Baltimore, MD—Just as pharmacists have suspected, a large portion of narcotic painkillers goes unused by postsurgical patients who fill prescriptions, and they rarely dispose of the excess drugs in recommended ways.

The article in JAMA Surgery was based on a review of six published studies in which patients self-reported use of opioids prescribed to them after surgery. Johns Hopkins University researchers found that a large majority of patients used only some of the pills or, in some cases, none at all. In addition, the study points out, more than 90% of patients receiving the prescriptions didn’t use recommended methods to dispose of the medications.

“Physicians write a lot of prescriptions for patients to fill for home use after they have inpatient or outpatient surgery, but our review suggests that there’s a lot we don’t know about how much pain medication people really need or use after common operations,” explained first author Mark Bicket, MD, an assistant professor of anesthesiology and critical care at the Johns Hopkins University School of Medicine.

Based on the review, 67% to 92% of the 810 patients in the studies did not use their entire opioid prescription. Yet they generally kept the drugs, creating an opportunity for misuse, Bicket emphasized.

He suggested that providing patient discretion in dosing for opioids—such as one pill every 4 hours “as needed” for pain—might not be the best approach, recommending instead that prescriptions and dosages be personalized for each patient.

“If we can better tailor the amount of opioids prescribed to the needs of patients, we can ensure patients receive appropriate pain control after surgery yet reduce the number of extra oxycodone and other opioid tablets in many homes that are just waiting to be lost, sold, taken by error, or accidentally discovered by a child,” Bicket said.

For the study, researchers searched three databases to examine published studies on opioid oversupply through October 18, 2016. Of the studies reviewed, six met criteria for inclusion and involved patients undergoing orthopedic surgery, urologic surgery, dermatologic surgery, thoracic surgery, Cesarean section, dental surgery, and general surgery, mostly outpatient.

A small number of patients either did not fill their opioid prescription (range of 0-21%) or filled the prescription but did not take any opioids (range of 7%-14%), the study noted. In total, between 42% and 71% of the pills went unused.

Most of the patients said they stopped taking opioids because their pain was controlled, but from 16% to 29% said opioid side effects, including nausea, vomiting, or constipations, caused them to discontinue the drugs, study authors report.

Two of the studies concerned storage safety, and the Johns Hopkins analysis indicates that around three-quarters of patients said their opioids were not stored in a locked container. Five of the studies looked at disposal practices and suggested that only a small percentage of patients properly disposed of unused opioids or planned to.

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