Doctors are prescribing surgery patients far more addictive opioid painkillers than they use after their procedures.
Almost all of the 1,000 patients surveyed by Mayo Clinic researchers reviewed were prescribed opioids to manage their post-op pain.
But nearly one third of them never took a single pill.
In total, more than 60 percent of the drugs were never used by the patients and only eight percent of them disposed of the drugs, meaning many more could wind up fueling or even starting someone’s opioid addition.
The opioid epidemic continues to kill more than 100 people every day in the US.
One in every three patients does not take any of the opioids their doctors presribe after surgery, the new Mayo Clinic study revealed
Though illicit heroin and, more recently, fentanyl, are the most deadly opioids, some 80 percent of people that get hooked on the street drugs started out taking prescription opioids.
Last summer, the National Survey on Drug Use and Health revealed that nearly half of those that misused painkillers did not have a prescription of their own and got the drugs from friends or relatives with leftover pills.
Even among those that eventually became addicted to heroin, 80 percent started out taking prescription drugs.
In response to the opioid epidemic, the US government has implemented stricter regulations for doctors, requiring them to prescribe fewer pills for shorter periods of time.
Opioid prescription rates have fallen in the last several years, but are still far higher than they were in the 1990s. Meanwhile, the number of opioid overdose deaths increased fivefold.
Most states now also mandate that doctors check a monitoring database to see how many times in the last year a patient has been prescribed opioids and log every time that they call in the pills for someone.
Yet doctors have observed that some of their colleagues do not comply, and there is little to be done to enforce the monitoring requirements.
The Mayo Clinic’s study further bolsters the notion that these physicians are still vastly over-prescribing opioids.
After having one of 25 common surgical procedures, 92 percent of patients surveyed were given a prescription for an opioid drug.
But collectively, the patients only took 37 percent of the pills, leaving 63 percent unused.
Almost all of the patients were satisfied with their pain management and 28 percent said that they were prescribed too many pills.
Nearly one third of the patients never took a single dose of their prescription, but only eight percent of the patients said they disposed of the drugs.
Many simply do not know what to do with leftover drugs, besides keep them in the back of a medicine cabinet, but this is particularly problematic in the case of opioids.
Most local governments have safe medicine take-back programs, with disposal sites at local pharmacies, police stations or municipal government bodies.
The Drug Enforcement Agency (DEA) also hosts the National Prescription Drug Take-Back Day twice a year at its locations throughout the country.
Disposing of drugs in the trash is not advised as they can easily be scavenged.
But, as a ‘last resort,’ the New York Department of Environmental Conservation advises to ‘mix medications do not crush tablets or capsules) with water and then add salt, ashes, dirt, cat litter, coffee grounds, or another undesirable substance, to avoid accidental or intentional misuse of drugs.’
But the medical community continues to push to preclude the issue from the source by curbing over-prescription.
‘This research provides a road map for physicians and surgical departments. It shows there are certain surgeries and types of patients who are likely receiving significantly more opioids than needed,’ said Dr Elizabeth Habermann, the study’s senior author.
The Centers for Disease Control and Prevention’s (CDC) recently revised prescribing guidelines advise that ‘three days or less will often be sufficient; more than seven days will rarely be needed.’
In the study, the median among that people used was about equivalent to six 5mg pills of oxycodone.
While they are a good starting place, the CDC’s guidance is general to all areas of medicine, despite the wide variety of reasons doctors might be prescribing opioids.
‘They are not patient-centered and may inadvertently encourage both over- and under-prescribing,’ says the study’s first author, Dr Cornelius Thiels.
‘Opioid prescribing guidelines should be based on evidence, considering patient factors and the type of procedure, but also allowing for prescriber discretion,’ Dr. Habermann added.
‘This research and numerous other opioid prescribing projects at Mayo Clinic are about identifying the best approach for each individual patient, whether that’s increasing, decreasing or maintaining prescription levels.”
The Mayo Clinic has already used its findings to implement its own practice guidelines for prescriptions follow each type of surgery.
The hospital says that its doctors have already reduced the amount of opioids prescribed after hip and knee surgeries by half.
Their new guidelines are intended to ‘allow prescribers to tailor their prescribing to address the needs of patients who need very little or no opioids, along with those who need more pain control, while still optimizing and reducing prescribing across the board,’ says Dr Thiels.