Evaluation of a drug deactivation system for safe disposal of opioids after ambulatory surgery

Background

Prescription opioids are commonly prescribed postoperatively and increase the risk of diversion or misuse when left unused and accessible. Despite awareness of the risks associated with unused opioids, harm reduction strategies like safe storage and drug take-back events may be limited by inconvenience and patient-specific barriers to access.

Objective

To evaluate a quality improvement project designed to facilitate at-home disposal of unused opioids after day surgery.

Methods

An observational, prospective quality improvement project was conducted in patients undergoing elective outpatient surgery at Newton-Wellesley Hospital from December 2019 to June 2020. Upon discharge, eligible patients received a Deterra drug disposal packet which deactivates unused medication. Follow-up surveys assessed packet use and reasons for nonuse 1 to 2 weeks after surgery.

Results

One hundred six participants received a disposal packet and responded to the survey. Among the 67 respondents with unused medication, 30% used the packet. Women were more likely to use the packet than men (predicted probability 30.2% vs. 10.4%, P = 0.033), and patients aged 18–25 were more likely to use the packet than those aged 26–40 (40.0% vs. 9.5%, P = 0.049). The most common reasons for packet nonuse included procrastination, holding onto prescriptions in case of future pain, and waiting to dispose of multiple medications.

Conclusion

The majority of patients surveyed had unused opioids 1 to 2 weeks after surgery, and approximately 1 in 3 patients with unused doses utilized the disposal packet. Common reasons for nonuse included procrastination and concerns about needing future medication for pain. Going forward, safe drug disposal efforts may emphasize improved patient education, partial prescription fill options, or alert systems to remind patients to safely dispose of unused medication.