Philadelphia—Pharmacists dispensing opioids to patients following surgical tooth extraction should assume that more than half of the pills will, in the best case, sit unused on a shelf, according to a new study outlining the possibility of more dire outcomes and how to avoid them.
The study, published recently in the journal Drug and Alcohol Dependence, warns that the leftover pills could be abused by friends and family members.
The investigators, led by researchers from the University of Pennsylvania’s Perelman School of Medicine and School of Dental Medicine, suggest that, to increase proper disposal of opioids by more than 20%, prescription disposal kiosks should be available in pharmacies and that a financial incentive should be offered to return unused painkillers.
“When translated to the broad U.S. population, our findings suggest that more than 100 million opioid pills prescribed to patients following surgical removal of impacted wisdom teeth are not used, leaving the door open for possible abuse or misuse by patients, or their friends or family,” explained lead author Brandon C. Maughan, MD, MHS, MSHP, who conducted the study while serving as a Robert Wood Johnson Foundation Clinical Scholar at the Perelman School of Medicine at the University of Pennsylvania. “Given the increasing concern about prescription opioid abuse in the United States, all prescribers—including physicians, oral surgeons and dental clinicians—have a responsibility to limit opioid exposure, to explain the risks of opioid misuse, and educate patients on proper drug disposal.”
For the study, opioid use was examined for 79 patients after dental impaction surgery, with researchers analyzing how a small financial incentive and information about a pharmacy-based drug disposal program would affect patients’ willingness to properly dispose of unused medications. Also tested was the effectiveness of a text message–based platform to collect data on pain and prescription medication use.
Study participants received a debit card preloaded with $10, with the option of receiving additional $3 credits—totaling $27—for completing pain-level and medication-use surveys. The questionnaires were delivered via text message every day for the first week following surgery, and again on days 14 and 21 following surgery. Patients who completed a follow-up health interview received an additional $10.
Within 24 hours after surgery, patients reported an average pain score of 5 out of 10 while taking pain medication, but, by the second day, more than half (51%) reported a low pain score (0-3 out of 10). That increased to nearly 80% reporting a low pain score by the fifth day.
Most of the patients, 94%, were prescribed opioids to manage pain, with 82% also receiving a prescription-strength nonsteroidal anti-inflammatory drug (NSAID), and 78% receiving a prescription antibiotic, according to the report.
Results indicate that, on average, participants who did not have postsurgical complications, 93%, received prescriptions containing 28 opioid pills, but only had used 13 within 3 weeks following surgery. In fact, only five patients used all of the prescribed pills.
Study authors also noted that offering information specific to a drug disposal program led to a 22% increase in the number of patients either properly disposing of, or planning to properly dispose of, leftover opioids.
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