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Opioid Oversupply After Joint and Spine Surgery

A Prospective Cohort Study

Bicket, Mark C., MD*; White, Elizabeth, RN*; Pronovost, Peter J., MD, PhD*,†,‡; Wu, Christopher L., MD*; Yaster, Myron, MD§; Alexander, G. Caleb, MD, MS

doi: 10.1213/ANE.0000000000003364
Chronic Pain Medicine: Original Clinical Research Report

BACKGROUND: Many patients receive prescription opioids at hospital discharge after surgery, yet little is known regarding how often these opioids go unused. We estimated the prevalence of unused opioids, use of nonopioid analgesics, and storage and disposal practices after same-day and inpatient surgery.

METHODS: In this prospective cohort study at a large, inner-city tertiary care hospital, we recruited individuals ≥18 years of age undergoing elective same-day or inpatient joint and spine surgery from August to November 2016. Using patient surveys via telephone calls, we assessed patient-reported outcomes at 2-day, 2-week, 1-month, and 6-month intervals, including: (1) stopping opioid treatment and in possession of unused opioid pills (primary outcome), (2) number of unused opioid tablets reported after stopping opioids, (3) use of nonopioid pain treatments, and (4) knowledge and practice regarding safe opioid storage and disposal.

RESULTS: Of 141 eligible patients, 140 (99%) consented (35% taking preoperative opioids; mean age 56 years [standard deviation 16 years]; 47% women). One- and 6-month follow-up was achieved for 115 (82%) and 110 patients (80%), respectively. Among patients who stopped opioid therapy, possession of unused opioids was reported by 73% (95% confidence intervals, 62%–82%) at 1-month follow-up and 34% (confidence interval, 24%–45%) at 6-month follow-up. At 1 month, 46% had ≥20 unused pills, 37% had ≥200 morphine milligram equivalents, and only 6% reported using multiple nonopioid adjuncts. Many patients reported unsafe storage and failure to dispose of opioids at both 1-month (91% and 96%, respectively) and 6-month (92% and 47%, respectively) follow-up.

CONCLUSIONS: After joint and spine surgery, many patients reported unused opioids, infrequent use of analgesic alternatives, and lack of knowledge regarding safe opioid storage and disposal. Interventions are needed to better tailor postoperative analgesia and improve the safe storage and disposal of prescription opioids.

From the *Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland

Armstrong Institute for Patient Safety and Quality

Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland

§Department of Anesthesiology, Children’s Hospital Colorado, Aurora, Colorado

Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Center for Drug Safety and Effectiveness, Johns Hopkins, Baltimore, Maryland.

Published ahead of print 16 February 2018.

Accepted for publication February 16, 2018.

Funding: This study was funded in part by the Blaustein Pain Research Fund; a “Stimulating and Advancing ACCM Research (StAAR)” grant from the Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University; and the National Institute of General Medical Sciences (T32GM075774). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Mark C. Bicket, MD, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, 600 N Wolfe St, Phipps 460, Baltimore, MD 21287. Address e-mail to

© 2019 International Anesthesia Research Society
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