R. Khorfan1, J. Coughlin1,2, M. Shallcross1, B. Yu3, N. Sanchez3, S. Parilla1, K. Bilimoria1,3,4, J. Stulberg1,3,4 1Feinberg School Of Medicine – Northwestern University,Surgical Outcomes And Quality Improvement Center,Chicago, IL, USA 2Rush University Medical Center,Department Of Surgery,Chicago, IL, USA 3Feinberg School Of Medicine – Northwestern University,Chicago, IL, USA 4Northwestern Memorial Hospital,Chicago, IL, USA
Introduction:
Opioid overdose continues to be a major cause of mortality in the U.S., with 42,249 deaths reported by the CDC in 2016. Between 50-70% of nonmedical users obtain prescription opioids through friends or relatives. With 70-90% of opioids prescribed after surgery going unused, disposal of these medications is a critical element for preventing opioid misuse, abuse, and death. We developed a multi-component opioid reduction program dedicated to supporting appropriate opioid drug disposal. Our objectives were to assess patient exposure to the interventions and associations with opioid use and disposal rates.
Methods:
We piloted a multicomponent opioid reduction intervention and implemented it in our Digestive Health Center (DHC) at Northwestern Memorial Hospital (NMH). Intervention components included; 1) patient education, 2) expectation setting, 3) provider education, and 4) an in-clinic disposal box. Patients were surveyed by phone 30-60 days after surgery regarding their experience with post-surgical pain management. Surveys were conducted from April – June 2018. Data were analyzed with descriptive statistics and are reported here. Data collection will continue with planned analyses including bivariate and multivariate regression analyses.
Results:
Fifty-five of 204 eligible patients agreed to participate in the telephone survey (27% response rate). Patients receiving both pre- and post-operative counseling on pain management were more likely to feel prepared to manage their pain (89%) than those who only received it pre- or postoperatively (72%). Patients who reported feeling prepared to manage their pain used fewer opioids on average than those who did not (7 vs 10 pills, respectively). Twenty-eight patients (78%) who filled their prescription had excess pills, and 21% disposed of their excess pills. Forty percent of patients who reported that they received opioid safety information disposed of their excess opioids, compared with 0% of those who did not.
Conclusion:
Exposure to clinic-based interventions can potentially decrease quantity of opioids used and increase disposal of excess opioids. Reinforcing patient education across phases of care may be key to achieving this effect. Nevertheless, additional strategies are needed to increase appropriate opioid disposal to prevent nonmedical opioid use and diversion.