http://jamanetwork.com/journals/jamasurgery/article-abstract/2644905

Mark C. Bicket, MD1Jane J. Long, BS1Peter J. Pronovost, MD, PhD1,2et al

Key Points

Question  How commonly are prescription opioid analgesics unused among adult patients after a surgical procedure?

Findings  In this review of 6 studies involving 810 unique patients who underwent orthopedic, thoracic, obstetric, and general surgical procedures, 67% to 92% of patients reported unused opioids. Rates of safe storage and/or disposal of unused prescription opioids were low.

Meaning  Unused opioids prescribed for patients after surgery are an important reservoir of opioids available for nonmedical use and could cause injuries or even deaths.

Abstract

Importance  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.

Objective  To quantify how commonly postoperative prescription opioids are unused, why they remain unused, and what practices are followed regarding their storage and disposal.

Evidence Review  MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from database inception to October 18, 2016, for studies describing opioid oversupply for adults after a surgical procedure. The primary outcome—opioid oversupply—was defined as the number of patients with either filled but unused opioid prescriptions or unfilled opioid prescriptions. Two reviewers independently screened studies for inclusion, extracted data, and assessed the study quality.

Findings  Six eligible studies reported on a total of 810 unique patients (range, 30-250 patients) who underwent 7 different types of surgical procedures. Across the 6 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 2 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 Food and Drug Administration–recommended disposal methods in more than 9% of patients.

Conclusions and Relevance  Postoperative prescription opioids often go unused, unlocked, and undisposed, suggesting an important reservoir of opioids contributing to nonmedical use of these products, which could cause injuries or even deaths.

Comment;

As long as opiates are Schedule II, dangerous & abusable (no foreseeable end to that!), doctors will tend to give a bit of a “generous” supply as we all have different pain thresholds/tolerances.  I’ve yet to meet a physician or surgeon who “enjoys” that after-hour call for more pain medications after surgery.  Addicts know the technique well, even those who have yet to discover that they carry the gene, were triggered and are now addicted.  Doctors are people.  We don’t want to take undue risks with our patients, but we also hate dealing with manipulative, pushy, often angry patients that may not even be ours if we’re covering for other physicians after-hours.  I don’t see a solution to this problem other than being VERY careful about how “generous” we are with these medications.

Dr. Raymond Oenbrink
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