Is the Solution to Proper Post-Surgical Opioid Disposal in the Bag?

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ANN ARBOR, MI – Patients provided a special bag to dispose of leftover painkillers when they left the hospital after surgery were much more likely to properly dispose of their prescription opioids, according to a new study.

The program was reported in a research letter published in JAMA Surgery. University of Michigan researchers reported that providing special disposal bags doubled the percentage of patients who safely discarded their unneeded opioids within six weeks of their operation. Just providing patients with education, but no bag, didn’t work nearly as well, they said.

"We need everyday disposal options that address patients' needs and break down common barriers for safe disposal through other means, such as bringing unneeded medications to take-back drives or law enforcement locations that require a special trip and may make some patients uncomfortable," explained Chad Brummett, MD, director of pain research at Michigan Medicine.

The study team pointed out the limitations of current disposal options, mainly Drug Enforcement Administration–authorized opioid collectors, including law enforcement agencies, pharmacies, and organized pill-drop events. Many patients remain unaware of them, researchers said.

That’s why they decided to try providing an activated charcoal bag that allows for in-home opioid disposal. The question was whether post-surgical patients would be more likely to use the containers, in which the charcoal binds to prescription drugs when water is added, making them unusable by humans -- for drug disposal, compared with usual care or educational materials detailing disposal resources.

During the study period from June 6, 2017 to July 21, 2017, participants and surgeons were initially blinded to the trial, and the intervention or usual care was presented perioperatively by the nurse. The 396 recruited patients – 208 remaining for the primary analysis -- were contacted by phone or email four to six weeks after their surgical procedure to inquire about their postoperative opioid use and disposal of unused medications.

Results indicate that 28.6% of the patients who received usual care reported disposing opioids, compared with 33.3% who received education regarding disposal locations. Of the patients who received a charcoal activated bag, however, 57.1% disposed of excess opioids.

Researchers calculated the odds of opioid disposal as 3.8 (95% CI, 1.7-8.5) times higher among participants who received a charcoal bag compared with those who received usual care. In addition, participants who received a charcoal bag reported less medication flushing, 5.0%, or inappropriate garbage disposal use, 5.0%, and were statistically significantly less likely to leave the home for disposal 2.5%, when compared with participants in the other two groups.

“Our findings suggest that simple, low-cost interventions (US $2.59-$6.99/bag), such as in-home deactivation methods, could reduce the number of unused opioids available for diversion,” study authors conclude.

All the news wasn’t good, however. Even among patients who received free disposal supplies, more than 40 percent still hadn't disposed of the drugs when the researchers contacted them four to six weeks after their operations, researchers write.

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