Opioids After Surgery Appropriate for Most Patients, Most Excess Pills Properly Disposed Of

After recovering from surgery, most patients were satisfied with prescribed pain relief medications and properly disposed of excess opioid pills. These findings, from a clinical trial, were published in the Journal of the American College of Surgeons.

Patients (N=229) undergoing elective surgery at Dartmouth-Hitchcock Medical Center in the United States were recruited for this study between 2018 and 2019. At hospital discharge, in addition to nonopioids, patients were prescribed opioids on the basis of predischarge use. Patients were instructed to take nonopioid medications first. Use of opioids and disposal of excess pills were assessed.

Patients were aged mean 59±12 years; 38.4% were men; and operations were performed for gynecologic oncology (27.1%), general oncology (26.2%), colorectal (21.4%), thoracic (13.5%), or other reasons (11.8%). In the time before discharge, patients consumed morphine milligram equivalents (MMEs) of 0 (n=100), 1-29 (n=101), and ³30 (n=28); as such, the guidelines for these groups were to prescribe 5, 15, and 30 pills of 30 mg oxycodone equivalents at discharge, respectively.

Patients who consumed more opioid equivalents during hospitalization were younger (P =.015) and less likely to have undergone open surgery (P =.015).

Opioid prescription guidelines were followed among 83.8% of the patients. Poor adherence was observed among the highest MME group (60.7%), in which 90.9% were prescribed a lower dosage than recommended. Among all patients prescribed a nonrecommended amount, 62% were underprescribed.

The patients in the lowest MME group consumed the fewest opioids after discharge (73.2% used no opioids). Nearly a quarter of patients in the intermediate MME group (24.2%) did not use opioids after discharge. Few patients in the highest MME group (7.1%) abstained from use.

Most patients (93.0%) were satisfied with their prescribed discharge drugs. Fewer patients in the high MME group were satisfied (P =.001).

Excess opioid pills were given to 62.1% of patients; only 16% of those patients kept their unused pills, for a total of 187 pills that were not disposed of properly. Among the patients who disposed of their excess drugs, 83% used a Food and Drug Administration (FDA) method (50.9% used a hospital drop-box, 28.1% used a police or fire department drop-box, 15.8% dissolved the drugs in water mixed with substance and disposed in garbage, or 5.3% used an inactivating agent).

FDA-compliant disposal methods did not associate with MME predischarge usage (low vs intermediate: odds ratio [OR], 0.63; 95% CI, 0.16-2.47; P =.51; low vs high: OR, 0.32; 95% CI, 0.03-3.76; P =.37).

This study may have been limited by its single-center design and the choice to exclude patients who had an established history of chronic opioid use.

These data indicated current post-operative opioid prescription guidelines were appropriate for the majority of patients and that in cases in which excess opioids were left after recovery, most patients used FDA-approved methods of disposal.

Reference

Porter ED, Bessen SY, Molloy IB, et al. Guidelines for patient-centered opioid prescribing and optimal fda-compliant disposal of excess pills after inpatient operation: prospective clinical trial. J Am Coll Surg. 2021;S1072-7515(21)00056-9. doi:10.1016/j.jamcollsurg.2020.12.057.