Abstract
Background:
Opioid analgesics are commonly prescribed for postoperative analgesia following pediatric surgery and often result in leftover opioid analgesics in the home. In order to reduce the volume of leftover opioids and overall community opioid burden, the State of Tennessee enacted a policy to reduce initial opioid prescribing to a 3-day supply for most acute pain incidents. We aimed to evaluate the extent of leftover opioid analgesics following pediatric ambulatory surgeries in the context of a state-mandated restrictive opioid prescribing policy. We also aimed to evaluate opioid disposal rates, methods of disposal, and reasons for non-disposal.
Methods:
Study personnel contacted the parents of 300 pediatric patients discharged with an opioid prescription following pediatric ambulatory surgery. Parents completed a retrospective telephone survey regarding opioid use and disposal. Data from the survey were combined with data from the medical record to evaluate proportion of opioid doses prescribed that were leftover.
Results:
The final analyzable sample of n=185 patients (62% response rate) were prescribed a median of 12 opioid doses (IQR: 12 – 18), consumed 2 opioid doses (IQR: 0 – 4), and had 10 opioid doses leftover (IQR: 7 – 13). Over 90% (n = 170/185) of parents reported they had leftover opioid analgesics, with 83% of prescribed doses leftover. A significant proportion (29%, n = 54/185) of parents administered no prescribed opioids after surgery. Less than half (42%, n = 71/170) of parents disposed of the leftover opioid medication, most commonly by flushing down the toilet, pouring down the sink, or throwing in the garbage. Parents retaining leftover opioids (53%, n = 90/170) were most likely to keep them in an unlocked location (68%, n = 61/90). Parents described forgetfulness and worry that their child will experience pain in the future as primary reasons for not disposing of the leftover opioid medication.
Conclusions:
Despite Tennessee’s policy aimed at reducing leftover opioids, a significant proportion of prescribed opioids were leftover following pediatric ambulatory surgeries. A majority of parents did not engage in safe opioid disposal practices. Given safety risks related to leftover opioids in the home, further interventions to improve disposal rates and tailor opioid prescribing are warranted after pediatric surgery.
Keywords: children, adolescents, prescription medication, drug safety, oxycodone
Introduction
Opioid analgesics are commonly prescribed in nearly half of pediatric ambulatory surgical encounters in the United States.1 Although opioid analgesics are effective at achieving acute analgesia, opioid prescribing practices have received increased scrutiny over the past decade due to the significant risks of overuse, misuse, addiction, diversion, and death due to overdose.2 While the recent rise in adult opioid overdoses in the United States was predominately attributed to illegal opioids such as synthetic fentanyl and heroin,3 opioids leftover from prescriptions for medical use can also pose a significant danger to families with children. For adolescents, access to prescription opioid medication has been associated with increased risk for non-medical opioid use and substance use disorder symptoms4-7 during a vulnerable developmental period.4,8,9 Improperly stored opioids pose a significant risk for young children due to their developmental stage and exploratory behaviors.10 Thus, evaluating and reducing leftover opioids in the homes of pediatric populations is important for mitigating opioid-related risks.
A number of factors can influence the volume of opioids prescribed and consumed following surgery. These include provider behavior, hospital or state policies, anesthetic technique, utilization of non-opioid analgesics, invasiveness of the surgical procedure, postoperative pain severity, and family beliefs regarding opioid use.11 In an effort to reduce the volume of leftover opioids and overall community opioid pill burden, the State of Tennessee enacted a policy to reduce initial opioid prescribing to a 3-day supply for most acute pain incidents.12 Quantifying leftover opioid analgesics in the context of these significant opioid prescribing restrictions has important implications for informing policy modifications and clinical practice.
Despite known risks of opioid analgesics, few families dispose of leftover opioid analgesics or engage in safe storage practices.13-17 The United States Food and Drug Administration (FDA) currently suggests that families take their leftover medication to a medication take-back location such as a police station or pharmacy, flush the drug down the toilet, or mix the drug with an undesirable substance like cat litter and throw in the trash.18 Data, however, suggest that less than 50% of parents dispose of leftover opioid medications.13-17 Understanding current opioid disposal rates, methods, and barriers are important for tailoring and targeting messaging to families to increase disposal rates for unused opioids.
We aimed to evaluate the amount of opioid analgesics prescribed, consumed, leftover, and disposed of following elective pediatric ambulatory surgeries at a tertiary pediatric hospital in Tennessee. We sought to evaluate the extent to which opioid prescriptions and consumption varied by demographic factors, average postoperative pain, and type of ambulatory surgery. We hypothesized that older age, greater postoperative pain intensity, and more invasive surgical procedures would result in larger opioid prescriptions and greater opioid consumption. Finally, we aimed to describe factors influencing opioid disposal (e.g., whether or not additional leftover opioids were in the home), methods of opioid disposal, and reasons for non-disposal.
Methods
Participants were parents or legal guardians of consecutive pediatric patients receiving an opioid prescription following an elective ambulatory surgery between January 1, 2020 and March 26, 2020. Parents were eligible for the current study if they received and filled an opioid prescription for a child between the ages of 0-17 years-old following an elective ambulatory surgical procedure, were English speaking, and able to answer a short 5-minute survey. Parents were excluded from the current study if their child was admitted to the hospital following the procedure or if their child was still taking the opioid at the time of the survey.
All procedures were approved by the Vanderbilt University Medical Center Institutional Review Board as a quality improvement project with the aim to improve opioid disposal rates. Data presented in this manuscript represents baseline data prior to any adjustments to clinical care regarding recommendations for proper opioid disposal. Study personnel contacted potentially eligible participants to complete a brief survey regarding opioid use and disposal between March 30, 2020 and May 20, 2020. Study personnel conducting phone calls were not involved in clinical decision-making regarding patient opioid prescriptions, surgeons prescribing the opioids were unaware of the current study, and parents were not told about this quality improvement project at the time of surgery. Thus, we made every attempt to reduce potential bias in prescribing or opioid use patterns due to the current study. In the context of these ambulatory pain management procedures, parents are typically instructed to either alternate weight-based dosages of acetaminophen and ibuprofen every six hours or give both agents together every six hours, utilizing opioid analgesics if the child experiences breakthrough pain.
Figure 1 presents the flow of participant recruitment. Of 300 potentially eligible participants, 191 parents (64%) completed the survey. Only one parent started the survey and discontinued by choice. Of the 191 parents completing the survey, six parents were excluded from data analysis due to not filling the prescription (n = 5), and child still using the medication (n = 1). Thus, the final sample for data analysis comprised 185 parents who filled an opioid prescription for pain control following their child’s surgery. The time between day of surgery and follow-up ranged from 2.49 weeks to 19.94 weeks (mean = 9.38 weeks, SD = 4.95).
Figure 1.
Flowchart for study participation and opioid disposal outcomes
Note. Data presented as (% [95% CI], n).
Study data were collected and managed using REDCap (Research Electronic Data Capture) electronic data capture tools, a secure, web-based software platform designed to support data capture for research studies, hosted at Vanderbilt University.19,20 Survey questions assessed for number of opioid doses administered (open-ended, “Approximately how many times did your child take the opioid medication?”), leftover opioids (fixed ranges, “What percentage of the opioid prescription bottle would you estimate was leftover?”), opioid disposal (yes/no/unknown, “Did you do anything to get rid of your child’s opioid prescription?”), method of disposal (open-ended, “How did you get rid of it?”), methods of handling leftover medication retained (open-ended, “What did you do with the leftover medication?”), and reasons for having leftover medication in the home (open-ended, “What is the primary reason you have not disposed of your child’s opioid medication?”). Open-ended responses were either coded in the moment to fit with pre-existing categories or recorded for later coding. Parents further estimated their child’s average pain score during the postoperative period on a 0-10 numeric rating scale (0 = no pain, 10 = worst pain possible) and also indicated if they had any other leftover opioid medications in the home (“Approximately how many leftover opioid prescriptions are currently in your home?”). Parents who indicated the presence of at least one leftover opioid prescription other than the one from their child’s surgery were coded as having additional prescribed opioids in the home.
Survey responses were combined with data pulled from the child’s electronic medical record including date of surgery, child sex, age, procedure, surgical service, and opioid prescription (type, form, dose, frequency). Opioid prescription data were converted to total morphine milligram equivalents (MMEs) per prescription to standardize data reporting across opioid types and forms (liquid versus tablets). Surgical procedures were grouped into five categories: hernia and other urologic surgery, soft tissue surgery, orthopedic extremity surgery, complex ear surgery, and tonsillectomy/adenoidectomy. The included surgical procedures were stratified into these groups based on type of surgery, expected duration of postoperative pain, and expected severity of postoperative pain.
Statistical Analysis.
Data analysis was conducted using SPSS version 25. Primary outcomes evaluated included number of opioid doses prescribed, consumed, and leftover. The number of opioid doses leftover was computed by subtracting the number of doses consumed (parent report) from the number of opioid doses prescribed (electronic medical record). Due to the skewed nature of the opioid data, medians with interquartile ranges (IQR) were used as the best representation of central tendency. Statistical analyses first aimed to describe the relationship between opioid outcomes, key demographic factors (child age, sex, and race), and average postoperative pain intensity. Nonparametric correlations (Spearman’s rho) were used to evaluate the relationship between continuous factors (child age, average postoperative pain intensity) and opioid outcomes. Nonparametric Mann-Whitney U tests evaluated the association of child sex (Male vs Female) and race (Non-Hispanic White vs Minority Group) with opioid outcomes. Kruskal-Wallis H tests evaluated differences between surgery type regarding opioid outcomes (number of doses prescribed, consumed, leftover). Pairwise comparisons following significant Kruskal-Wallis H tests were evaluated using z-tests with a Bonferroni adjusted p-value corrected for 10 comparisons (adjusted significance criterion of P < 0.005). Furthermore, rates of leftover opioids, disposal, methods of disposal, and reasons for non-disposal were evaluated using descriptive statistics. Chi-square tests evaluated whether rates of opioid disposal significantly differed based on having additional leftover opioid prescriptions in the home (yes/no).
An initial recruitment of 300 patients was targeted a priori based on clinical data to capture approximately 3 months of pediatric ambulatory surgical patients. As the primary outcomes were descriptive in nature, the width of 95% confidence intervals (CI) for observed proportions and correlations was estimated using the percentile bootstrap method to aid interpretation of the findings. Bootstrap resampling is a robust technique to estimate standard errors and confidence intervals non-parametrically. In the present study, bootstrapping used case resampling with replacement from the original dataset, a 95% CI, and 1000 bootstrap samples. CIs used the 2.5th and 97.5th percentiles of the bootstrap values as the lower and upper bounds of the interval.
Results
Children were most commonly discharged with a 3-day supply of oxycodone hydrochloride (HCl) in liquid form (Table 1). Children were prescribed a median of 12 opioid doses (IQR: 12 – 18), consumed a median of 2 doses (IQR: 0 – 4), and had a median of 10 doses leftover (IQR: 7 – 13). Nonparametric correlations (Spearman’s rho) between age, opioid-related outcomes, and postoperative pain intensity are summarized in Table 2. Higher child average pain intensity (parent proxy-report) was significantly related to greater number of opioid doses consumed, but not with the number of opioid doses prescribed or leftover. Older child age significantly correlated with fewer opioid doses leftover. The number of opioid doses prescribed and consumed were not significantly related to child age. The number of opioid doses prescribed, consumed, and leftover also did not significantly differ by child sex or race (p-values > 0.05).
Table 1.
Demographic characteristics of the sample
| Demographic factor | Pediatric patients (n = 185) |
|---|---|
| Child sex, % (n) | |
| Male | 58%, 107 |
| Female | 42%, 78 |
| Child age, Mean (SD) | 9.10 (4.27) |
| Child age category, % (n) | |
| 0 - 4 years-old | 14%, 26 |
| 5 - 11 years-old | 57%, 105 |
| 12+ years-old | 29%, 54 |
| Child race, % (n) | |
| White | 79%, 146 |
| Black | 17%, 31 |
| Asian | 2%, 3 |
| Other | 2%, 4 |
| Child ethnicity, % (n) | |
| Hispanic | 2%, 4 |
| Number of children in home, Median (IQR) | 1 (1 – 2) |
| Other leftover opioid prescription(s) in home, % (n) | |
| Yes | 14% (25) |
| No | 86% (158) |
| Surgical procedure, % (n) | |
| Hernia and other urologic | 19%, 36 |
| Soft tissue | 25%, 47 |
| Orthopedic extremity | 17%, 31 |
| Complex ear | 11%, 20 |
| Tonsillectomy/adenoidectomy | 28%, 51 |
| Type of opioid prescribed, % (n) | |
| Oxycodone HCI | 82%, 151 |
| Hydrocodone/Acetaminophen | 17%, 31 |
| Tramadol HCL | 1%, 3 |
| Opioid form, % (n) | |
| Liquid | 72 %, 134 |
| Tablets | 28%, 51 |
| Weight-based dosing, % (n) | |
| Yes | 56%, 103 |
| No | 42%, 78 |
| Not specified | 2%, 4 |
| Opioid RX duration in days, % (n) | |
| 1-2 days | 8%, 14 |
| 3 days | 71%, 131 |
| 5 days | 17%, 32 |
| 7-8 days | 2%, 4 |
| Total MMEs prescribed, Median (IQR) | 45 (27 – 67) |
| Average postoperative pain intensity (0 - 10), Mean (SD) | 5.72 (2.38) |
Table 2.
The relationship between age, opioid-related outcomes, and postoperative pain intensity
| 1. | 2. | 3. | 4. | 5. | |
|---|---|---|---|---|---|
| 1. Age at surgery | -- | ||||
| 2. Average postoperative pain intensity | −0.02 (−0.16, 0.13) | -- | |||
| 3. Opioid doses prescribed | −0.11 (−0.26, 0.05) | 0.08 (−0.07, 0.23) | -- | ||
| 4. Opioid doses consumed | 0.14 (−0.24, 0.28) | 0.42** (0.29, 0.53) | 0.08 (−0.08, 0.23) | -- | |
| 5. Opioid doses leftover | −0.21** (−0.36, −0.06) | −0.12 (−0.27, 0.02) | 0.77** (0.67, 0.85) | −0.46** (−0.60, −0.30) | -- |
Note: Values are Spearman’s rho with the 95% confidence interval based on 1000 bootstrap samples; opioid doses leftover represents the difference between opioid doses prescribed and consumed
p-value < 0.01
The number of opioid doses prescribed significantly differed by surgical procedure (Table 3), χ2(4) = 32.15, p < .001. Pairwise comparisons indicated patients undergoing tonsillectomy and/or adenoidectomy received significantly more opioid doses than patients undergoing hernia and other urologic surgery (z = 5.04, p < 0.001), soft tissue surgery (z = 4.19, adjusted p < 0.001), and orthopedic extremity surgery (z = 3.67, p < 0.001). Similarly, there was a statistically significant difference in opioid doses consumed by surgical procedure, χ2(4) = 11.87, p = .018. Pairwise comparisons indicated patients undergoing tonsillectomy and/or adenoidectomy, compared to soft tissue surgery, consumed significantly more opioids (z = 2.82, p = 0.0048).
Table 3.
Opioids prescribed, consumed, and leftover following pediatric ambulatory surgery by surgery type
| Surgery Type | n | Age Mean (SD) |
MMEs Prescribed, Median (IQR) |
Doses Prescribed, Median (IQR) |
Doses Consumed, Median (IQR) |
Doses Leftover, Median (IQR) |
% RX Doses Leftover,* Median (IQR) |
Patient used no opioid, % (n) |
Patient used 100% of opioid, % (n) |
Patients with leftover opioids, % (n) |
Opioid Disposal, % (n) |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Hernia and other urologic | 36 | 7.03 (3.51) | 26 (15, 45) | 12 (9, 12) | 1 (0, 3) | 9 (7, 11) | 89% (75%, 100%) | 33% (12) | 8% (3) | 92% (33) | 30% (9) |
| Soft tissue | 47 | 8.81 (5.63) | 38 (23, 60) | 12 (8, 18) | 1 (0, 3) | 10 (6, 16) | 94% (70%, 100%) | 43% (20) | 9% (4) | 92% (43) | 51% (21) |
| Orthopedic extremity | 31 | 11.81 (3.97) | 88 (59, 90) | 12 (12, 12) | 3 (1, 6) | 9 (5, 11) | 75% (42%, 92%) | 19% (6) | 13% (4) | 87% (27) | 48% (12) |
| Complex ear | 20 | 9.14 (3.47) | 59 (24, 68) | 14 (11, 18) | 3 (0, 5) | 11 (7, 15) | 78% (71%, 99%) | 25% (5) | 5% (1) | 95% (19) | 42% (8) |
| Tonsillectomy/adenoidectomy | 51 | 7.88 (2.63) | 45 (36, 60) | 18 (12, 20) | 3 (1, 5) | 12 (10, 18) | 80% (67%, 95%) | 22% (11) | 6% (3) | 94% (48) | 46% (21) |
| Overall | 185 | 8.75 (4.28) | 45 (27, 68) | 12 (12, 18) | 2 (0, 4) | 10 (7, 13) | 83% (67%, 100%) | 29% (54) | 8% (15) | 92% (170) | 42% (71) |
% RX Doses Leftover = the percent of opioid doses prescribed that were leftover
Figure 1 presents an overview of rates of leftover opioids, opioid disposal, and opioid storage in the current study. The vast majority of families had leftover opioid medication (92%, n = 170/185, 95% CI: 88%, 96%) and few used the entire opioid prescription (8%, n =15/185, 95% CI: 4%, 12%). Less than half of parents (42%, n = 71/170, 95% CI: 34%, 49%) disposed of their leftover opioid medication. Flushing down the toilet or pouring down the sink was the most common disposal method, followed by throwing the opioids in the garbage. Few parents used a secure opioid disposal site such as a pharmacy, medical provider, or law enforcement office (Table 4). Opioid disposal rates significantly differed between parents with other leftover opioid prescriptions in the home (disposed: 23% [95% CI: 6%, 42%], n = 5/22; did not dispose: 77% [95% CI: 58%, 94%], n = 17/22) and parents without additional leftover prescriptions in the home (disposed: 48% [95% CI: 39%, 56%], 66/139, did not dispose: 53% [95% CI: 44%, 61%], n = 73/139), X2 (1,) = 4.72, p = 0.03. Rates of opioid disposal did not significantly differ by surgery type (Table 3).
Table 4.
Methods for opioid disposal and reasons for non-disposal
| Parent response | %, n | 95% CI |
|---|---|---|
| Method of disposal | ||
| Toilet or sink | 22%, 37/170 | 15% - 28% |
| Trash | 11%, 18/170 | 6% - 15% |
| Pharmacy or provider | 5%, 8/170 | 2% - 8% |
| Law enforcement | 5%, 8/170 | 2% - 8% |
| Reason for non-disposal | ||
| Forgot | 19%, 33/170 | 14% - 16% |
| Child future pain | 15%, 26/170 | 10% - 21% |
| Waiting for opportunity (e.g., drug takeback event) | 8%, 13/170 | 4% - 12% |
| Don’t know how | 5%, 8/170 | 2% - 8% |
| Medicine had not expired | 2%, 3/170 | 0% - 4% |
| Financial loss | 1%, 2/170 | 0% - 3% |
| Need for someone else | 1%, 2/170 | 0% - 3% |
| Other | 2%, 3/170 | 0% - 4% |
Note: 95% CI = 95% confidence interval based on 1000 bootstrapped samples
Parents who still had the leftover medication in their home (53%, n = 90/170, 95% CI: 46%, 61%) tended to keep medications in an unlocked location (68%, n = 61/90, 95% CI: 58%, 78%). The most common reasons opioid medications were not disposed of were parent forgetfulness or intentionally saving the medication in case their child needed it for future pain. Other reasons included waiting for an opportunity to dispose of the medication such as a drug takeback event, not knowing how to dispose of opioids, not wanting to incur financial loss since they already paid for the medication, thinking they may need the medication for another individual in the home, and a general habit of keeping medications until they expire (Table 4).
Discussion
Despite Tennessee’s policy aimed at limiting excess opioids, we found that 83% of opioid doses prescribed were leftover. Providers commonly prescribed a 3-day supply of opioid analgesics for postoperative analgesia following pediatric ambulatory surgery in compliance with state opioid laws. Even for more invasive procedures resulting in higher opioid prescribing and consumption (e.g., orthopedic surgeries), 75% of opioid doses remained leftover and less than one-fifth of patients used the whole prescription. High rates of leftover opioid analgesics represent a significant safety risk as less than half of families responsibly disposed of leftover medication. Leftover opioid analgesics stored in the home were most commonly kept in an unlocked location, potentially allowing for inadvertent ingestion by children or diversion by teenagers or adults.
In the current study, nearly 30% of families discharged with an opioid prescription did not use any of the medication, and those who used the medication typically gave only one to three doses. In line with prior studies,21,22 we found that only 42% of parents with leftover opioids disposed of the medication. Parents who disposed of opioid medications favored methods that could be done in their home such as pouring the medication down the sink or throwing the medication in the garbage in comparison to methods that required the parent to leave the home such as taking the medication to a secured disposal site. Although the FDA advises flushing or pouring medications down the sink,18 the United States Environmental Protection Agency (EPA) warns against methods of drug disposal that end up in our drinking water supply.23 Further, throwing opioid medication in the garbage is not considered a recommended method for disposal unless the medication is first mixed with an undesirable substance like cat litter or charcoal. Providing education to families on methods of responsible opioid disposal is of paramount importance if opioids are prescribed after pediatric surgery. Increasing parental use of safe opioid disposal methods is a primary prevention target for reducing opioid misuse, diversion, and accidental ingestion in pediatric populations.
Parents reported modifiable factors such as forgetfulness or worry about their child experiencing pain in the future as reasons for not disposing of opioids. Evidence from randomized controlled trials suggest that providing parents with a safe disposal method, such as a drug disposal bag, or a reminder to dispose of medications significantly improve opioid disposal rates.22,24 Strategies such as motivational interviewing could help parents evaluate the benefits and risks to keeping opioid medications and elicit change talk and action plans that could enhance opioid disposal. Motivational interviewing has shown efficacy for improving other pediatric health outcomes and behaviors such as oral health and diet.25,26 If parents desire to keep opioid medications, similar strategies could be used to encourage safe storage in a locked location. Parent prior behavior (e.g., having other leftover opioid medications in the home) was indicative of current opioid disposal behavior. Interventions such as the Scenario-Tailored Messaging Program22 targeted at parents’ underlying core beliefs related to opioid-related risks could be useful to change recurrent behaviors.
Implementing new procedures for opioid prescribing such as a shared provider-family decision making model27 or a precision medicine approach8 could help tailor the number of opioids prescribed without compromising analgesia. In addition to genetic factors, a precision medicine approach should take into consideration surgical factors such as invasiveness of the surgical procedure and anticipated postoperative pain as well as contextual factors such as parent beliefs regarding opioid medications and pronociceptive psychosocial factors that may underlie differences in opioid effects and willingness of parents to use opioids (e.g., depression, anxiety).28-30 Results from the present study supported differences in opioid use between surgical procedures, with more invasive orthopedic extremity surgeries having the highest level of opioid use. In contrast, 43% of soft tissue surgeries did not use any of the opioid prescription. The difference in leftover opioids between orthopedic surgeries and soft tissue surgeries is supported by a recent meta-analysis in adult surgical populations31, and might argue for data-driven procedure-specific prescribing guidelines.
Further, it is important to note that leftover opioid medication could be an indicator of undermanaged postoperative pain. The present study did not assess parent or patient satisfaction with postoperative pain management or other metrics such as emergency department visits for pain that could indicate the child’s pain was managed inadequately at home. Given concerns that children’s pain is often undermanaged,32,33 future studies should evaluate the extent to which parents underutilize opioid analgesics in the context of severe postoperative pain due to fear or lack of knowledge regarding appropriate use.
The present study had a number of strengths including the inclusion of consecutive English-speaking ambulatory surgical patients discharged with an opioid, the use of electronic prescription records to capture exact amount of opioid analgesics prescribed, and the relatively high rate of parent responsiveness to the survey. Further, parents and surgeons did not know that this study was occurring and thus did not have a chance to modify behavior. Limitations of the present study included potential recall bias (i.e., outcomes based on parent memory regarding opioid use), reporting bias due to social desirability (i.e., wanting to appear to the interviewer like they used and disposed of opioids in an acceptable manner), variability in timing of parent interviews relative to day of surgery, exclusion of non-English speakers, and the single site design. Study results may not be readily generalizable to other children’s hospitals or geographic regions with different opioid prescribing policies and different sociocultural norms regarding opioid use.
In conclusion, high levels of leftover opioid analgesics are common following ambulatory pediatric surgery despite restrictive prescription policies mandated by state law. During the perioperative process, there are multiple timepoints where interventions could reduce opioid-related risks for children. Specifically, encouraging safe opioid disposal, ensuring safe opioid storage, and further tailoring the amount of opioids prescribed represent three areas of behavior that could improve child safety. Interventions designed to improve these behaviors likely require multidisciplinary teams that consider the multifactorial influences on both parent and provider behavior.
Key Points:
Question: In the context of restrictive opioid prescription policies, to what extent are opioid analgesics prescribed, consumed, leftover, and appropriately disposed of following pediatric ambulatory surgery?
Findings: Most patients were prescribed a 3-day supply of opioids in line with the policy, 83% of opioid doses prescribed were leftover, and 42% of parents disposed of leftover opioids.
Meaning: Even when opioid prescribing is limited by policy, parents are frequently left with excess opioids in the home following pediatric ambulatory surgery and often do not engage in safe disposal practices.
Acknowledgments
Funding: This project was supported in part by Vanderbilt Institute for Clinical and Translational Research (VICTR) grant support (UL1 TR000445) and T32 GM108554 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Glossary of Terms
- FDA
United States Food and Drug Administration
- REDCap
Research Electronic Data Capture
- MMEs
morphine milligram equivalents
- HCl
hydrochloride
- IQR
interquartile range
- 95% CI
95% confidence interval
- EPA
United States Environmental Protection Agency
- SD
standard deviation
Footnotes
Conflicts of Interest: The authors have no conflicts of interest to disclose.
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