Overprescription of Postoperative Narcotics: A Look at Postoperative Pain Medication Delivery, Consumption and Disposal in Urological Practice

Bates, Cory; Laciak, Robert; Southwick, Andrew; Bishoff, Jay T.

doi:10.1016/j.juro.2010.09.088

Cited by 363 publications

(285 citation statements)

References 10 publications

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“…10 A 10% increase was selected as this is a similar absolute improvement in opioid behaviours noted in other educational intervention studies. 17,18 We anticipated a 60% survey response rate based on other surveys performed at our institution.…”

Section: Discussionmentioning

confidence: 97%

“…[6][7][8] Substantial portions of prescribed opioid medications go unused, and many patients do not dispose of them properly, risking diversion into the community. 9,10 In fact, in some postoperative data, only 1% of patients appropriately return unused opioids to a pharmacy. 10 Because up to 90% of post-surgical patients keep their unused opioids in their home, secure storage is important to avoid inadvertent ingestion by other susceptible individuals as well as diversion of opioids into the community.…”

Section: Résumémentioning

confidence: 99%

“…9,10 In fact, in some postoperative data, only 1% of patients appropriately return unused opioids to a pharmacy. 10 Because up to 90% of post-surgical patients keep their unused opioids in their home, secure storage is important to avoid inadvertent ingestion by other susceptible individuals as well as diversion of opioids into the community. 10 Recent studies revealed that only 9% of oncology patients and 0% of patients recently discharged from the emergency department with an opioid prescription stored opioids in a locked area.…”

Section: Résumémentioning

confidence: 99%

“…10 Because up to 90% of post-surgical patients keep their unused opioids in their home, secure storage is important to avoid inadvertent ingestion by other susceptible individuals as well as diversion of opioids into the community. 10 Recent studies revealed that only 9% of oncology patients and 0% of patients recently discharged from the emergency department with an opioid prescription stored opioids in a locked area. 11,12 Published data are lacking to show that improper storage and disposal of opioid medications may be associated with an increase in opioid abuse, morbidity, or mortality; however, approximately 70% of those using opioids for non-medical purposes acquired opioids from friends or relatives prescribed these medications.…”

Section: Résumémentioning

confidence: 99%

“…These domains were selected based on deficits in safe opioid handling and disposal reported previously as well as common questions that patients at our institution asked about opioid analgesics which did not seem to be adequately addressed by prescribers. [10][11][12] A formal evaluation of the pamphlet was not performed, but it was piloted in preoperative and postoperative patients to ensure that the content was at an appropriate reading level.…”

Section: Interventionmentioning

confidence: 99%

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Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study

Rose

Sakai

Argue

et al. 2015

Can J Anesth/J Can Anesth

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Purpose Half of postoperative patients are prescribed an opioid, but a majority do not store or dispose of them properly thus risking diversion. We examined the efficacy of an opioid educational pamphlet addressing opioid weaning, storage, and disposal. We hypothesized that the pamphlet would increase the rate of proper opioid disposal, storage, and weaning. Methods This prospective before and after study was conducted at UBC Hospital in primary total hip or knee arthroplasty patients. Adults with American Society of Anesthesiologists physical class I-III, with no addiction history and consuming B 30 mg of morphine equivalents daily were enrolled in the study. Two groups received similar standard management, except the intervention group additionally received the opioid education pamphlet. Patients were contacted four weeks postoperatively to complete a survey. The primary endpoint was to evaluate proper opioid disposal rates. Secondary endpoints were to evaluate opioid storage and weaning rates. Results Two hundred twenty-six patients were enrolled and 172 (76%) completed the survey. Among patients who had discontinued opioids, rates of proper disposal increased from 2/42 (5%) to 12/45 (27%) in those receiving the pamphlet (difference in proportions, 22%; 95% confidence interval (CI), 5 to 38; P = 0.005). Secure opioid storage did not improve in those receiving the opioid pamphlet [before, 18/86 (21%) vs after, 20/86 (23%); difference in proportions, 3%; 95% CI, -11 to 15; P = 0.713]. The proportion of patients weaned from opioids was unchanged by the pamphlet [before, 42/86 (49%) vs after, 45/86 (52%); P = 0.735]. Conclusion The introduction of an education pamphlet significantly improved self-reported proper opioid disposal rates in postoperative patients. RésuméObjectif Un opioïde est prescrit en postopératoire à près de la moitié des patients, mais la majorité d'entre eux ne les conserve pas ni ne les élimine de façon appropriée, ce qui expose au risque de détournement des médicaments. Nous avons examiné l'efficacité d'un dépliant éducatif sur les opioïdes, leur sevrage, conservation et élimination. Nous avons émis l'hypothèse que le dépliant augmenterait les taux de pratique adéquate d'élimination, conservation et sevrage aux opioïdes. Méthodes Cette étude prospective avant et après a été menée à l'hô pital UBC avec des patients ayant subi une arthroplastie de première intention de hanche ou de genou.

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Section: Discussionmentioning

confidence: 97%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

See 3 more Smart Citations

Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study

Rose

Sakai

Argue

et al. 2015

Can J Anesth/J Can Anesth

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Long-term Analgesic Use After Low-Risk Surgery

Alam¹

2012

Arch Intern Med

692

540

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Development of Persistent Opioid Use After Cardiac Surgery

et al. 2020

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IMPORTANCEThe overuse of opioids for acute pain management has led to an epidemic of persistent opioid use.OBJECTIVE To determine the proportion of opioid-naive patients who develop persistent opioid use after cardiac surgery and investigate the association between the initial amount of opioids prescribed at discharge and the likelihood of developing new persistent opioid use. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study used data from a national administrative claims database from January 1, 2004, to December 31, 2016 and included 35 817 patients who underwent coronary artery bypass grafting (CABG) (25 673 [71.7%]) and heart valve (10 144 [28.3%]) procedures. All patients were opioid-naive within 180 days before the index procedure and filled an opioid prescription within 14 days after surgery.EXPOSURES Opioid medications after cardiac surgery. MAIN OUTCOMES AND MEASURESThe proportion of opioid-naive patients who developed new persistent opioid use within 90 to 180 days after surgery was determined. Oral morphine equivalents (OMEs) were calculated for the first opioid prescription filled after discharge. A multivariable logistic regression with cubic splines was used to analyze the association among the OMEs at discharge and likelihood of developing persistent opioid use. RESULTSOf the 25 673 patients who underwent CABG, the mean (SD) age for those without (n = 23 064) vs with (n = 2609) persistent opioid use was 62.9 (9.8) years vs 61.6 (9.7) years, respectively, and the number who were men were 18 758 (81.3%) vs 1998 (76.6%). Of the 10 144 patients who underwent heart valve surgery, the mean (SD) age for those without (n = 9343) vs with (n = 821) persistent opioid use was 63.2 (12.4) years vs 61.2 (12.5) years, respectively, and the number who were men were 6378 (68.3%) vs 511 (62.2%). Persistent opioid use is a substantial concern after cardiac surgery and occurred in 2609 patients undergoing CABG (10.2%) and 821 valve surgery patients (8.1%; P = .001). The likelihood for developing persistent opioid use was decreased among heart valve surgery recipients (odds ratio [OR], 0.78; P < .001) and increased for patients who were women; younger; with preoperative congestive heart failure, chronic lung disease, diabetes, kidney failure, chronic pain, and alcoholism; and those taking preoperative benzodiazepines and muscle relaxants

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Overprescription of Postoperative Narcotics: A Look at Postoperative Pain Medication Delivery, Consumption and Disposal in Urological Practice

Cited by 363 publications

References 10 publications

Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study

Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study

Long-term Analgesic Use After Low-Risk Surgery

Development of Persistent Opioid Use After Cardiac Surgery

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