Guidelines for Patient Centered Opioid Prescribing and Optimal FDA-Compliant Disposal of Excess Pills after Inpatient Surgery: A Prospective Clinical Trial.

Abstract

BACKGROUND\nTo optimize responsible opioid prescribing after inpatient surgery, we implemented a clinical trial with two objectives. 1) Prospectively validate patient-centered opioid prescription (rx) guidelines. 2) Increase the FDA-compliant disposal rate of leftover opioid pills to higher than currently reported rates of 20-30%.\n\n\nSTUDY DESIGN\nWe prospectively enrolled 229 patients admitted for ≥ 48-hours after elective general, colorectal, urologic, gynecologic or thoracic surgery. At discharge, patients received a rx for both non-opioid analgesics and opioids based on their opioid usage the day prior to discharge: if 0-oral morphine milligram equivalents (MME) used, then 5-oxycodone 5 mg pill-equivalents (PE) prescribed; 1-29-MME used, 15-PE s prescribed; >30-MME used, 30-PE s prescribed. We considered patients opioid pain medication needs to be satisfied if no opioid refills were obtained. To improve FDA-compliant disposal of leftover pills we implemented: 1) patient education, 2) convenient drop-box 3) reminder phone call, and 4) questionnaire.\n\n\nRESULTS\nOur opioid guideline satisfied 93% (213/229) of patients. Satisfaction was significantly higher in lower opioid usage groups (p=0.001): 99% (99/100) in the 0-MME group, 90% (91/101) in the 1-29-MME group and 82% (23/28) in the >30-MME group. Overall, 95% (217/229) of patients used non-opioid analgesics. 60% (138/229) had leftover pills; 83% (114/138) disposed of them using an FDA-compliant method and 51% (58/114) utilized the convenient drop-box. Within 2604 prescribed pills, only 187 (7%) were kept by patients.\n\n\nCONCLUSION\nThis clinical trial prospectively validated a patient-centered opioid discharge rx guideline that satisfied 93% of patients. FDA-compliant disposal of excess pills was achieved in 83% of patients with easily actionable interventions.