IN BRIEF

Free Disposal Bags Increase Rate of Proper Opioid Disposal

August 1, 2019
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With or without the bags, families of young children prescribed opioids after surgery properly discard drugs at more than double the rate of adults prescribed post-operative opioids.

Handing parents a free drug-disposal bag and discussing its usage significantly increases the rate of proper disposal of unused opioid pain medication leftover after surgery, a study at Nationwide Children’s Hospital has found. The research was published in JAMA Pediatrics.

Of 77 parents who received the bag and filled their child’s opioid prescription, 85% reported properly disposing of unused liquid medicine or pills. Nearly all used the bag instead of options such as taking them to a drop-off box or flushing them.

Of 77 parents who did not receive the disposal bag and discussion, 65% reported they properly disposed of leftover drugs. Most flushed the drugs down the sink or toilet.

The proper disposal rates for both groups were more than twice the 10% to 30% rate reported in studies of adult patients prescribed opioids following surgery.

“It’s a really a good idea for physicians who prescribe opioids for acute pain to provide disposal bags or refer patients to pharmacies that provide them freely or have them available,” says Jennifer Cooper, PhD, a principal investigator in the Center for Innovation in Pediatric Practice in the Abigail Wexner Research Institute at Nationwide Children’s, and study leader.

“The findings show an easy, inexpensive tool can reduce the amount of opioids present in the home and community,” says Dr. Cooper, who is also a research assistant professor at The Ohio State University College of Medicine. “Combined with reducing unnecessary prescribing, these tools can hopefully reduce misuse and accidental use and the tragic consequences we often see.”

Studies have found that young children with opioids in the home are at risk for opioid overdose through unintentional ingestion. High rates of opioid misuse and nearly 10% of drug overdose deaths in the United States occur among adolescents and young adults. Drugs prescribed to family or friends and leftover pills from their own prescriptions are the most common sources.

In this randomized study, all families received opioid-use and disposal education; nearly all parents who participated were gauged to be adequately health literate. Most children in the study had undergone a tonsillectomy. Their average age was 6 to 7.

Staff engaged parents who received a bag in an additional discussion on the risks of opioids and the importance of proper disposal. Staff instructed parents to place all leftover drugs in the bag, which contains activated charcoal, then add water and shake. The charcoal-water mix deactivates the opioids and the bag can be thrown in the trash.

Follow-up calls and emails two to three weeks after surgery revealed that the number of days opioids were taken, dosage and reported pain did not differ by group.

The researchers suggest that the high rate of disposal by both groups compared to adult patients, and the finding that most parents disposed of the drugs quickly after stopping usage, may be due to the education provided.

 “Surprisingly, a slightly greater proportion of families who received the bag decided not to fill the opioid prescription at all,” Dr. Cooper says. “We think the additional discussion may have encouraged some families not to take that risk.”

The reported pain from these families was consistent with those who filled the prescription.

The study also indicates opioids were being prescribed in excess for some families. Quality initiatives and this study and others that track post-operative pain medication use have been used to reduce opioid prescriptions, but further reductions may be warranted, Dr. Cooper says.

 

Citation:

Lawrence AE, Carsel AJ, Leonhart KL, Richards HW, Harbaugh CM, Waljee JF, McLeod DJ, Walz PC, Minneci PC, Deans KJ, Cooper JN. Effect of drug disposal bag provision on proper disposal of unused opioids by families of pediatric surgical patients. JAMA Pediatrics. 2019 Jun 24:e191695.

Image credit: Nationwide Children’s