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Original Investigation
June 24, 2019

Effect of Drug Disposal Bag Provision on Proper Disposal of Unused Opioids by Families of Pediatric Surgical Patients: A Randomized Clinical Trial

Author Affiliations
  • 1Center for Surgical Outcomes Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
  • 2Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, Ohio
  • 3Department of Surgery, University of Michigan, Ann Arbor
  • 4Section of Urology, Nationwide Children’s Hospital, Columbus, Ohio
  • 5Department of Urology, College of Medicine, The Ohio State University, Columbus
  • 6Department of Otolaryngology, Nationwide Children’s Hospital, Columbus, Ohio
  • 7Department of Otolaryngology, College of Medicine, The Ohio State University, Columbus
  • 8Department of Surgery, College of Medicine, The Ohio State University, Columbus
  • 9Department of Pediatrics, College of Medicine, The Ohio State University, Columbus
  • 10Division of Epidemiology, College of Public Health, The Ohio State University, Columbus
JAMA Pediatr. 2019;173(8):e191695. doi:10.1001/jamapediatrics.2019.1695
Key Points

Question  Does the provision of a drug disposal bag increase the rate of proper excess opioid disposal among families of children prescribed opioids after outpatient surgery?

Findings  This randomized clinical trial of 202 families found that compared with providing only standard postoperative discharge instructions on opioid use, storage, and disposal, also providing a drug disposal bag significantly increased the rate of proper disposal of excess opioids by approximately 20% among families of children receiving postoperative opioids.

Meaning  Greater availability of drug disposal products may complement prescribing reduction efforts in the fight to end the opioid epidemic.

Abstract

Importance  Although opioids are an important component of pain management for children recovering from surgery, postoperative opioid prescribing has contributed to the current opioid crisis in the United States because these medications are often prescribed in excess and are rarely properly disposed. One potential strategy to combat opioid misuse is to remove excess postoperative opioids from circulation by providing patients with drug disposal products that enable safe disposal of opioids in the home garbage.

Objective  To determine whether the provision of a drug disposal bag increases proper opioid disposal among the families of pediatric patients undergoing ambulatory surgery.

Design, Setting, and Participants  This randomized clinical trial enrolled 202 parents or guardians of children 1 to 17 years of age who underwent otolaryngologic or urologic surgery at the outpatient surgery centers of a tertiary children’s hospital in Columbus, Ohio, from June to December 2018 and who received an opioid prescription prior to discharge.

Interventions  Families randomized to intervention were provided a drug disposal bag containing activated charcoal and instructions for use plus standard postoperative discharge instructions on opioid use, storage, and disposal. Families in standard care arm received standard postoperative discharge instructions only. All participants completed a baseline survey and a follow-up survey 2 to 4 weeks postoperatively.

Main Outcomes and Measures  Primary outcome was proper opioid disposal, defined as disposal using a drug disposal bag or a disposal method recommended by the US Food and Drug Administration.

Results  Of 202 parents or guardians enrolled, 181 completed follow-up (92 in intervention arm and 89 in standard care arm). Most patients in both groups were white (75 [73.5%] vs 79 [80.6%]) and male (63 [61.2%] vs 54 [54.6%]), and the median (interquartile range) age was 6 (5-9) years in the intervention arm and 7 (6-10) years in the standard care arm. For intention-to-treat analyses, 92 families receiving a disposal bag and 89 families not receiving a disposal bag were included. Among them, 66 families (71.7%) randomized to receive a disposal bag reported properly disposing of their child’s opioids, whereas 50 parents (56.2%) who did not receive a disposal bag reported proper opioid disposal (difference in proportions, 15.5%; 95% CI, 1.7%-29.3%; P = .03). Among only those families who filled an opioid prescription and had leftover opioids after resolution of their child’s pain, 66 of 77 parents or guardians (85.7%) who had received a disposal bag and 50 of 77 parents or guardians (64.9%) who had received standard care reported properly disposing of their child’s opioids (difference in proportions, 20.8%; 95% CI, 7.6%-34.0%).

Conclusions and Relevance  Results of this study indicated that providing drug disposal bags to families of children receiving postoperative opioids increased the likelihood of excess opioid disposal. Greater availability of disposal products may complement ongoing prescribing reduction efforts aimed at decreasing opioid misuse.

Trial Registration  ClinicalTrials.gov identifier: NCT03575377

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