Two-thirds of Opioid Prescriptions Go Unused but not Disposed

More than two-thirds of patients reported unused prescription opioids following surgery, and safe storage and disposal rarely occurred, suggesting an important source for nonmedical use, according to a study published by JAMA Surgery.

Prescription opioid analgesics play an important role in the treatment of postoperative pain; however, unused opioids may be diverted for nonmedical use and contribute to opioid-related injuries and deaths. Based on the 2015 National Survey on Drug Use and Health, an estimated 3.8 million Americans engage in the nonmedical use of opioids every month. Mark C. Bicket, MD, of the Johns Hopkins University School of Medicine, Baltimore, and colleagues reviewed six studies (810 patients who underwent seven different types of surgical procedures) to examine how commonly postoperative prescription opioids are unused, why they remain unused, and what practices are followed regarding their storage and disposal.

Across the six studies, 67% to 92% of patients reported unused opioids. Of all the opioid tablets obtained by surgical patients, 42% to 71% went unused. Most patients stopped or used no opioids owing to adequate pain control, and 16% to 29% of patients reported opioid-induced adverse effects. In two studies examining storage safety, 73% to 77% of patients reported that their prescription opioids were not stored in locked containers. All studies reported low rates of anticipated or actual disposal. but no study reported US FDA-recommended disposal methods in more than 9% of patients.

A limitation of the study was that the studies examined were of intermediate rather than high methodological quality, and the questionnaires completed by patients varied in form, structure, phrasing, and timing across the studies.

“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,” the authors write.