What Happens to the 25% Leftover Opioid Prescriptions?

With a surfeit of opioids floating around, it is important to get a handle on what is behind illicit diversion.

A new study on this topic, “Characterization of opioid consumption and disposal patterns after total knee arthroplasty,” appears in the June 30, 2019 edition of The Bone and Joint Journal.

Ajay Premkumar, M.D., M.P.H., an orthopedic resident at Hospital for Special Surgery (HSS), and lead author explained the genesis of the study to OTW, “Within the context of a public health crisis regarding opioid misuse in the United States, my co-authors and I noted that there remain significant opportunities to improve opioid prescribing guidelines after orthopaedic surgery to be more data-driven and patient focused.”

“While the opioid epidemic is multifactorial in nature, orthopaedic surgeons are currently among the top five clinical groups for opioid prescribing, in part related to the magnitude of postoperative pain after most orthopaedic surgery.”

“However, there exists limited high-quality data on which to establish opioid prescribing guidelines after many common surgeries, including total knee arthroplasty. This study sought to establish an initial benchmark on opioid consumption after uncomplicated, primary unilateral total knee replacement, which may help inform patient expectations and form the basis for data-driven prescribing guidelines.”

Therefore, the investigators enrolled 103 patients for prospective analysis of their opioid consumption patterns. They found that opioid consumption varied significantly. On average, the 103 enrolled patients consumed 72 tablets of oxycodone 5mg (range 0 to 216 tablets). Of those patients, nearly two-thirds (64.1%) stopped taking opioids within six weeks of surgery. The average length of time patients chose to take their opioids was 22.3 days. For those who stopped taking opioids, 25.7% had leftover pills.

Dr. Premkumar concluded: “This prospectively collected data provides an initial benchmark for general opioid consumption after uncomplicated primary unilateral TKA in opioid-naive patients. Many patients are prescribed more opioids than they require, and leftover medication is infrequently disposed of appropriately, which may increase the risk for illicit diversion. In addition, our data supports that if prescribed more opioids, patients are likely to consume more opioids in the acute postoperative period with similar self-reported pain levels.”

“These results may be used to help establish guidelines for opioid reduction, inform patient expectations and form the initial basis for data-driven prescribing guidelines. Further research and initiatives will likely further reduce opioid requirements and improve pain control in the early postoperative period following total knee arthroplasty and other common orthopaedic procedures.”