Surgery patients can help prevent opioid abuse

(Reuters Health) - Simple brochures given to patients having surgery might ultimately help control the opioid epidemic, a study suggests.

The brochures explain the importance of proper disposal of unused pain pills.

One reason for the opioid abuse epidemic, researchers write in the Journal of the American College of Surgeons, is that addictive pain-relieving opioid medications are often over-prescribed, with extra pills left sitting in people’s medicine cabinets.

For example, a primary care physician may prescribe opioids – such as Percocet, OxyContin or Vicodin - to curb chronic pain. A surgeon might then write an additional prescription to help manage pain after an operation for the same condition – and the patient may end up with more of the painkillers than what’s actually needed.

But the real problem, researchers say, lies in patients’ hesitancy to dispose of leftover pills and to do so in the correct manner - that is, return them to a pharmacy, take them to a police station, or mix them with an unpalatable substance (such as laundry detergent) and then discard in household trash.

Dr. Susan Mackinnon at Washington University in St. Louis, Missouri, and colleagues tested a new brochure designed to educate patients about four things: (1) the opioid epidemic, (2) the high likelihood of receiving an over-prescription, (3) inadequate disposal methods and (4) instructions for proper disposal of unused medication.

As reported in the Journal of the American College of Surgeons, all 334 participants in the study were having surgery for painful conditions such as carpal tunnel syndrome, severed nerves and various compression injuries.

Half of the patients were randomly selected to receive the educational brochure at the time of surgery scheduling in the outpatient clinic and then again after the surgery, before they went home. The rest of the patients did not receive the brochure.

Both groups answered questions before and after the surgery about their prior opioid usage, post-surgical opioid use, whether they kept or discarded excess pills, and what was done with the medication if they hadn’t kept it.

Overall, only 29% of patients used all the opioids their doctors prescribed.

Of those who had pain medicine left over, 49% kept the unused opioids and 16% disposed of them – with only 9% disposing of the drugs in manner recommended by the brochure.

Those who received the brochure were twice as likely (22%) to dispose of their excess opioids than those who did not receive the brochure (11%), the study showed.

There was no difference, however, in the proportion of patients from each group who followed the disposal instructions recommended by the brochure.

“We know prescription opioid medications are circulating and being used for unintended purposes by unintended parties,” said study co-author Jessica Hasak, also at Washington University, in email to Reuters Health.

According to the National Survey on Drug Use and Health, in 2014, an estimated 9.5 million adults in the U.S. misused prescription opioids, resulting in drastic spikes in morbidity and mortality.

“Rather than from a dealer, the most common source is from a friend or relative, followed by over personal-prescription by physicians,” MacKinnon said in a phone interview.

“It’s not unusual to keep unused drugs. People hoard them,” MacKinnon said. “But this is different. We need to get these substances out of our medicine cabinets so some young teenager doesn’t get a hold of them and experiment. What’s more, we need to get rid of them in the proper manner. Everyone has laundry detergent and a plastic bag. There are absolutely no barriers to using this approach. With increased patient education, we can strive for a 100% disposal rate of excess opioids.”

In the U.S., locations of medication disposal sites are available at

SOURCE: Journal of the American College of Surgeons, online January 10, 2018.