Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review

Area of Science:

• Pain Management
• Public Health
• Pharmacology

Background:

• Prescription opioid analgesics are vital for managing postoperative pain.
• Unused opioids pose risks of diversion, nonmedical use, and associated injuries or deaths.

Purpose of the Study:

• To determine the prevalence of unused postoperative opioids.
• To identify reasons for opioid underutilization.
• To assess storage and disposal practices for these medications.

Main Methods:

• A systematic review of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials was conducted.
• Studies involving adults undergoing surgical procedures and reporting opioid oversupply were included.
• Opioid oversupply was defined as filled but unused or unfilled opioid prescriptions.

Main Results:

• Six studies involving 810 patients found 67%–92% reported unused opioids.
• 42%–71% of obtained opioid tablets were unused, primarily due to adequate pain control or adverse effects.
• Most opioids were not stored securely (73%–77%), and disposal rates following recommended guidelines were very low (<9%).

Conclusions:

• A significant proportion of postoperative prescription opioids are frequently unused, stored insecurely, and inadequately disposed of.
• This represents a substantial reservoir of opioids with potential for diversion and misuse, contributing to public health risks.
• Improved strategies for managing and disposing of unused postoperative opioids are critical to mitigate harm.