Effect of Drug Disposal Bag Provision on Proper Disposal of Unused Opioids by Families of Pediatric Surgical Patients

Abstract

IMPORTANCE Although opioids are an important component of pain management for children recovering from surgery, postoperative opioid prescribing has contributed to the current opioid crisis in the United States because these medications are often prescribed in excess and are rarely properly disposed. One potential strategy to combat opioid misuse is to remove excess postoperative opioids from circulation by providing patients with drug disposal products that enable safe disposal of opioids in the home garbage. OBJECTIVE To determine whether the provision of a drug disposal bag increases proper opioid disposal among the families of pediatric patients undergoing ambulatory surgery. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial enrolled 202 parents or guardians of children 1 to 17 years of age who underwent otolaryngologic or urologic surgery at the outpatient surgery centers of a tertiary children's hospital in Columbus, Ohio, from June to December 2018 and who received an opioid prescription prior to discharge. INTERVENTIONS Families randomized to intervention were provided a drug disposal bag containing activated charcoal and instructions for use plus standard postoperative discharge instructions on opioid use, storage, and disposal. Families in standard care arm received standard postoperative discharge instructions only. All participants completed a baseline survey and a follow-up survey 2 to 4 weeks postoperatively. MAIN OUTCOMES AND MEASURES Primary outcome was proper opioid disposal, defined as disposal using a drug disposal bag or a disposal method recommended by the US Food and Drug Administration. RESULTS Of 202 parents or guardians enrolled, 181 completed follow-up (92 in intervention arm and 89 in standard care arm). Most patients in both groups were white (75 [73.5%] vs 79 [80.6%]) and male (63 [61.2%] vs 54 [54.6%]), and the median (interquartile range) age was 6 (5-9) years in the intervention arm and 7 (6-10) years in the standard care arm. For intention-to-treat analyses, 92 families receiving a disposal bag and 89 families not receiving a disposal bag were included. Among them, 66 families (71.7%) randomized to receive a disposal bag reported properly disposing of their child's opioids, whereas 50 parents (56.2%) who did not receive a disposal bag reported proper opioid disposal (difference in proportions, 15.5%; 95% CI, 1.7%-29.3%; P = .03). Among only those families who filled an opioid prescription and had leftover opioids after resolution of their child's pain, 66 of 77 parents or guardians (85.7%) who had received a disposal bag and 50 of 77 parents or guardians (64.9%) who had received standard care reported properly disposing of their child's opioids (difference in proportions, 20.8%; 95% CI, 7.6%-34.0%). CONCLUSIONS AND RELEVANCE Results of this study indicated that providing drug disposal bags to families of children receiving postoperative opioids increased the likelihood of excess opioid disposal. Greater availability of disposal products may complement ongoing prescr...

Provision of a Drug Deactivation System for Unused Opioid Disposal at Surgical Dismissal

“…12 Additionally, a similarly designed study in pediatric surgical patients found that 86% of participants with leftover opioids and that were provided with a DDS disposed of the leftover medication, compared with 65% of participants with leftover opioids who received disposal education only. 13 The higher rates of disposal in these studies may be related to institutional opioid prescribing guidelines, survey timing, different baseline rates of opioid disposal, and differences between pediatric and adult patient populations. However, if participants who reported plans to use the DDS are added to the reported disposal rates in our study, our results are comparable.…”

Development and implementation of SafeMedWaste, a chemical denaturant for non-hazardous disposal of controlled medications

“…Previous research has shown that patients are uncomfortable with the idea of flushing unused medication 31 and respond positively to the inclusion of a disposal bag with their prescriptions: the rate of proper disposal of opioid medications increased approximately 20% amongst families of children receving postoperative opioids when the disposal bag was included 7 . In that study, the efficacy of the disposal bag was not reported.…”

“…This can happen at multiple levels: in the home, in the clinic, and in the factory. In the home, unused medications are frequently left in cabinets, thrown in the trash, or flushed down the toilet 7 – 10 . It is estimated that half of people with opioid use disorder obtain drugs from friends and family 11 .…”

Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review

“…Formal and informal social support networks can be leveraged to influence individuals' behaviors through improving doctor-patient communication [58-60, 64, 72, 74] or by actively engaging family members in the process [39,40,75]. Four interventions aimed to encourage disposal of leftover opioids among postoperative patients by employing a combination BCWs of education, enablement, and environment restructuring (BCTs: 4.1, 4.2, 5.1, 5.2, 8.2, 12.1, 12.5), which reported positive impact [76][77][78][79]. Two longitudinal RCTs on school-based universal preventive interventions in the USA that aimed to strengthen families and build life skills were introduced to middle schoolers [39,40] and reported a lasting impact on preventing non-medical use of prescription drugs into adulthood.…”

“…The most promising measure was an intervention delivered face-to-face, where consumers were told that they had the option of switching back to brand-name drugs anytime [51,100,101]; hence, an intervention that leverages human behavioral mechanisms may be more effective and cost-effective in optimizing decision making than repeated, expensive education campaigns. In response to the recent opioid epidemic across the globe, promising prevention programs aimed not only to improve the knowledge and awareness of the risk of nonmedical use of prescription drugs among at risk individuals, but also to empower healthcare consumers by providing skills or tools that enable them to take action prior to the occurrence of misuse and/or before the development of poor habits [39,40,[76][77][78][79]. These interventions further improved the socio-ecological surroundings of the target audience by involving family members and restructuring their social or physical environments [39,40,[76][77][78][79].…”