Nudging patients and surgeons to change ambulatory surgery pain management: Results from an opioid buyback program

Abstract

Background: Optimal postoperative opioid stewardship combines adequate pain medication to control expected discomfort while avoiding abuse and community diversion of unused prescribed opioids. We hypothesized that an opioid buyback program would motivate patients to return unused opioids, and surgeons will use that data to calibrate prescribing. Methods: Prospective cohort study of postambulatory surgery pain management at a level II Veterans Affairs rural hospital (2017e2019). Eligible patients were offered $5/unused opioid pill ($50 limit) returned to our Veterans Affairs hospital for proper disposal. After 6 months, buyback data was shared with each surgical specialty. Results: Overall, 934 of 1,880 (49.7%) eligible ambulatory surgery patients were prescribed opioids and invited to participate in the opioid buyback. We had 281 patients (30%) return 3,165 unused opioid pills; this return rate remained constant over the study period. In 2017, 62.4% of patients were prescribed an opioid; after data was shared with providers, prescriptions for opioids were reduced to 50.7% and 38.3% of eligible patients in 2018 and 2019, respectively (P < .0001). The median morphine milligram equivalents prescribed also decreased from 108.8 morphine milligram equivalents in 2017 to 75.0 morphine milligram equivalents in 2018 and sustained at 75.0 morphine milligram equivalents in 2019 (P < .001). Surgical providers, surgeries performed, patient characteristics, and 30-day refill rates were similar throughout the study period. Conclusion: A small financial incentive resulted in patients returning unused opioids after ambulatory surgery. Feedback to surgeons regarding opioids returned reduced the proportion of patients prescribed an opioid and the amount of opioid after ambulatory surgery without an increase in refills.

Efficacy of a password‐protected, pill‐dispensing device with mail return capacity to enhance disposal of unused opioids after cancer surgery

“…21,46 Published interventions have focused on patient education, [18][19][20][21][22][23][24] provision of drug disposal kits, [25][26][27][28][29][30][31][32]47 and take-back programs. [33][34][35] These initiatives have shown mixed results in trials and generally rely on patient self-report without a mechanism to directly verify opioid removal from the home. To our knowledge, only one other study has evaluated mail return of unused pills.…”

“…Although there is agreement about the need for disposal of unused pills, the optimal method is uncertain 21,46 . Published interventions have focused on patient education, 18–24 provision of drug disposal kits, 25–32,47 and take‐back programs 33–35 . These initiatives have shown mixed results in trials and generally rely on patient self‐report without a mechanism to directly verify opioid removal from the home.…”

“…Interventions to enhance disposal of unused pills have focused on patient education,, 18–24 provision of drug disposal kits, 25–32 and take‐back programs 33–35 . These endeavors have shown mixed results in trials and are likely insufficient in isolation.…”

“…17 Interventions to enhance disposal of unused pills have focused on patient education,, [18][19][20][21][22][23][24] provision of drug disposal kits, [25][26][27][28][29][30][31][32] and take-back programs. [33][34][35] These endeavors have shown mixed results in trials and are likely insufficient in isolation. A more comprehensive solution is needed to promote safe storage and disposal of opioids, with the potential to improve patient comfort with indicated opioid use for postsurgical pain.…”

Opioids and Public Health: The Prescription Opioid Ecosystem and Need for Improved Management

“…Recent examples of local success in reducing postsurgical opioid pills counts are very promising. [88][89][90][91] However, patient effects beyond this intermediate outcome are yet unknown. Enhanced recovery after surgery protocols that promote opioid-sparing if not Fig.…”