Laird Harrison

October 26, 2015

SAN DIEGO — There is an increase in the risk for drug abuse because physicians prescribe more opioids than necessary to control children's pain, a new study indicates.

"We have an ethical and moral duty to treat pain, but right now we are dispensing more medication than we need," said Myron Yaster, MD, from Johns Hopkins Hospital in Baltimore.

In the United States, the gateway to drug abuse is the nonmedical use of prescription opioids. "All that leftover medication is left in the medicine cabinet. That's a catastrophe that we're contributing to," Dr Yaster told Medscape Medical News.

He presented the research here at Anesthesiology 2015.

Dr Yaster's team interviewed 292 parents of patients 1 to 21 years of age who were discharged in the previous 2 days with an opioid prescription, and interviewed them again 8 to 12 days later.

In the study cohort, weight ranged from 8.4 kg to 168.0 kg, and 89% of the patients were prescribed oxycodone (44% in a liquid formulation). Fifteen patients (5%) did not fill their prescriptions, and 71 (25%) misidentified or did not know the name of the opioid prescribed.

 
All that leftover medication is left in the medicine cabinet. That's a catastrophe that we're contributing to.
 

Patients took opioids for an average of 5 days (range, 0 - 13 days). Pain control was rated as excellent by 47% of patients, good by 34%, fair by 10%, and poor by 0%; pain control was unrated by 9%.

"We did a great job at treating the pain," Dr Yaster reported. On average, however, patients used only 42% of their prescription. Fourteen days after discharge, an average of 36.4 tablets remained unused, as did 66.8 mL of liquid opioids.

But most families didn't know what to do with the leftover medication. Only 6% got rid of it at the end of the therapy; 82% received no information on how to dispose of it.

That's a problem because it creates a "big stockpile" of leftover medication, said one of the study researchers, Aaron Hsu, MHS, also from Johns Hopkins. Previous research has shown that friends and family are the most common sources of illegally obtained medication, he told Medscape Medical News.

Gateway to Drug Abuse

In this study, the average patient had one sibling, and 46% had a sibling 12 years or older. "That population is highly susceptible to diverting these drugs," he explained.

Is this overprescribing "related to the difficulty of getting a prescription, the regulatory burden?" an audience member asked after the presentation.

Dr Yaster reported that the team is conducting a study to find out why doctors are prescribing more opioids than their patients need. So far, he said, a couple of possible reasons have been identified through focus groups.

Surgeons worry that patients will run out of medications, and want to eliminate the second copayment that some patients have to pay for a refill. "We don't know if the surgeons recognize the public health issue," he said.

The researchers are also investigating exactly how much of each medication the average patient needs for a given procedure. "Take something like a tonsillectomy," said Dr Yaster. "There are no data to tell you how long you need pain control. We have to tailor the amount of drug to what patients need."

It is hard for patients to dispose of leftover opioids, said session moderator Robert Wilder, MD, from the Mayo Clinic in Rochester, Minnesota.

Dr Yaster said he agrees. The US Food and Drug Administration advises that leftover opioids be flushed down the toilet, but the Environmental Protection Agency warns that this can cause harmful pollution, he said.

Some law enforcement agencies will accept them, but often at inconvenient times or places, said Dr Wilder. One solution might be to require pharmacies to accept the unused drugs they have dispensed, he told Medscape Medical News.

An oxycodone pill sells for $60 on the street, he said. "We ought to make it easy to get rid of these things."

The study was not funded. Dr Yaster and Dr Wilder have disclosed no relevant financial relationships.

Anesthesiology 2015 from the American Society of Anesthesiologists (ASA): Abstract 1056. Presented October 24, 2015.

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