Many patients do not use or discard prescription opioids after surgery, review finds

More needs to be done to reduce the oversupply of opioids after surgery because prescriptions are often not fully used, and easily diverted for nonmedical use, study authors said.

Patients commonly do not use, lock, or discard their postoperative prescription opioids, according to a recent systematic review.

Researchers reviewed six studies of 810 unique patients (range, 30 to 250 patients) undergoing seven different types of surgical procedures to assessed opioid oversupply. They defined the primary outcome, opioid oversupply, as the number of patients who did not fill their opioid prescriptions or filled but did not use them.

Results were published online on Aug. 2 by JAMA Surgery.

Overall, 67% to 92% of patients in the studies reported unused opioids. Of the opioids that patients did obtain, 42% to 71% were not used. Most patients who stopped or did not use opioids (71% to 83%) reported doing so because their pain was adequately controlled. About 16% to 29% of patients reported concerns about opioid-induced adverse effects.

Two studies that looked at storage safety found that 73% to 77% of patients reported that their prescription opioids were not stored in locked containers. Only 4% to 9% of patients considered or used FDA-recommended disposal methods.

The study authors noted limitations to their analysis, such as the intermediate rather than high methodological quality of the studies they reviewed and heterogeneity among the studies. They added that the studies did not report leftover morphine equivalents or more granular data on unused opioid pill counts.

“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 study authors wrote.

In related news, the President's Commission on Combating Drug Addiction and the Opioid Crisis recently released an interim report outlining draft recommendations for federal action. The recommendations to the president include declaring a national emergency, rapidly increasing treatment capacity, mandating prescriber education initiatives, and funding a federal incentive to enhance access to medication-assisted treatment.