in understanding caregiver analgesic decision making.

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An evaluation of opioid use during acute hospital admissions

Journal of Prescribing Practice ◽

10.12968/jprp.2022.4.1.24 ◽

2022 ◽

Vol 4 (1) ◽

pp. 24-31

Author(s):

Alison Blackburn

Keyword(s):

Acute Pain ◽

Hospital Admissions ◽

Hospital Setting ◽

Acute Hospital ◽

Opioid Use ◽

Opioid Medication ◽

Age Range ◽

The Impact ◽

Acute Hospital Setting

Long-term opioid use can begin with the treatment of acute pain. However, there is little evidence concerning the impact that better opioid awareness in the acute phase may have on reducing the use of opioids in the long term. This project explored which opioids are routinely prescribed within an acute hospital setting and how these opioids were used over the course of the hospital stay. Codeine and morphine remain the most commonly prescribed opioids. Opioids were prescribed and given to people across the age range, from 16 to 98 years. The project found that 19% of patients were admitted with a pre-existing opioid. Up to 66% of patients were discharged with opioid medication, with almost 20% leaving with more than one opioid. Regular opioid use routinely exposes patients to long-term opioid use and those patients initiated onto opioid medication during admission should have the benefit of planned de-escalation before discharge.

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Efficacy of a password-protected pill-dispensing device to enhance disposal of unused opioids after cancer surgery.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.264 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 264-264

Author(s):

Jacob Cogan ◽

Melissa Kate Accordino ◽

Melissa Parsons Beauchemin ◽

Sophie Ulene ◽

Elena B. Elkin ◽

...

Keyword(s):

Pain Control ◽

Cancer Surgery ◽

High Rate ◽

Smartphone App ◽

Opioid Use ◽

Structured Interviews ◽

Health Crisis ◽

Patient Reported ◽

After Cancer ◽

The Impact

264 Background: Opioid misuse is a public health crisis. Initial opioid exposures often occur post-operatively, and 10% of opioid-naïve patients who undergo cancer surgery subsequently become long-term opioid users. It has been shown that 70% of opioids prescribed post-operatively go unused, but only 9% of unused pills are disposed appropriately, which increases the risk of unintended use. We evaluated the impact of an inexpensive, password-protected dispensing device with mail return capacity on retrieval of unused pills after cancer surgery. Methods: Adult patients scheduled for major cancer-related surgery were eligible. Enrolled patients received opioid prescriptions in a password-protected, pill-dispensing device (Addinex) from a specialty pharmacy. The mechanical device links to a smartphone app, which provides passwords on a prescriber-defined schedule. Patients request a password when they are in pain, enter the password into the device and receive a pill if the prescribed time has elapsed. The smartphone app provides clinical guidance based on patient-reported pain levels, and suggests tapering strategies. Patients are instructed to return the device in a DEA-approved mailer when opioid use is no longer required for pain control. Unused pills are destroyed upon receipt. The primary objective was to determine the feasibility of device return, defined as > 50% of patients with device return. We also explored patterns of device use, patient reported outcomes, and device satisfaction via surveys and semi-structured interviews. Results: Between October, 2020 and April, 2021, 13 patients completed the study; 4 patients are currently enrolled. Among the initial 13 patients, 7 underwent abdominal hysterectomy, 4 underwent mastectomy and 2 underwent cutaneous tumor resections. The majority of these patients (n = 10, 77%) returned the device, and more than half (n = 7, 54%) returned the device within 6 weeks of surgery. Only a minority of patients (n = 5, 38%) used the device to obtain opioids; most (n = 8, 62%) used no opioids at home, and all of these patients returned the device and the unused pills. Of 11 patients who participated in semi-structured interviews, most (n = 7, 64%) said they felt safer having opioids in the device instead of a regular pill bottle. Among device users, the majority (n = 4, 80%) reported an overall positive experience. All non-users reported having no opioid requirement for pain control. Conclusions: Our early findings suggest that use of an inexpensive, password-protected, pill-dispensing device to assist with opioid dispensing and return is feasible, with a high rate of device and unused opioid return to the pharmacy. This strategy may be effective for reducing opioid diversion. Analyses and recruitment are ongoing to evaluate the benefits of reducing post-operative opioid consumption.

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New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures

Foot & Ankle International ◽

10.1177/1071100719851117 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1043-1051 ◽

Cited By ~ 5

Author(s):

Timothy D. Gossett ◽

Fred T. Finney ◽

Hsou Mei Hu ◽

Jennifer F. Waljee ◽

Chad M. Brummett ◽

...

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Ankle Fracture ◽

Opioid Use ◽

Patient Factors ◽

Distal Fibula ◽

Opioid Prescription ◽

Opioid Dose ◽

Closed Treatment ◽

Open Treatment

Background:The aim of this study was to define the rate of new persistent opioid use and risk factors for persistent opioid use after operative and nonoperative treatment of ankle fractures.Methods:Using a nationwide insurance claims database, Clinformatics DataMart Database, we identified opioid-naïve patients who underwent surgical treatment of unstable ankle fracture patterns between January 2009 and June 2016. Patients who underwent closed treatment of a distal fibula fracture served as a comparative group. We evaluated peritreatment and posttreatment opioid prescription fills. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after the procedure. Logistic regression was used to evaluate the effect of patient factors, and the differences of the effect were tested using Wald statistics. The adjusted persistent use rates were calculated. A total of 13 088 patients underwent treatment of an ankle fracture and filled a peritreatment opioid prescription.Results:When compared with closed treatment of a distal fibula fracture, only 2 surgical treatment subtypes demonstrated significantly increased rates of persistent use compared with the closed treatment group: open treatment of bimalleolar ankle fracture (adjusted odds ratio [aOR], 1.32; 95% CI, 1.10-1.58; P = .002) and open treatment of trimalleolar ankle fracture with fixation of posterior lip (aOR, 1.47; 95% CI, 1.04-2.07; P = .027). Rates were significantly increased (aOR, 1.56; 95% CI, 1.34-1.82; P < .001) among patients who received a total peritreatment opioid dose that was in the top 25th percentile of total oral morphine equivalents. Factors independently associated with new persistent opioid use included mental health disorders, comorbid conditions, tobacco use, and female sex.Conclusion:All ankle fracture treatment groups demonstrated high rates of new persistent opioid use, and persistent use was not directly linked to injury severity. Instead, we identified patient factors that demonstrated increased risk of persistent opioid use. Limiting the peritreatment opioid dose was the largest modifiable risk factor related to new persistent opioid use in this privately insured cohort.Level of Evidence:Level III, retrospective cohort study.

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A Collaborative Approach to Pain Control Reduces In-hospital Opioid Use and Improves Range of Motion following Total Knee Arthroplasty

Cureus ◽

10.7759/cureus.4678 ◽

2019 ◽

Author(s):

Christopher Roberts ◽

Devon Foster ◽

Glen G Shi ◽

Elizabeth R Lesser ◽

Michael G Heckman ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Range Of Motion ◽

Knee Arthroplasty ◽

Pain Control ◽

Collaborative Approach ◽

Opioid Use ◽

Total Knee

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Postoperative Pain Control Following Cardiac Implantable Electronic Device Implantation

10.5772/intechopen.101517 ◽

2021 ◽

Author(s):

Peter Magnusson ◽

Jo Ann LeQuang ◽

Joseph V. Pergolizzi

Keyword(s):

Postoperative Pain ◽

Pain Control ◽

Electronic Device ◽

Perioperative Period ◽

Cardiac Implantable Electronic Device ◽

Opioid Use ◽

Acute Postoperative Pain ◽

Device Implantation ◽

Analgesic Regimen ◽

Short Course

Postoperative pain following cardiac implantable electronic device (CIED) surgery may not always be adequately treated. The postoperative pain trajectory occurs over several days following the procedure with tenderness and limited arm range of motion lasting for weeks after surgery. Pain control typically commences in the perioperative period while the patient is in the hospital and may continue after discharge; outpatients may be given a prescription and advice for their analgesic regimen. It is not unusual for CIED patients to be discharged a few hours after implantation. While opioids are known as an effective analgesic to manage acute postoperative pain, growing scrutiny on opioid use as well as their side effects and potential risks have limited their use. Opioids may be considered for appropriate patients for a short course of treatment of acute postoperative pain, but other analgesics may likewise be considered.

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