The majority of opioids prescribed after surgery go unused, creating leftover pills that have a high risk of being used inappropriately, according to a review conducted by the Johns Hopkins University and published this week in the Journal of the American Medical Association.
In a review of six different studies involving 810 total patients, researchers including Dr. Mark Bicket, assistant professor of anesthesiology and critical care medicine at Hopkins’ School of Medicine, found that two out of three patients did not use their entire opioid prescription after surgery, and did not dispose of the pills afterward.
Many opioid prescriptions offer vague dosage instructions, according to the study, such as suggesting one pill every four hours "as needed" for pain. Bicket said this creates a mismatch between what people are prescribed and what they need. The unused pills pose a risk of being abused, he added.
“They go undisposed, and they may be a reservoir for opioids that are used in nonindicated ways, meaning they’re misused and maybe diverted,” he said.
The findings come during a time when opioid abuse and drug overdoses are rampant in many American communities, including Baltimore. The city saw 694 overdose deaths last year, according to the state Department of Mental Health and Hygiene, comprising about one third of the 2,089 overdose deaths in the state. These numbers were a record high in Maryland and a 66 percent increase from 2015.
And on Friday, state health officials reported the number of drug-and alcohol-related deaths in Maryland climbed 37 percent in the first three months of this year, with the biggest increase related to people taking opioids laced with the potent additive fentanyl.
The 2015 National Survey on Drug Use and Health showed an estimated 3.8 million Americans use opioids in a nonmedical way every month, Bicket said. More than half of these people obtained opioids from a friend or relative, whether they were free, purchased or stolen. Having access to leftover opioid medication in the house after surgery leads to the potential for misuse, he said, and lead to use of more illicit drugs.
“Many patients who use heroin transition from using opioids," Bicket said.
The review also found that just 10 percent of the patients disposed of their prescription opioids in FDA-approved methods. Moreover, 73 percent to 77 percent of patients reported their prescription opioids were not stored in locked containers.
There are several reasons why patients might not use their entire prescription after surgery, Bicket said. The majority of patients in the study cited "adequate pain control,” while others stopped because of opiod-induced side effects.
Bicket said more personalized pain-management measures are necessary to prevent overprescription. He said that rather than using a “one-size-fits-all” approach, clinicians need to do a better job assessing the individual needs of each patient.
“We need better data about what patients actually use in terms of opioid medication and other medications after surgery,” he said.