"Extra" pain pills fuel opiate epidemic, researchers find

Sep 07 2017

“Extra” pain pills fuel opiate epidemic, researchers find

As an epidemic of opiate addiction has spread across America, public health officials have cited improper disposal of prescription pain pills as a major contributing factor. A new review conducted by researchers at Johns Hopkins University supports that belief.

The review indicates that most of the opioids prescribed after surgery go unused, resulting in leftover pills that increase the risk they will be used inappropriately. In a review of six different studies involving 810 total patients, a team led by 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.

The study notes that dosage instructions provided with opioid prescriptions are often too vague – for example, suggesting one pill every four hours “as needed” for pain. Bicket said this causes a disparity between what people are prescribed and what they need. The unused pills increase the risk of abuse, he told The Baltimore Sun. “Many patients who use heroin transition from using opioids,” Bicket said.

In a review of half a dozen published studies in which patients self-reported use of opioids prescribed to them after surgery, John Hopkins researchers reported that a large majority of patients used only some or none of the pills prescribed, and more than 90 percent failed to dispose of the leftovers in recommended ways.

A summary of the review, published August 2 in JAMA Surgery, emphasizes the need for more personalized pain management to avoid overprescribing opioids and reduce risks caused by improperly storing opioids in the home.

“Physicians write a lot of prescriptions for patients to fill for home use after they have inpatient or outpatient surgery, but our review suggests that there’s a lot we don’t know about how much pain medication people really need or use after common operations,” Bicket says.

In their review Bicket and his team found that 67 to 92 percent of a total of 810 patients in the six studies did not use their entire opioid prescription, yet kept their pills, increasing the risk of misuse, says Bicket.

Bicket says physicians need to do a better job of personalizing prescriptions and dosing for each patient. He also advises prescribers to spend more time assessing postoperative pain and prescribe smaller amounts of opioids or alternatives, as appropriate.

“If we can better tailor the amount of opioids prescribed to the needs of patients, we can ensure patients receive appropriate pain control after surgery yet reduce the number of extra oxycodone and other opioid tablets in many homes that are just waiting to be lost, sold, taken by error, or accidentally discovered by a child.”

The researchers found that between 67 and 92 percent of patients reported unused opioids. A small number of patients either did not fill their opioid prescription (range of 0 to 21 percent) or filled the prescription but did not take any opioids (range of 7 to 14 percent).

Overall, the researchers report, between 42 and 71 percent of prescribed pills dispensed went unused among the 810 patients.

A majority of patients reported they stopped or used no opioids due to adequate pain control, while 16 to 29 percent of patients reported they stopped due to medication side effects, such as nausea, vomiting or constipation.

“We need to do more research into why some people need more medication than others. Perhaps there are some characteristics in a patient, such as whether he/she is on opioids before the surgery or has certain genetic markers, that can let me determine that one needs more pain medication than another,” Bicket says.

The high rate of unused opioids found in the review indicates that doctors often prescribe more than patients need, he adds.

The most important message, Bicket says, is that “we need better data and tools to ensure patients have access to adequate pain relief after surgery while reducing the risks of opioid overprescribing.”