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Recruiting hand therapists improves disposal of unused opioid medication

      Highlights

      • An educational brochure improves disposal rates of unused opioids after upper extremity surgery.
      • Recruiting hand therapists in brochure distribution further increases opioid disposal rates.
      • Brochure administration is more effective when coupled an active discussion of opioid use.
      • Older age is associated with higher rates of opioid disposal.

      Abstract

      Background

      Opioids often remain unused after upper extremity surgery, and leftover prescriptions are frequently diverted. When administered in a hand surgery clinic, an educational brochure outlining a simple method of opioid disposal has been shown to improve disposal rates after surgery.

      Purpose

      To understand whether administration of an opioid disposal educational brochure in a hand therapy clinic would increase opioid disposal rates, compared to a hand surgery clinic.

      Study Design

      Prospective cohort study.

      Methods

      Patients who presented to a hand therapy clinic postoperatively were recruited to participate in this prospective cohort study. An educational brochure outlining a simple method of opioid disposal was made available at the hand therapy and surgery clinics. A questionnaire was later issued to obtain: location of brochure receipt, demographic information, pre- and post-operative opioid use history, and opioid disposal patterns. Chi-square tests and multivariable binary logistic regression assessed associations between medication disposal and explanatory variables.

      Results

      Patients who received the brochure were significantly more likely to dispose of excess opioid medication, compared to those who did not receive the brochure (57.1% vs 10.8%, p < .001). Patients who received the brochure at the hand therapy clinic were significantly more likely to dispose of excess opioids (86.4%) compared to those who received the brochure at the surgery clinic (25.0%). Older age was predictive of increased disposal (p =.028*). There were no significant associations between gender, length of follow-up, or surgery type with the incidence of opioid disposal.

      Conclusion

      Recruiting both hand therapists and surgeons in the distribution of a simple, educational brochure on opioid disposal can increase disposal rates. Patients who received the brochure from the hand therapist were more likely to dispose of excess opioids. The longstanding patient-therapist relationship creates an opportunity for educational initiatives and discussion of stigmatized topics, such as opioid use.

      Keywords

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      References

        • Rudd RA
        • Seth P
        • David F
        • Scholl L.
        Increases in drug and opioid-involved overdose deaths - United States, 2010-2015.
        MMWR Morb Mortal Wkly Rep. 2016; 65: 1445-1452
        • Saloner B
        • McGinty EE
        • Beletsky L
        • et al.
        A public health strategy for the opioid crisis.
        Public Health Rep. 2018; 133: 24s-34shttps://doi.org/10.1177/0033354918793627
        • Silva MJ
        • Kelly Z.
        The escalation of the opioid epidemic due to COVID-19 and resulting lessons about treatment alternatives.
        Am J Manag Care. 2020; 26: e202-e204
        • Devin CJ
        • Lee DS
        • Armaghani SJ
        • et al.
        Approach to pain management in chronic opioid users undergoing orthopaedic surgery.
        J Am Acad Orthop Surg. 2014; 22: 614-622https://doi.org/10.5435/JAAOS-22-10-614
        • Waljee JF
        • Li L
        • Brummett CM
        • Englesbe MJ.
        Iatrogenic opioid dependence in the United States: Are surgeons the gatekeepers?.
        Ann Surg. 2017; 265: 728-730https://doi.org/10.1097/SLA.0000000000001904
      1. Centers for Disease Control and Prevention National Center for Health Statistics. Multiple cause of death 1999–2010. CDC WONDER online database, 2015. Data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed 17 December 2020.

        • Jones CM
        • Logan J
        • Gladden RM
        • Bohm MK.
        Vital Signs: Demographic and substance use trends among heroin users - United States, 2002-2013.
        Morb Mortal Wkly Rep. 2015; 64: 719-725
        • Bicket MC
        • Long JJ
        • Pronovost PJ
        • Alexander GC
        • Wu CL.
        Prescription opioid analgesics commonly unused after surgery: A systematic review.
        JAMA Surg. 2017; 152: 1066-1071https://doi.org/10.1001/jamasurg.2017.0831
        • Johnson SP
        • Chung KC
        • Zhong L
        • et al.
        Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures.
        J Hand Surg Am. 2016; 41: 947-957https://doi.org/10.1016/j.jhsa.2016.07.113
        • Alam A
        • Gomes T
        • Zheng H
        • Mamdani MM
        • Juurlink DN
        • Bell CM.
        Long-term analgesic use after low-risk surgery: a retrospective cohort study.
        Arch Intern Med. 2012; 172: 425-430https://doi.org/10.1001/archinternmed.2011.1827
        • Clarke H
        • Soneji N
        • Ko DT
        • Yun L
        • Wijeysundera DN.
        Rates and risk factors for prolonged opioid use after major surgery: population based cohort study.
        Bmj. 2014; 348: g1251https://doi.org/10.1136/bmj.g1251
        • Goesling J
        • Moser SE
        • Zaidi B
        • et al.
        Trends and predictors of opioid use after total knee and total hip arthroplasty.
        Pain. 2016; 157: 1259-1265https://doi.org/10.1097/j.pain.0000000000000516
        • Hasak JM
        • Bettlach CL
        • Santosa KB
        • et al.
        Empowering post-surgical patients to improve opioid disposal: A before and after quality improvement study.
        J Am Coll Surg. 2018; 226 (235-240.e3)https://doi.org/10.1016/j.jamcollsurg.2017.11.023
        • Bettlach CL
        • Hasak JM
        • Santosa KB
        • et al.
        A simple brochure improves disposal of unused opioids: An observational cross-sectional study.
        Hand (NY). 2020; (1558944720959898. DOI 10.1177%2F1558944720959898)
        • Bernhardsson S
        • Larsson ME
        • Johansson K
        • Öberg B.
        In the physio we trust": A qualitative study on patients' preferences for physiotherapy.
        Physiother Theory Pract. 2017; 33: 535-549https://doi.org/10.1080/09593985.2017.1328720
        • Klaber Moffett JA
        • Richardson PH
        The influence of the physiotherapist-patient relationship on pain and disability.
        Physiother Theory Pract. 1997; 13: 89-96https://doi.org/10.3109/09593989709036451
        • McLaughlin GH
        SMOG grading-a new readability formula.
        Journal of Reading. 1969; 23: 639-646
        • Brangan S.
        Development of SMOG-Cro readability formula for healthcare communication and patient education.
        Collegium antropologicum. 2015; 39: 11-20
        • Nick TG
        • Campbell KM.
        Logistic regression.
        Topics in biostatistics. 2007; 404: 273-301
      2. Soper, D (n.d.). A-priori sample size calculator for multiple regression. Retrieved from Available at: https://www.danielsoper.com/statcalc. Accessed 2020 September 23.

        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        2nd ed. Lawrence Earlbaum Associates, Hillsdale, NJ1988
        • Rose P
        • Sakai J
        • Argue R
        • Froehlich K
        • Tang R.
        Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study.
        Can J Anaesth. 2016; 63: 31-37https://doi.org/10.1007/s12630-015-0502-0
        • Nahhas CR
        • Hannon CP
        • Yang J
        • Gerlinger TL
        • Nam D
        • Della Valle CJ.
        Education increases disposal of unused opioids after total joint arthroplasty: A cluster-randomized controlled trial.
        J Bone Joint Surg Am. 2020; 102: 953-960https://doi.org/10.2106/JBJS.19.01166
        • Lewis ET
        • Cucciare MA
        • Trafton JA.
        What do patients do with unused opioid medications?.
        Clin J Pain. 2014; 30: 654-662https://doi.org/10.1097/01.ajp.0000435447.96642.f4
        • Arwi GA
        • Schug SA.
        Potential for harm associated with discharge opioids after hospital stay: A systematic review.
        Drugs. 2020; 80: 573-585https://doi.org/10.1007/s40265-020-01294-z
        • Dwyer CL
        • Soong M
        • Hunter A
        • Dashe J
        • Tolo E
        • Kasparyan NG.
        Prospective evaluation of an opioid reduction protocol in hand surgery.
        J Hand Surg Am. 2018; 43: 516-522https://doi.org/10.1016/j.jhsa.2018.01.021
        • Kim N
        • Matzon JL
        • Abboudi J
        • et al.
        A prospective evaluation of opioid utilization after upper-extremity surgical procedures: Identifying consumption patterns and determining prescribing guidelines.
        J Bone Joint Surg Am. 2016; 98: e89https://doi.org/10.2106/JBJS.15.00614
        • Cochrane SK
        • Calfee RP
        • Stonner MM
        • Dale AM.
        The relationship between depression, anxiety, and pain interference with therapy referral and utilization among hand patients.
        J Hand Ther. 2020; 35: 24-31
        • Gifford LS
        • Butler DS.
        The integration of pain sciences into clinical practice.
        J Hand Ther. 1997; 10: 86-95https://doi.org/10.1016/S0894-1130(97)80063-4
        • Lagueux E
        • Dépelteau A
        • Masse J.
        Occupational therapy's unique contribution to chronic pain management: A scoping review.
        Pain Res Manag. 2018; 5378451https://doi.org/10.1155/2018/5378451
        • Crepeau EB
        • Garren KR.
        I looked to her as a guide: the therapeutic relationship in hand therapy.
        Disabil Rehabil. 2011; 33: 872-881https://doi.org/10.3109/09638288.2010.511419
        • Cooper C.
        Fundamentals of Hand Therapy-E-Book: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity.
        Elsevier Health Sciences, 2014
        • Ozelie R
        • Janow J
        • Kreutz C
        • Mulry MK
        • Penkala A.
        Supervision of occupational therapy level II fieldwork students: Impact on and predictors of clinician productivity.
        Am J Occup Ther. 2015; 69 (6901260010p1-7)https://doi.org/10.5014/ajot.2015.013532
        • Grice KO.
        The use of occupation-based assessments and intervention in the hand therapy setting: A survey.
        J Hand Ther. 2015; 28: 300-305https://doi.org/10.1016/j.jht.2015.01.005
        • De la Cruz M
        • Reddy A
        • Balankari V
        • et al.
        The impact of an educational program on patient practices for safe use, storage, and disposal of opioids at a comprehensive cancer center.
        Oncologist. 2017; 22: 115-121https://doi.org/10.1634/theoncologist.2016-0266
        • Gandhi T
        • Best T.
        Educate patients about proper disposal of unused Rx medications—for their safety.
        Current Psychiatry. 2015; 4 (60, 67)
        • Sharma M
        • Ugiliweneza B
        • Aljuboori Z
        • Nuño MA
        • Drazin D
        • Boakye M.
        Factors predicting opioid dependence in patients undergoing surgery for degenerative spondylolisthesis: analysis from the MarketScan databases.
        J Neurosurg Spine. 2018; 29: 271-278https://doi.org/10.3171/2018.1.SPINE171258
        • Grigsby TJ
        • Howard JT.
        Prescription opioid misuse and comorbid substance use: Past 30-day prevalence, correlates and co-occurring behavioral indicators in the 2016 National Survey on Drug Use and Health.
        Am J Addict. 2019; 28: 111-118https://doi.org/10.1111/ajad.12866
        • Menendez ME
        • Ring D
        • Bateman BT.
        Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery.
        Clin Orthop Relat Res. 2015; 473: 2402-2412https://doi.org/10.1007/s11999-015-4173-5
        • Lavoie-Gagne O
        • Nwachukwu BU
        • Allen AA
        • Leroux T
        • Lu Y
        • Forsythe B.
        Factors predictive of prolonged postoperative narcotic usage following orthopaedic surgery.
        JBJS Rev. 2020; 8: e0154https://doi.org/10.2106/JBJS.RVW.19.00154
        • Zarling BJ
        • Yokhana SS
        • Herzog DT
        • Markel DC.
        Preoperative and postoperative opiate use by the arthroplasty patient.
        J Arthroplasty. 2016; 31: 2081-2084https://doi.org/10.1016/j.arth.2016.03.061
        • Stokes SM
        • Kim RY
        • Jacobs A
        • et al.
        Home disposal kits for leftover opioid medications after surgery: Do they work?.
        J Surg Res. 2020; 245: 396-402https://doi.org/10.1016/j.jss.2019.07.034
        • Sun EC
        • Darnall BD
        • Baker LC
        • Mackey S.
        Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period.
        JAMA Intern Med. 2016; 176: 1286-1293https://doi.org/10.1001/jamainternmed.2016.3298
        • Leroux TS
        • Saltzman BM
        • Sumner SA
        • et al.
        Elective shoulder surgery in the opioid naïve: Rates of and risk factors for long-term postoperative opioid use.
        Am J Sports Med. 2019; 47: 1051-1056
        • Larach DB
        • Sahara MJ
        • As-Sanie S
        • et al.
        Patient factors associated with opioid consumption in the month following major surgery.
        Ann Surg. 2021; 273: 507-515https://doi.org/10.1097/SLA.0000000000003509
        • Maughan BC
        • Hersh EV
        • Shofer FS
        • et al.
        Unused opioid analgesics and drug disposal following outpatient dental surgery: A randomized controlled trial.
        Drug Alcohol Depend. 2016; 168: 328-334https://doi.org/10.1016/j.drugalcdep.2016.08.016
        • Garren BR
        • Lawrence MB
        • McNaull PP
        • et al.
        Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients.
        J Pediatr Urol. 2019; 15 (260.e1-260.e7)https://doi.org/10.1016/j.jpurol.2019.02.009
        • Alexander GC
        • Stoller KB
        • Haffajee RL
        • Saloner B
        An epidemic in the midst of a pandemic: opioid use disorder and COVID-19.
        Ann Intern Med. 2020; 173: 57-58https://doi.org/10.7326/M20-1141