Publications (Old)

• A discharge opioid was prescribed to 22% of 675 children younger than 18 years 
  • Median 10 doses (25th to 75th percentile, 6-15) 
• Circumcision, elbow fracture, and orchiopexy had the highest opioid use; yet only 1 in 3 patients used an opioid, typically for 3 days or less.
• Overall, pain control was reported as good among 82% of children with or without a discharge opioid prescription.

• Patients use only 27% of opioids prescribed to them 
• Patients use an additional 5 pills for every 10 extra pills prescribed to them 
• The quantity of opioid prescribed is associated with higher patient-reported opioid consumption
• Greater association between prescription size and consumption than reported pain levels and consumption

• The proportion of initial prescriptions for surgery, emergency, and dental care increased by nearly 16% from 2010 to 2016.
• Dental care prescribing saw the greatest growth, with a 68% increase, while surgical patients received the highest proportion of potent opioids (90.2%).

• Prior to the intervention, post-laparoscopic cholecystectomy (gall bladder removal surgery) opioid prescribing exceeded patient pain management needs by approximately 88%, based on patient- reported opioid use.
• Implementation of evidence-based prescribing guidelines reduced post-laparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills.
• Patients who received smaller opioid prescriptions after the intervention reported using fewer opioids, indicating that anchoring and adjustment heuristics may impact patient opioid use.

Association of Caregiver-Reported Education With Locked Storage and Disposal of Prescription Opioids After Children’s Surgery

Sloss, K. R., Vargas, G., Brummett, C. M., Englesbe, M. J., Waljee, J. F., Gadepalli, S., & Harbaugh, C. (2020). Association of caregiver-reported education with locked storage and disposal of prescription opioids after children’s surgery. Journal of pediatric surgery, 55(11), 2442–2447. https://doi.org/10.1016/j.jpedsurg.2020.04.022

• In 2016, 8485 (0.6%) of the 1.5 million opioid prescriptions filled by US adults and children with family insurance plans occurred when at least 1 family member met criteria for prescriber and pharmacy shopping. *
• Among the 8485 index fills, 68.1% of prescribing clinicians were physicians, 7.9% were physician assistants, 7.2% were nurse practitioners, and 43% were dentists.
• The most common physician specialties among the 8485 index fills were family medicine (17.1%), pain medicine (16.4%), internal medicine (9.6%), and orthopedic surgery (6.5%)

*prescriber and pharmacy shopping is when an individual obtains opioids from high numbers of prescribers and pharmacies

• 60.4% of caregivers reported storage education despite only 18.3% keeping the opioids in locked storage. Caregivers who reported verbal and/or written storage education were more likely to lock opioids in storage
• Of the 606 caregivers surveyed, 451 (74%) had leftover opioids. Of the 451, only half (50.1%) reported disposal education and a quarter (24.6%) disposed of the excess opioids. 
• There was no association between leftover opioid disposal and verbal and/or written disposal education.

• 56% of families who only received standard postoperative discharge instructions on opioid safety reported proper opioid disposal compared to 72% of families who received a drug disposal bag and the standard postoperative discharge instructions.
• 20% increase in the rate of proper opioid disposal with the provision of a drug disposal bag. 
• Higher than expected rate of opioid disposal among families that did not receive a disposal bag suggests that standardized, multimodal, opioid related education provided to families of surgical patients does impact disposal rates.