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10/26/2015 Young People Receive More Pain Relievers Than They Need
http://www.medscape.com/viewarticle/853243?src=stfb 1/2
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All that leftovermedication is left
in the medicinecabinet. That's acatastrophe thatwe're contributing to.
Medscape Medical News from theAnesthesiology 2015 from the American Society of Anesthesiologists (ASA)
Medscape Medical News > Conference News
Young People Receive More Pain Relievers Than TheyNeedLaird Harrison
October 26, 2015
SAN DIEGO — There is an increase in the risk for drug abusebecause physicians prescribe more opioids than necessary tocontrol children's pain, a new study indicates.
"We have an ethical and moral duty to treat pain, but right nowwe are dispensing more medication than we need," said MyronYaster, MD, from Johns Hopkins Hospital in Baltimore.
In the United States, the gateway to drug abuse is thenonmedical use of prescription opioids. "All that leftovermedication is left in the medicine cabinet. That's a catastrophethat we're contributing to," Dr Yaster told Medscape MedicalNews.
He presented the research here at Anesthesiology 2015.
Dr Yaster's team interviewed 292 parents of patients 1 to 21years of age who were discharged in the previous 2 days withan opioid prescription, and interviewed them again 8 to 12 dayslater.
In the study cohort, weight ranged from 8.4 kg to 168.0 kg, and89% of the patients were prescribed oxycodone (44% in a
liquid formulation). Fifteen patients (5%) did not fill their prescriptions, and 71 (25%) misidentified or didnot know the name of the opioid prescribed.
Patients took opioids for an average of 5 days (range, 0 13 days).Pain control was rated as excellent by 47% of patients, good by 34%,fair by 10%, and poor by 0%; pain control was unrated by 9%.
"We did a great job at treating the pain," Dr Yaster reported. Onaverage, however, patients used only 42% of their prescription.Fourteen days after discharge, an average of 36.4 tablets remainedunused, as did 66.8 mL of liquid opioids.
But most families didn't know what to do with the leftover medication.Only 6% got rid of it at the end of the therapy; 82% received no information on how to dispose of it.
That's a problem because it creates a "big stockpile" of leftover medication, said one of the studyresearchers, Aaron Hsu, MHS, also from Johns Hopkins. Previous research has shown that friends andfamily are the most common sources of illegally obtained medication, he told Medscape Medical News.
Gateway to Drug Abuse
In this study, the average patient had one sibling, and 46% had a sibling 12 years or older. "Thatpopulation is highly susceptible to diverting these drugs," he explained.
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10/26/2015 Young People Receive More Pain Relievers Than They Need
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Is this overprescribing "related to the difficulty of getting a prescription, the regulatory burden?" anaudience member asked after the presentation.
Dr Yaster reported that the team is conducting a study to find out why doctors are prescribing moreopioids than their patients need. So far, he said, a couple of possible reasons have been identifiedthrough focus groups.
Surgeons worry that patients will run out of medications, and want to eliminate the second copaymentthat some patients have to pay for a refill. "We don't know if the surgeons recognize the public healthissue," he said.
The researchers are also investigating exactly how much of each medication the average patient needsfor a given procedure. "Take something like a tonsillectomy," said Dr Yaster. "There are no data to tellyou how long you need pain control. We have to tailor the amount of drug to what patients need."
It is hard for patients to dispose of leftover opioids, said session moderator Robert Wilder, MD, from theMayo Clinic in Rochester, Minnesota.
Dr Yaster said he agrees. The US Food and Drug Administration advises that leftover opioids be flusheddown the toilet, but the Environmental Protection Agency warns that this can cause harmful pollution, hesaid.
Some law enforcement agencies will accept them, but often at inconvenient times or places, said DrWilder. One solution might be to require pharmacies to accept the unused drugs they have dispensed,he told Medscape Medical News.
An oxycodone pill sells for $60 on the street, he said. "We ought to make it easy to get rid of thesethings."
The study was not funded. Dr Yaster and Dr Wilder have disclosed no relevant financial relationships.
Anesthesiology 2015 from the American Society of Anesthesiologists (ASA): Abstract 1056. PresentedOctober 24, 2015.
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Cite this article: Young People Receive More Pain Relievers Than They Need. Medscape. Oct 26, 2015.