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Analysis Examines Amount of Prescribed Opioids Left Unused Following Dental Surgery and the Impact of an Intervention to Encourage Appropriate Medication Disposal

October 13, 2016 A recent in-press study1 attempted to assess the quantity of prescribed opioids left unused following outpatient dental surgery and to measure the impact of a behavioral intervention on patient willingness to appropriately dispose of unused medication.  A key hypothesis tested by the study was that patients who received specific information about a pharmacy-based drug disposal program would be more likely to appropriately dispose of unused medications than would patients who received routine postoperative discharge instructions.

Patients randomized to the control arm (n=39) received usual postoperative instructions along with a controlled substance information sheet that included details about adverse drug effects and the potential for drug dependence. The control information also contained a brief description of the risks of keeping unused opioid analgesics and information regarding a hotline that would provide direction for appropriate drug disposal. Participants in the intervention arm (n=40) received the same postoperative instructions as the control arm, with the addition of a single page of information that described risks of keeping unused prescription opioids and detailed the specifics of a pharmacy-based drug disposal program. The additional information explained that the study was investigating disposal of unused opioid medications at local pharmacies in exchange for a small in-store credit and patients were instructed the call the study hotline if they were interested in the program. Because regulations permitting pharmacy-based opioid disposal programs were established only a short time before the study was initiated, patients who called the study hotline would be informed that no drug disposal programs existed in the area and would be provided information on safe drug disposal.

A total of 72 patients ultimately filled opioid prescriptions. The informational behavioral intervention was associated with a 22% absolute increase in the proportion of patients who either disposed of or reported intent to dispose of unused opioids; this increase was not statistically significant.  The authors characterized the effect size of the intervention as “robust,” despite not reaching statistical significance, and postulated that the study was limited by a small sample size, lacking sufficient power to detect differences.  Patients received an average of 28 opioid pills per prescription and had 15 pills (54%) left over, for a total of 1,010 unused pills across the study.  In the Conclusions section, the authors suggested that “Dentists and oral surgeons could substantially reduce the amount of prescription opioids for diversion by reducing the quantity of opioids prescribed following these procedures…”

References

  1. Maughan BC, Hersh EV, Shofer FS, et al. Unused opioid analgesics and drug disposal following outpatient dental surgery: A randomized controlled trial. Drug Alcohol Depend 2016. In press.

Prepared by: Center for Scientific Information, ADA Science Institute

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