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As Many as 92% of Surgical Patients Are Overprescribed Opioids

Prescription painkillers go unused and undisposed of by the majority of surgical patients.

Published: August 2, 2017

More than two-thirds of patients reported unused prescription opioids following surgery, and safe storage and disposal rarely occurred, according to a study published by JAMA Surgery that strongly suggests that overprescribing after surgery is fueling the nation's opioid addiction and abuse crises.

Most patients reported taking fewer opioids than prescribed because of adequate pain control or, to a lesser degree, opioid-induced adverse effects, according to a new study conducted by researchers from Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health. The researchers reviewed 6 studies involving 810 patients who underwent 1 of 7 different surgical procedures — obstetric, urologic, thoracic and orthopedic surgery, among them — and found that unused opioids were quite common across the spectrum.

But where do these unused drugs go? Most linger in patients' homes, the researchers say, though as many as 77% of patients store them in unsecure locations, and less than 30% of patients either disposed of unused prescriptions or planned to do so. Some meds ultimately end up in the hands of the estimated 3.8 million Americans ages 12 and older who misuse opioid pain relievers every month, according to the Substance Abuse and Mental Health Services Administration's 2015 National Survey on Drug Use and Health.

"We can't choose between treating patients' pain and doing better for those who are getting exposed to medications that are leading to the injuries and deaths we've grown accustomed to reading about in the headlines," says lead researcher Mark C. Bicket, MD, director of the pain fellowship program and assistant professor of anesthesiology and critical care at Johns Hopkins University School of Medicine in Baltimore, Md. "We recognize that any solution to this problem requires interventions on multiple fronts — from prescribers, from patients and from policy makers."

Dr. Bicket says prescribers need more reliable data in the form of additional studies about the proper amount of pain-control medication — opioids and non-opioids alike — the average patient requires after specific types of surgery. He also says clinicians must do a better job of educating patients about how to use pain medications appropriately, including non-steroidal anti-inflammatory drugs and non-opioid analgesics such as acetaminophen.

"What we don't want to happen is exercise a reflexive, one-size-fits-all reduction that indiscriminately reduces opioids use across the board," he says. "Pain after surgery has often been undertreated, and opioids can be an essential tool in certain situations. We need to be cautious not to deny that."

Bill Donahue

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