Opioids: Too Much Overprescribing, Yet Unused Drugs

Opioids: Too Much Overprescribing, Yet Unused Drugs

Opioids: Too Much Overprescribing, Yet Unused Drugs

While there is an opioid crisis in this country, there is another part of the problem: too often the medications targeted for post-surgeries aren’t used. They are left in the house, and may be taken by someone else or accidentally picked up by a child.

Not only do many people take only some or none of the prescribed pills, but more than 90 percent fail to dispose of the leftovers in the recommended way, which may be potentially hazardous to others and also hurt the environment.

That was found in an extensive Johns Hopkins Medicine study that raised the question of whether physicians also were prescribing too many of the opioids. The researchers said they highlighted the need for more personalized pain management to avoid overprescribing opioids and reduce risks linked to improperly stored opioids in the home.  (Separately, that personalized management – which is focused on what the needs are for patients in care – is the kind of healthcare provider to person relationship that is developed in Chinese Medicine.)

Drug Accidents

The opioid crisis revolves around medications often prescribed for painkillers that have led to many overdose deaths. From 1999 to 2016, more than 200,000 people died in the U.S. from overdoses related to prescription opioids.

Accidental drug overdoses are surprisingly common in the U.S. From 2006 to 2011 unintentional poisonings from prescription opioids alone accounted for 138,603 trips to the emergency room, according to Consumer Reports.

Too Much Prescribing?

Various studies have shown that opioid painkillers are prescribed too much after surgery, and one of three patients didn’t take a “single pill” according to a report from the Mayo Clinic in Rochester, Minn.  “That showed us there’s an opportunity to prescribe a certain select group of patients zero opioids,” said Elizabeth Habermann, scientific director for surgical outcomes at the Mayo Clinic in a statement to HealthDay. Instead, patients should be able to take care of their pain with non-opioid medications, such as anti-inflammatory drugs that are considered over-the-counter, and not prescribed.

One of the problems is that physicians write too many prescriptions that patients can use at home because of the uncertainty exactly how much are needed, the researchers found.

“There’s a lot we don’t know about how much pain medication people really need or use after common operations,” said Mark Bicket, MD, an assistant professor of anesthesiology and critical care at Johns Hopkins University School of Medicine and the paper’s first author in the report published in the Journal of the American Medical Association Surgery.

The studies say that non-opioid drugs like acetaminophen and naproxen can often suffice for moderate post- operative pain. Prescribers should spend more time assessing postoperative pain and prescribe smaller amounts of opioids or alternatives as appropriate.

“If we can tailor the amount of opioids prescribed to the needs of the 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,” says Bicket.

Some of the surgeries involved in the unused opioid medications were orthopedic, urology, Cesarean section, dental and general. The researchers said that 67 to 92 percent of the patients reported unused opioids. Some of the patients never filled their prescriptions, or did so and didn’t take the opioids.  Overall, 42 to 71 percent of prescribed pills were unused among more than 800 patients, according to the study.

Unused and Discarded Medications

The problem, too, is what happens to these drugs when they aren’t used: they wind up left homes, “inviting abuse and the potential for addiction,” according to the report.

In 2017, a national survey by Consumer Reports found that one-third of Americans hadn’t cleaned out a medicine cabinet in the past year, and nearly one-fifth hadn’t done so in five years. Occasionally, patients stopped using the drugs because they had adequate alternative pain control, or because of the opioid-related side effects.

When it came to storing the drugs, most patients took inadequate measures, studies showed.

Take the Proper Disposal Steps

When medicines are no longer needed, they should be disposed of promptly. Consumers and caregivers should remove expired, unwanted and unused medications from their homes as quickly as possible.

Experts say don’t leave medications in your medicine cabinet for a lengthy period or give them to friends or throw them away.

While medications are ready to be disposed, some types of prescription drugs can be disposed of in your household trash. But the Food and Drug Administration says opioids are too dangerous to go out with your garbage. Drugs may go into the wrong hands and be fatal.

In some cases, flushing unused opioid medication is OK when the medication cannot be safely or securely stored. That would include oxycodone, hydrocodone, fentanyl and many other opioids.

References:

Johns Hopkins Medicine. Study Adds to Evidence That Most Prescribed Opioid Pills Go Unused. 2017. Retrieved from: https://www.hopkinsmedicine.org/news/media/releases/study_adds_to_evidence_that_most_prescribed_opioid_pills_go_unused_

Dennis Thompson. HealthDay. Addictive Opioids Still Overprescribed After Surgery: Study. Retrieved from:   https://consumer.healthday.com/bone-and-joint-information-4/opioids-990/addictive-opioids-still-overprescribed-after-surgery-study-733107.html

U.S. Food and Drug Administration. Disposal of Unused Medicines: What You Should Know. Retrieved from: https://www.fda.gov/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseofmedicine/safedisposalofmedicines/ucm186187.htm

Consumer Reports. 2018. Retrieved from: https://www.washingtonpost.com/national/health-science/many-people-fail-to-get-rid-of-unneeded-and-expired-drugs/2018/07/20/0c87e024-65d6-11e8-a768-ed043e33f1dc_story.html?utm_term=.97b069f7190e

Mayo Clinic. 2018. How to use opioids safely.

https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/how-to-use-opioids-safely/art-20360373

Salynn Boyles. Study: Trash Old, Unused Drugs. WebMD. Retrieved from: https://www.webmd.com/women/news/20120518/study-trash-old-unused-drugs#1

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