Public health authorities have described, with growing alarm, an unprecedented increase in morbidity and mortality associated with use of opioid pain relievers (OPRs). Efforts to address the opioid crisis have focused mainly on reducing nonmedical OPR use. Too often overlooked, however, is the need for preventing and treating opioid addiction, which occurs in both medical and nonmedical OPR users. Overprescribing of OPRs has led to a sharp increase in the prevalence of opioid addiction, which in turn has been associated with a rise in overdose deaths and heroin use. A multifaceted public health approach that utilizes primary, secondary, and tertiary opioid addiction prevention strategies is required to effectively reduce opioid-related morbidity and mortality. We describe the scope of this public health crisis, its historical context, contributing factors, and lines of evidence indicating the role of addiction in exacerbating morbidity and mortality, and we provide a framework for interventions to address the epidemic of opioid addiction.

Importance Prescription opioids play an important role in the treatment of post-operative pain, yet unused opioids may be diverted for non-medical use and contribute to opioid-related injuries and deaths. Objective To quantify how commonly post-operative opioids are unused, why they remain unused, and practices regarding their storage and disposal after surgery. Evidence Review We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from inception to 18 October 2016 for studies describing opioid over-supply for adults after any surgery or procedure. We defined our primary outcome, opioid over-supply, as the number of patients with either filled prescriptions with unused opioids or unfilled opioid prescriptions. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality. Findings Six eligible studies reported on a total of 810 patients (range 30–250) undergoing seven different procedure types. Across the six studies, between two-thirds (67%) to nine-tenths (92%) of patients reported unused opioids. Among opioids obtained by surgical patients, 42% to 71% of all tablets went unused. A majority of patients stopped or used no opioids due to adequate pain control, while 16% to 29% of patients reported opioid-induced side effects. In two 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, while no study reported FDA-recommended disposal methods in more than 9% of patients. Conclusions & Relevance Post-operative prescription opioids often go unused, unlocked, and undisposed, suggesting an important reservoir of opioids contributing to non-medical use of these products.

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