More than two thirds of patients report that they have prescription opioids left over after surgery and that they don’t safely store or dispose of them, researchers say.
“The combination of unused opioids, poor storage practices, and
lack of disposal sets the stage for the diversion of opioids for nonmedical use,” write Mark C. Bicket, MD, from the Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues.
They published a systematic review of studies on this oversupply of opioids in JAMA Surgery.
Nearly 4 million Americans use opioids for nonmedical purposes every month, and more than half obtained these drugs from a friend or relative, according to the 2015 National Survey on Drug Use and Health.
To understand how surgery fits into this pattern, the researchers searched for studies that reported on unused opioids after both inpatient and outpatient surgery. They excluded retrospective studies and those that described nonsurgical or pediatric procedures.
That left them with six studies on a total of 810 patients who underwent seven types of surgical procedure.
The proportion of patients reporting unused opioids in these studies ranged from 67% to 92%.
The highest proportion of patients reporting unused opioids was in general surgery (92%), followed by dental surgery (91%), Cesarean delivery (90%), dermatological surgery (89%), thoracic surgery (81%), orthopedic surgery (77%), and urologic surgery (67%).
Of all the opioid tablets obtained by surgical patients, 42% to 71% percent went unused.
Most patients stopped or used no opioids because their pain control was adequate. Another 16% to 29% reported opioid-induced adverse effects. In one study on thoracic surgery, 8% of patients reported not taking the opioids they were prescribed for fear of addiction.
Five of the studies looked at unfilled prescriptions and showed that this occurred in 0% to 21% of the patients. Three studies showed that 7% to 14% of patients filled their prescriptions but never used any of the medication.
Two of the studies examined storage safety and found that 73% to 77% of patients did not store their opioids in locked containers.
The studies all reported that few patients planned to dispose of their unused opioids; no more than 9% of patients used disposal methods recommended by the US Food and Drug Administration.
The researchers found that the studies they examined were of intermediate methodological quality. The questionnaires completed by patients varied in form, structure, phrasing, and timing across the studies, making it hard to compare them.
Still, the evidence is strong enough to show that opioids are being prescribed unnecessarily, they said. They recommended against a “one-size-fits-all” approach to prescribing these medications, urging clinicians to look for ways of judging which patients will need most help managing pain.
National guidelines call for greater reliance on nonopioid analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, and gabapentinoids, as well as nonpharmacologic approaches such as exercise, cold, and heat, the authors write.
“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,” they write.
Authors of the study reported financial relationship with the FDA, Pain Navigator, and QuintilesIMS.
JAMA Surg. Published online August 2, 2017. Abstract
For more news, join us on Facebook and Twitter
Tidak ada komentar:
Posting Komentar