Effect of an Activated Charcoal Bag on Disposal of Unused Opioids After an Outpatient Surgical Procedure: A Randomized Clinical Trial.
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ABSTRACT:
SUBMITTER: Brummett CM
PROVIDER: S-EPMC6584709 | biostudies-literature | 2019 Jun
REPOSITORIES: biostudies-literature
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Effect of an Activated Charcoal Bag on Disposal of Unused Opioids After an Outpatient Surgical Procedure: A Randomized Clinical Trial.
Brummett Chad M CM Steiger Rena R Englesbe Michael M Khalsa Caitlin C DeBlanc Jennie J JJ Denton Lindsay R LR Waljee Jennifer J
JAMA surgery 20190601 6
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Project description:ImportanceAlthough opioids are an important component of pain management for children recovering from surgery, postoperative opioid prescribing has contributed to the current opioid crisis in the United States because these medications are often prescribed in excess and are rarely properly disposed. One potential strategy to combat opioid misuse is to remove excess postoperative opioids from circulation by providing patients with drug disposal products that enable safe disposal of opioids in the home garbage.ObjectiveTo determine whether the provision of a drug disposal bag increases proper opioid disposal among the families of pediatric patients undergoing ambulatory surgery.Design, setting, and participantsThis randomized clinical trial enrolled 202 parents or guardians of children 1 to 17 years of age who underwent otolaryngologic or urologic surgery at the outpatient surgery centers of a tertiary children's hospital in Columbus, Ohio, from June to December 2018 and who received an opioid prescription prior to discharge.InterventionsFamilies randomized to intervention were provided a drug disposal bag containing activated charcoal and instructions for use plus standard postoperative discharge instructions on opioid use, storage, and disposal. Families in standard care arm received standard postoperative discharge instructions only. All participants completed a baseline survey and a follow-up survey 2 to 4 weeks postoperatively.Main outcomes and measuresPrimary outcome was proper opioid disposal, defined as disposal using a drug disposal bag or a disposal method recommended by the US Food and Drug Administration.ResultsOf 202 parents or guardians enrolled, 181 completed follow-up (92 in intervention arm and 89 in standard care arm). Most patients in both groups were white (75 [73.5%] vs 79 [80.6%]) and male (63 [61.2%] vs 54 [54.6%]), and the median (interquartile range) age was 6 (5-9) years in the intervention arm and 7 (6-10) years in the standard care arm. For intention-to-treat analyses, 92 families receiving a disposal bag and 89 families not receiving a disposal bag were included. Among them, 66 families (71.7%) randomized to receive a disposal bag reported properly disposing of their child's opioids, whereas 50 parents (56.2%) who did not receive a disposal bag reported proper opioid disposal (difference in proportions, 15.5%; 95% CI, 1.7%-29.3%; P = .03). Among only those families who filled an opioid prescription and had leftover opioids after resolution of their child's pain, 66 of 77 parents or guardians (85.7%) who had received a disposal bag and 50 of 77 parents or guardians (64.9%) who had received standard care reported properly disposing of their child's opioids (difference in proportions, 20.8%; 95% CI, 7.6%-34.0%).Conclusions and relevanceResults of this study indicated that providing drug disposal bags to families of children receiving postoperative opioids increased the likelihood of excess opioid disposal. Greater availability of disposal products may complement ongoing prescribing reduction efforts aimed at decreasing opioid misuse.Trial registrationClinicalTrials.gov identifier: NCT03575377.
| S-EPMC6593625 | biostudies-literature
Project description:ObjectiveOne strategy to combat opioid misuse is to remove excess opioids from circulation by providing patients with drug disposal products that enable the safe disposal of opioids. We aimed to evaluate opioid use and disposal of unused opioids among children and young adults before and after pharmacy staff at our institution began to provide patients and families filling opioid prescriptions with a drug disposal bag.MethodsWe performed a prospective pre-post cohort study of patients who filled an opioid prescription in May-August 2019 at the outpatient pharmacies of a large tertiary children's hospital. Patients and caregivers were enrolled at the time the opioids were dispensed. During the first half of the study period, standard opioid-related education was offered by pharmacy staff. During the second half of the study period, standard education was offered, and a drug disposal bag and instructions on its use were provided when the opioids were dispensed. A follow-up survey to assess opioid use and disposal was completed online or by telephone 4-7 weeks after the opioids were dispensed.ResultsA total of 215 participants were enrolled; 117 received a drug disposal bag and 98 did not. Of those, 68% of the participants completed a follow-up survey. In both groups, the median patient age was 11 years, and most patients had been prescribed opioids after a procedure. More than 70% had opioids leftover after they had stopped taking them, and this did not vary by group. However, among families with leftover opioids, the receipt of a drug disposal bag was associated with a higher likelihood of disposal of the unused opioids (71.7% vs. 52.1%, P = 0.04).ConclusionProviding a drug disposal bag to families of children receiving opioids increases the likelihood of excess opioid disposal. Greater availability of drug disposal products can complement prescribing reduction efforts aimed at decreasing prescription opioid misuse.
| S-EPMC7796943 | biostudies-literature
Project description:Introduction: Opioid misuse and overprescription have contributed to a national public health crisis in the United States. Postoperatively, patients are often left with unused opioids, which pose a risk for diversion if not appropriately disposed of. Patients are infrequently provided instructions on safe disposal methods of surplus opioids. Purpose: We sought to determine the current rates of disposal of unused opioids and the reported disposal mechanisms for unused opioids that were prescribed for acute postoperative pain control. Methods: A systematic review was performed of the PubMed, Cochrane, and Embase databases for relevant articles from their earliest entries through October 2, 2019. We used the search terms "opioid" or "narcotic" and "disposal" and "surgery." Studies were considered for inclusion if they reported the rate of disposal of unused opioids following surgery. A screening strategy was used to identify relevant articles using Covidence. For studies meeting inclusion criteria, relevant information was extracted. Results: Sixteen studies met inclusion criteria. We found that surplus opioid disposal rates varied widely, from 4.9% to 87.0%. Among studies with no intervention (opioid disposal education or drug disposal kit/bag), rates of opioid disposal ranged from 4.9% to 46.5%. While 7 studies used opioid disposal education as an intervention, only 3 showed a significant increase in surplus opioid disposal compared with standard care. All 3 studies that used an opioid disposal kit or bag as an intervention demonstrated significant increases in opioid disposal. Conclusions: Baseline rates of surplus opioid disposal are relatively low in the postoperative setting. Our findings suggest that opioid disposal kits significantly increase rates of surplus opioid disposal postoperatively. Further research, including a large-scale cost-benefit analysis, will be necessary prior to recommending widespread implementation of drug disposal kits or bags.
| S-EPMC8361585 | biostudies-literature
Project description:ObjectiveTo evaluate the effects of an environmentally friendly drug deactivation bag on opioid disposal among patients undergoing gynecologic surgery.MethodsThis prospective cohort study included patients undergoing gynecologic procedures requiring an opioid prescription from March 2020 to December 2020. Patients were managed on a restrictive opioid prescribing algorithm and given an opioid disposal bag. The carbon drug deactivation bag neutralizes the opioid medication and can be discarded safely in the trash. Patients were educated about pain management goals and the disposal bag. Patients were surveyed at their postoperative visit to evaluate satisfaction, number of leftover pills, and disposal methods. Statistical analysis was performed using SPSS Statistics 26.ResultsTwo hundred patients were asked to complete the survey, with a response rate of 78%. The most common procedures were exploratory laparotomy (50%) and minimally invasive hysterectomy (41%). Most patients (91%, 95% CI 91-97) filled their opioid prescription and 64 (41%, 95% CI 34-48) had leftover opioid pills. Most patients with leftover opioid pills (73%, 95% CI 67-79) discarded them; 78%, 95% CI 69-80 used the disposal bag. Patients undergoing an exploratory laparotomy most commonly used the disposal bag. All patients who used the disposal bag stated they would use it again.ConclusionDespite a restrictive opioid prescribing algorithm, 41% of gynecologic surgical patients had leftover opioid pills. This study demonstrated that leftover opioid pills were safely discarded 73% of the time when patients were provided an opioid disposal bag and preoperative education.
| S-EPMC8717636 | biostudies-literature
Project description: Not available
| S-EPMC9077482 | biostudies-literature
Project description:Leftover prescription opioids pose risks to children and adolescents, yet many parents keep these medications in the home. Our objective in this study was to determine if providing a behavioral disposal method (ie, Nudge) with or without a Scenario-Tailored Opioid Messaging Program (STOMP) (risk-enhancement education) improves parents' opioid-disposal behavior after their children's use. Parents whose children were prescribed a short course of opioids were recruited and randomly assigned to the Nudge or control groups with or without STOMP. Parents completed surveys at baseline and 7 and 14 days. Main outcomes were (1) prompt disposal (ie, immediate disposal of leftovers after use) and (2) planned retention (intention to keep leftovers). There were 517 parents who took part, and 93% had leftovers after use. Prompt disposal behavior was higher for parents who received both the STOMP and Nudge interventions (38.5%), Nudge alone (33.3%), or STOMP alone (31%) compared with controls (19.2%; P ≤ .02). Furthermore, the STOMP intervention independently decreased planned retention rates (5.6% vs 12.5% no STOMP; adjusted odds ratio [aOR] 0.40 [95% confidence interval (CI) 0.19-0.85]). Higher risk perception lowered the odds of planned retention (aOR 0.87 [95% CI 0.79-0.96]), whereas parental past opioid misuse increased those odds (aOR 4.44 [95% CI 1.67-11.79]). Providing a disposal method nudged parents to dispose of their children's leftover opioids promptly after use, whereas STOMP boosted prompt disposal and reduced planned retention. Such strategies can reduce the presence of risky leftover medications in the home and decrease the risks posed to children and adolescents.
| S-EPMC6939843 | biostudies-literature
Project description:ObjectiveTo determine the impact of a drug deactivation system to post-surgical patients on the rate of opioid prescription disposal.Patients and methodsTwo hundred post-operative patients discharged after inpatient surgery at a large academic medical center. This study was conducted August 20, 2018, through November 30, 2018. Patients were provided with a drug deactivation system (DDS) and instruction sheet along with their opioid prescription. Three to 4 weeks after dismissal, patients were surveyed about quantity of opioids remaining, use of DDS or other disposal methods, and satisfaction with DDS if used.ResultsOne hundred forty-nine of 200 (74.5%) patients were surveyed. One hundred six reported leftover opioids and 29 (27.3%) had disposed of these medications. By the time of survey, 23 (21.2%) participants with leftover opioids had used the DDS to destroy their remaining supply and an additional 33 (31.1%) participants reported plans to use the disposal bag on a future date. Of the 23 participants who used the DDS, 22 (96.0%) reported that they were very satisfied with the disposal process.ConclusionParticipants are willing to use a DDS and are satisfied with the process; however, additional education is needed to ensure timely disposal.
| S-EPMC7411158 | biostudies-literature
Project description:IntroductionCommunities throughout the United States have implemented medicine disposal programs to prevent diversion of unused opioid analgesics from homes but a general lack of awareness may contribute to low rates of utilization. The objective of this study was to develop and test community-based campaign messages promoting appropriate disposal of unused opioids at disposal programs.MethodsIn Fall 2019, 491 residents (79% female, 97% White, mean age: 40 years) of five rural, Appalachian counties (3 in Kentucky and 2 in North Carolina) completed a web-based, experimental survey. Participants were randomly exposed to two of four messages and rated each message separately. A pretest-posttest design was utilized to assess change in beliefs about retaining unused prescription opioids in the home following exposure to message sets.ResultsAll messages favorably influenced participants' perceptions related to concerns and risks of retaining unused prescription opioids and importance of - and self-efficacy in disposing of unused opioid medications. After controlling for social and demographic characteristics and baseline beliefs in generalized linear mixed models, Message 1 outperformed other messages in increasing participants' concern about retaining unused prescription opioids in the home and Message 3 was most effective in increasing self-efficacy to dispose of unused prescription opioids.ConclusionsMessages including young children and pictorially demonstrate how to dispose of medications may have the greatest impact on behavioral actions related to medication disposal. The findings from this study can be used to inform community-based campaigns to facilitate disposal of unused prescription opioids.
| S-EPMC7752658 | biostudies-literature
Project description:BackgroundThe community practice towards disposal of expired and unused medications in spite of its adverse impact have been widely neglected in many developing countries. The available guidelines in Tanzania focus on the disposal of expired medications and cosmetics in hospitals and community pharmacies only.AimThe aim of this study was to assess the disposal practice of expired and unused medications at household level in Mwanza city, north-western Tanzania.MethodologyThe household based cross-sectional study was conducted among 359 randomly selected household members. Semi-structured questionnaires were used for interview during data collection and while STATA® version 13 was used for analysis.ResultsOut 359 households visited, 252 (70.19%) had medications kept in their houses at the time of data collection. Among them, 10 (4.0%) households had kept medications at their houses because they were still continuing with treatment while 242 (96.0%) kept unused medications which were supposed to be discarded. The main reason for keeping unused or expired medications at home was uncompleted course of treatment (199 (82.20%) after feeling that they had recovered from illness. The main reason for discarding medications were recovering from illness (141(48.7%) and expiry (136 (46.9%). The major discarding practices for medications were disposing into domestic trashes (219 (75.5%) and pit latrines (45 (15.5%). Majority of respondents (273 (76%) were aware that improper disposal of expired medications are detrimental to human health and environment in general.ConclusionImproper disposal of unused and expired medications at household level was a common practice in the study area. Tailor-made interventions by the Food and Drugs Authority (FDA) and other national as well as local stake holders are urgently needed to address the situation.
| S-EPMC7861449 | biostudies-literature
Project description:ObjectiveAccumulation at home and improper disposal of unused medicines pose a major public health problem. Knowledge and attitude of patients may contribute to accumulation and disposal practice of unused medicines. As there are no such data at the study setting, this study aimed to assess disposal practices, knowledge and attitude of adult patients visiting outpatient pharmacy (OPD) towards unused medicines.DesignDescriptive cross-sectional design.SettingDebre Tabor Comprehensive Specialized Hospital, Debre Tabor, Ethiopia.ParticipantsAdults who visited OPD services agreed to participate and were selected using systematic random sampling technique from 31 May to 30 June 2022. Data were collected through face-to-face interview using a questionnaire.Data analysisData were entered and analysed using SPSS V.26.0. Variables of interest were described in frequency and presented in tables.ResultsIn total, 257 participants were included in the analysis. Of these, 55.6% were male. The prevalence of unused medicines at home was 47.5%. The majority of respondents (183, 71.2%) knew that improper disposal of unused medicines could cause harm. However, more than half of respondents did not know about medicine waste and had no prior information about medicine disposal instructions. Regarding their attitude, 203 (79%) of respondents 'agreed' that there are potential risks associated with having unused medicines at home, and 163 (63.4%) 'strongly agreed' that children are more vulnerable to the risks associated with unused medicines. The most preferred disposal practice for unused medicines was throwing them in household garbage (108, 42%) followed by flushing down the toilets/sinks (77, 30%).ConclusionThe majority of participants disposed of unused and expired medicine in household garbage and toilets/sinks. This is in contrast to the recommendations of national and international policies and guidelines for safe and appropriate pharmaceutical waste disposal.
| S-EPMC11499776 | biostudies-literature