S. M. Stokes1, A. C. Jacobs2, B. S. Brooke4, E. Jordan1, A. C. Kwok3, R. Glasgow1, T. K. Varghese5, L. C. Huang1 1University Of Utah,Department Of Surgery, Division Of General Surgery,Salt Lake City, UT, USA 2University Of Utah,School Of Medicine,Salt Lake City, UT, USA 3University Of Utah,Department Of Surgery, Division Of Plastic Surgery,Salt Lake City, UT, USA 4University Of Utah,Department Of Surgery, Division Of Vascular Surgery,Salt Lake City, UT, USA 5University Of Utah,Department Of Surgery, Division Of Cardiothoracic Surgery,Salt Lake City, UT, USA
Introduction: Post-operative patients often have excess opioid and non-opioid pain medications after surgery. Many patients save these medications for later use or divert them to family and friends. Patients are encouraged to properly dispose of excess medications at drug take-back days or at DEA-approved disposal sites but these options require significant initiative. We hypothesized that a convenient home disposal kit will result in more appropriate disposal of excess medications.
Methods: We conducted a prospective cohort study at a single academic institution to identify patient practices regarding excess pain medications left over following a variety of surgical procedures. Procedures included general, breast, colorectal, foregut, vascular, and plastic surgery procedures. Patients were divided into two groups — those who received a home disposal kit and an educational handout, and those who did not. At the first follow-up visit, patients completed a survey in which they recorded the amount of pain medications remaining and what they had done or planned to do with their excess medications. Patients were also asked about risk factors for chronic opioid use. We used multivariable linear and logistic regression to identify independent factors associated with lower patient-reported likelihood to dispose of pain medications.
Results:The survey was administered to 346 patients with a response rate of 84% (289 responses). Of the 289 respondents, 15% did not use opioids after surgery, as they were not prescribed opioids or did not fill their prescription. The survey was completed a median of 17 days (IQR 13-27 days) after discharge. Overall, 113 patients (40.5%) reported taking all of their prescribed pain medications. Of the 121 (42%) who still had excess pain medications, 14% reported ongoing need, 39% reported keeping the medications for future use, and 36% reported the intention to dispose of their medications. 50 patients (17.7%) received a home disposal kit. Among patients disposing of medications and received a kit, 84% used it, 17% disposed of it by the garbage/toilet, and 0% used other methods. In the group that did not receive the disposal kit, 16% were interested in a kit, but other methods were highly variable — opioid disposal location (38%), toilet/garbage (16%), opioid takeback program (22%), and other (9%). However, the proportion of patients disposing of medications did not change between those who received the kit (31.6%) and those who did not (34%, p = 0.486). No factors were identified during multivariable analysis that increased a patient’s likelihood for disposal.
Conclusion: Use of the home disposal kit was high among those intending to dispose of excess medications, suggesting that it was easier to use than other methods. However, distribution of the kit and handout was not sufficient to encourage more patients to choose disposal. Further research is needed on effective strategies for better medication stewardship.