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      Opioid Use and Storage Patterns by Patients after Hospital Discharge following Surgery

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          Abstract

          Introduction

          Opioid-based analgesic therapy represents a cornerstone of pain management after surgery. The recent rise in opioid sales and opioid overdoses suggests it is important to maximize the safety of opioid prescribing after surgery. Given that patients may live with other family members in the home, safe storage and appropriate disposal of excess opioids after hospital discharge are necessary to prevent unintended secondary exposures. Identifying characteristics of patients who are likely to be prescribed excess opioids after surgery may enable more targeted prescription practices and safety interventions. Our study aimed to elucidate patient-reported opioid use patterns and modes of home storage of opioids among patients discharged home after Cesarean section (C-section) and thoracic surgery. Specifically, we sought to identify characteristics of patients who reported using about half or more versus less of the opioids prescribed to them for use after hospital discharge.

          Methods

          For this cohort study, we developed a survey on quality of analgesia following hospital discharge, amounts of opioids taken relative to the amount prescribed, reasons for not taking all prescribed medications, and storage and disposal methods for leftover opioids. Adult patients, who had C-section or thoracic surgery at a tertiary academic medical center, were given a web-based self-administered survey after discharge. Descriptive statistics (means and standard deviations, proportions) were used to describe the study sample and survey results. Comparisons between patients who reported taking about half or more versus less of the opioids prescribed to them for use after hospital discharge were made using unpaired t-tests, Mann-Whitney tests, and Chi-square tests as appropriate.

          Results

          The majority (53%) of respondents after C-section (N = 30) reported taking either no or very few (less than 5) prescribed opioid pills; 83% reported taking half or less; and 17% of women, reported taking all or nearly all (5 or fewer pills left over) of their opioid prescription. In a cohort of patients after thoracic surgery (n = 31) 45% reported taking either no or very few (5 or less) prescribed opioid pills; 71% reported taking half or less; and 29% of patients reported taking all or nearly all (5 or fewer pills left over) of their opioid prescription. In both cohorts, use of opioids while hospitalized was higher in the group reporting using about half or more of prescribed opioids after discharge. Leftover opioids were stored in an unlocked location in 77% and 73% of cases following C-section and thoracic surgery, respectively.

          Conclusion

          Our findings from surveys in two distinct patient populations at a single academic medical center suggest that current opioid prescribing practices for pain management at hospital discharge following Cesarean section and thoracic surgery may not account for individual patients’ analgesic requirements. Excess opioid pills are commonly stored in unsecured locations and represent a potential source for non-medical opioid use and associated morbidity and mortality in patients and their families. Research to develop goal-directed and patient-centered post-discharge opioid prescription practices and encourage opioid safety practices after surgery is needed.

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          Most cited references 14

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          Pharmaceutical overdose deaths, United States, 2010.

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            Overprescription of postoperative narcotics: a look at postoperative pain medication delivery, consumption and disposal in urological practice.

            Prescription narcotic abuse is a significant social problem. Surplus medication following surgery is 1 source of prescription diversion. We assessed prescribing practices, consumption and disposal of prescribed narcotics after urological surgery.
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              Prescription drug overdoses: a review.

              Overdoses involving prescription drugs in the United States have reached epidemic proportions over the past 20 years. This review categorizes and summarizes literature on the topic dating from the first published reports through 2011 using a traditional epidemiologic model of host, agent, and environment. Host factors include male sex, middle age, non-Hispanic white race, low income, and mental health problems. Agent risk factors include use of opioid analgesics and benzodiazepines, high prescribed dosage for opioid analgesics, multiple prescriptions, and multiple prescribers. Environmental factors include rural residence and high community prescribing rates. The epidemiology of prescription drug overdoses differs from the epidemiology of illicit drug overdoses. Incomplete understanding of prescription overdoses impedes prevention efforts. This epidemic demands additional attention from injury professionals. Published by Elsevier Ltd.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                29 January 2016
                2016
                : 11
                : 1
                Affiliations
                [1 ]Department of Anesthesiology, University of Colorado Denver, Aurora, Colorado, United States of America
                [2 ]Department of Anesthesiology, Children's Hospital Colorado, Aurora, Colorado, United States of America
                [3 ]Division of Substance Dependence, Department of Psychiatry, University of Colorado Denver, Aurora, Colorado, United States of America
                [4 ]Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States of America
                [5 ]Division of General Internal Medicine, Department of Medicine, University of Colorado Denver, Aurora, Colorado, United States of America
                Boston Children’s Hospital and Harvard Medical School, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KB LMM IAB. Performed the experiments: KB CD KJB. Analyzed the data: KB CJH IAB. Contributed reagents/materials/analysis tools: LMM KJB CD KB. Wrote the paper: KB CJH IAB.

                Article
                PONE-D-15-43236
                10.1371/journal.pone.0147972
                4732746
                26824844
                © 2016 Bartels et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 3, Tables: 0, Pages: 10
                Product
                Funding
                This work was supported by National Institutes of Health/ National Center for Advancing Translational Sciences Colorado Clinical and Translational Science Awards Grant Number UL1 TR001082. Dr. Hopfer was supported was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number K24DA03255 and Award Number R01DA035804. Dr. Binswanger was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number R34DA035952. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Analgesics
                Opioids
                Medicine and Health Sciences
                Pain Management
                Analgesics
                Opioids
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Opioids
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Obstetric Procedures
                Cesarean Section
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Thoracic Surgery
                Medicine and Health Sciences
                Surgical and Invasive Medical Procedures
                Research and Analysis Methods
                Research Design
                Survey Research
                Surveys
                Medicine and Health Sciences
                Pain Management
                Medicine and Health Sciences
                Pharmacology
                Drugs
                Analgesics
                Medicine and Health Sciences
                Pain Management
                Analgesics
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Analgesia
                Custom metadata
                All relevant data were appropriately de-identified and are within the paper and its Supporting Information files as well as in a limited data file held in a public repository accessible at http://dx.doi.org/10.5061/dryad.s0pb0.

                Uncategorized

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