Activated Charcoal Bag Tied to Big Rise in Proper Disposal of Unused Opioids After Surgery

By Marilynn Larkin

April 08, 2019

NEW YORK (Reuters Health) - Post-op patients given an activated charcoal bag upon discharge showed close to a four-fold increase in appropriate disposal of unused opioids, researchers say.

Many opioid pills prescribed after surgery go unused and sit unsecured in medicine cabinets for years, where they are a major source of misuse and abuse, said Dr. Chad Brummett, Co-Director of the Michigan Opioid Prescribing Engagement Network and Associate Professor of Anesthesiology at the University of Michigan in Ann Arbor.

"Current disposal options are limited, as most DEA (Drug Enforcement Agency)-registered safe-disposal sites for opioids are in law enforcement facilities," he told Reuters Health by email. As for flushing unused pills down the toilet, he added, a recent environmental survey found detectable levels of opioids in oysters in the Puget Sound.

"Our team has organized statewide opioid take-back drives, but these are only held twice per year and still do not reach many people," he said. "Convenient, environmentally-friendly disposal options are needed for opioids and other controlled substances."

Dr. Brummett and colleagues randomized 208 opioid-naïve patients (mean age, 46; about 45% women) undergoing outpatient procedures to receive usual care (63 patients), an educational pamphlet with instructions for DEA-registered disposal locations (75), or a charcoal-activated bag (70).

Participants were contacted four to six weeks later regarding their postoperative opioid use and disposal of unused medications.

As reported online March 27 in JAMA Surgery, 18 patients (28.6%) who received usual care reported disposing opioids, compared with 25 (33.3%) who received education and 40 (57.1%) who received a charcoal-activated bag.

After adjustment for preoperative patient characteristics, the odds of opioid disposal were 3.8 times higher among those who received a charcoal-activated bag compared with those who received usual care.

Further, patients who received the bag reported less medication flushing (5%) or inappropriate garbage disposal (5%) and were significantly less likely to leave home for disposal (2.5%) compared with participants in the other two groups.

"We see this as a very scalable intervention that could greatly reduce the number of unused pills that are available for diversion and abuse," Dr. Brummett said. "While we do not recommend its use in chronic opioid users, as they would be expected to use all of their pills, we can see a role for this or a similar device for all acute care prescriptions - e.g., surgery, dentistry or emergency medicine."

Dr. Manny Sethi, an orthopedic trauma surgeon and director of the Vanderbilt Orthopaedic Institute Center for Health Policy at Vanderbilt University Medical Center in Nashville, told Reuters Health, "In places like Tennessee, where there are more prescriptions than people for opioid medications and overdose deaths climbed to almost 2,000 in 2017, facile and low-cost strategies for disposal would offer an alternative strategy for abuse deterrence."

"Furthermore, in this study, on average, 70% of opioid medications were not utilized by patients," he said by email. "This would suggest that surgeons must strongly reconsider prescribing patterns to limit access to these drugs."

"Prior to introducing (the charcoal bag) on a large scale, a large multicenter randomized, controlled trial would be useful," Dr. Sethi concluded.


JAMA Surgery 2019.


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