75% of urologic surgery patients have unused opioids

Current prescribing practices after urologic procedures may be leading to a substantial oversupply of opioids in the community, amounting to millions of unused pills every year, results of a recent survey suggest.

Three-quarters of patients reported unused opioids from their initial postoperative prescription, and on average, the patients had only used about half of the pills they received, according to the survey data.

That translates into tens of millions of excess pills unused if extrapolated to the broader urology community, said researcher Kathryn E. Hacker, MD, PhD, a urology resident at the University of North Carolina at Chapel Hill, working with Matthew E. Nielsen, MD, MS, and colleagues.

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Reducing the oversupply of opioids related to urologic procedures could have a substantial impact on the nation’s current opioid crisis, suggested Dr. Hacker, who presented the survey findings in a presentation at the 2018 American College of Surgeons clinical congress in Boston.

“I think one specific way we can practice opioid stewardship is just to be aware of what we’re prescribing, and work on prescribing what patients need versus what we have historically prescribed, which a lot of studies-including this one-show is in excess,” Dr. Hacker said in an interview.

Results of the survey are consistent with those of another telephone survey-based study, published in Urology (2018; 123:101-7), showing that 60% of prescribed opioids went unused among 155 patients who had undergone major prostate or kidney operations. In that study, conducted by researchers at the University of Pittsburgh Medical Center, overprescribing just in those 155 individuals led to an estimated 2,622 excess pills in the community.

Since conducting their own survey, Dr. Hacker and colleagues have put together a list of appropriate prescribing amounts for urologic procedures to share with colleagues.

“For each procedure, we now have a standard amount that we prescribe,” Dr. Hacker said. “We vary that if someone has shown increased pain postoperatively and we know they’ll need more, but I think having a set amount and setting patient expectations has been a big change for us that we’re really working on.”

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In the present study, Dr. Hacker and colleagues conducted a telephone survey of 606 patients who had undergone urologic procedures over a 6-month period spanning 2017-2018. They were able to contact 264 of those patients, approximately 2 weeks after their procedures to ask about their postoperative opioid usage, storage, and disposal.

Of those patients, 75% reported they had unused opioids. The average amount of the prescription used was just 55%, survey results show.

Reported usage ranged from 20% to 60%, meaning that in some cases, up to 80% of the prescription went unused, Dr. Hacker told Urology Times.

Read: Urology practice must-knows for opioid prescribing

That translated into about 2,800 unused opioid pills just for this group of 264 patients. However, if that’s extrapolated to the 11,703 practicing urologists listed in the AUA’s 2015 census, there are about 24 million excess opioid pills going out into the community each year related to urologic procedures, Dr. Hacker and colleagues reported.

One other notable finding from the survey was that only 13% of patients used locked storage locations for their opioid prescriptions.

“That’s now something that we can target in order to make sure that these medications aren’t sitting out on the kitchen counter, available for diversion by other family members,” Dr. Hacker said.