Two-Thirds of Patients Report Unused, Improperly Stored Prescription Opioids

More than 2 out of 3 patients who were prescribed opioids for pain report that they have leftover medication, and that it doesn’t get safely stored or disposed of, according to a study examination from Johns Hopkins.

Opioid use is a topic of contention across the United States, and just as recently as last week, a special commission designated by the president called on him to declare a state of emergency on the matter.

Every month, nearly 4 million Americans utilize opioids for nonmedical purposes, according to the 2015 National Survey on Drug Use and Health.

“The combination of unused opioids, poor storage practices, and lack of disposal sets the stage for the diversion of opioids for nonmedical use,” Mark C. Bicket, MD, assistant professor and director of the pain fellowship program in the department of anesthesiology and critical care medicine at Johns Hopkins University (pictured), and colleagues wrote.

Data consisted of 6 studies involving 810 patients that had undergone orthopedic, obstetric, thoracic, or general surgeries. The findings of those studies revealed that 67% (542 patients) to 92% (745 patients) of the participants reported having unused, leftover opioid prescription medicines.

Across the different surgery populations inspected, general surgery saw the highest percentage of patients with unused opioids, at 92%. General surgery was followed by dental surgery (91%), Cesarean delivery (90%), dermatological surgery (89%), thoracic surgery (81%), orthopedic surgery (77%), and urologic surgery (67%).

In 2 of the studies examined, storage safety was assessed, revealing that 73% to 77% of patients with leftover medication did not store their opioids in a locked container. Across all studies, it was found that only 9% of patients used proper disposal methods recommended by the US Food and Drug Administration.

In total, 42% to 71% of the prescribed tablets given to patients went unused.

All in all, most of the patients reported their use of the opioids halting because pain control was sufficient. In 1 of the studies examining thoracic surgery patients, 8% of them stated they did not take their prescriptions for fear of addiction. Across all studies, between 16% and 29% of patients said they experienced opioid-induced adverse effects.

"Increased efforts are needed to develop and disseminate best practices to reduce the oversupply of opioids after surgery, especially given how commonly opioid analgesics prescribed by clinicians are diverted for nonmedical use and may contribute to opioid-associated injuries and deaths," Bicket and colleagues concluded.

The authors recommended against a “one-size-fits-all” approach to opioid prescriptions, stating that these prescriptions are mostly unnecessary. The authors also reminded that national guidelines suggest a greater use of nonopioid analgesics like nonsteroidal anti-inflammatories, acetaminophen, and gabapentinoids, in addition to exercise, cold, and heat, among other nonpharmacological approaches.

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