Data from: Opioid use and storage patterns in patients after hospital discharge following surgery

Introduction: Opioid-based analgesic therapy represents a cornerstone of pain management after surgery. The recent rise in opioid sales and opioid overdoses suggests it is important to maximize the safety of opioid prescribing after surgery. Given that patients may live with other family members in the home, safe storage and appropriate disposal of excess opioids after hospital discharge are necessary to prevent unintended secondary exposures. Identifying characteristics of patients who are likely to be prescribed excess opioids after surgery may enable more targeted prescription practices and safety interventions. Our study aimed to elucidate patient-reported opioid use patterns and modes of home storage of opioids among patients discharged home after Cesarean section (C-section) and thoracic surgery. Specifically, we sought to identify characteristics of patients who reported using about half or more versus less of the opioids prescribed to them for use after hospital discharge. Methods: For this cohort study, we developed a survey on quality of analgesia following hospital discharge, amounts of opioids taken relative to the amount prescribed, reasons for not taking all prescribed medications, and storage and disposal methods for leftover opioids. Adult patients, who had C-section or thoracic surgery at a tertiary academic medical center, were given a web-based self-administered survey after discharge. Descriptive statistics (means and standard deviations, proportions) were used to describe the study sample and survey results. Comparisons between patients who reported taking about half or more versus less of the opioids prescribed to them for use after hospital discharge were made using unpaired t-tests, Mann-Whitney tests, and Chi-square tests as appropriate. Results: The majority (53%) of respondents after C-section (N = 30) reported taking either no or very few (less than 5) prescribed opioid pills; 83% reported taking half or less; and 17% of women, reported taking all or nearly all (5 or fewer pills left over) of their opioid prescription. In a cohort of patients after thoracic surgery (n = 31) 45% reported taking either no or very few (5 or less) prescribed opioid pills; 71% reported taking half or less; and 29% of patients reported taking all or nearly all (5 or fewer pills left over) of their opioid prescription. In both cohorts, use of opioids while hospitalized was higher in the group reporting using about half or more of prescribed opioids after discharge. Leftover opioids were stored in an unlocked location in 77% and 73% of cases following C-section and thoracic surgery, respectively. Conclusion: Our findings from surveys in two distinct patient populations at a single academic medical center suggest that current opioid prescribing practices for pain management at hospital discharge following Cesarean section and thoracic surgery may not account for individual patients’ analgesic requirements. Excess opioid pills are commonly stored in unsecured locations and represent a potential source for non-medical opioid use and associated morbidity and mortality in patients and their families. Research to develop goal-directed and patient-centered post-discharge opioid prescription practices and encourage opioid safety practices after surgery is needed.

引言：阿片类镇痛治疗（Opioid-based analgesic therapy）是术后疼痛管理的核心手段。近年来阿片类药物销量及阿片类药物过量事件的攀升，凸显了优化术后阿片类处方安全性的重要性。考虑到患者可能与其他家庭成员共同居住，出院后剩余阿片类药物的安全储存与合规处置，对预防非预期的二次暴露至关重要。明确术后可能被开具过量阿片类药物的患者特征，有助于制定更具针对性的处方方案与安全干预措施。本研究旨在阐明剖宫产（Cesarean section, C-section）与胸外科手术后出院患者的自我报告阿片类药物使用模式及家庭储存方式。具体而言，我们旨在识别出院后使用所开具阿片类药物约一半及以上，与使用不足一半的两类患者的特征。
方法：本队列研究设计了一份关于出院后镇痛质量、实际服用阿片类药物量与处方量的比值、未按处方服药的原因，以及剩余阿片类药物的储存与处置方式的调查问卷。本研究纳入在某三级学术医疗中心接受剖宫产或胸外科手术的成年患者，患者于出院后填写网络自主调查问卷。采用描述性统计方法（均值、标准差、构成比）对研究样本及调查结果进行分析。根据研究设计需求，采用非配对t检验、曼-惠特尼U检验及卡方检验，对出院后使用处方阿片类药物约一半及以上与使用不足一半的患者进行组间比较。
结果：剖宫产队列（N=30）中，多数（53%）受访者表示未服用或仅服用极少量（少于5片）处方阿片类药物；83%的受访者服用量不超过处方量的一半；仅17%的女性表示服用了全部或几乎全部（剩余不足5片）处方阿片类药物。胸外科手术队列（n=31）中，45%的患者表示未服用或仅服用极少量（≤5片）处方阿片类药物；71%的患者服用量不超过处方量的一半；29%的患者表示服用了全部或几乎全部（剩余不足5片）处方阿片类药物。在两个队列中，出院后使用处方阿片类药物约一半及以上的患者，其住院期间的阿片类药物使用量均更高。剖宫产与胸外科手术患者中，分别有77%与73%的剩余阿片类药物被储存在未上锁的位置。
结论：本研究针对单中心两类不同患者群体的调查结果显示，剖宫产与胸外科手术患者出院后的镇痛阿片类处方方案，可能未充分考虑个体患者的镇痛需求。剩余阿片类药物常被储存在无安全防护的位置，这将为患者及其家属带来非医疗用途阿片类药物使用的潜在风险，并可能引发相关不良事件甚至死亡。未来亟需开展相关研究，制定以目标为导向、以患者为中心的出院后阿片类处方方案，并推广术后阿片类药物安全管理实践。