Information and Access for Safe Narcotic Disposal: A Cluster-Randomized Trial Among Pediatric Orthopaedic Surgical...

Greater than two-thirds of individuals report unused opioids following surgical procedures. The need for improved prescribing practices notwithstanding, efforts to improve safe narcotic disposal are requisite to decreasing aberrant narcotic availability and opioid-related hospitalizations. This study aimed to evaluate the additive efficacy of education and access to DEA-compliant narcotic return receptacles on narcotic disposal rates among pediatric orthopaedic surgical patients.

From July 2021 to July 2023, patients aged 5 to 17 years at two disparate sites were recruited for enrollment. Cluster randomization was done weekly to determine whether education was given on safe narcotic disposal versus standard discharge instructions. Halfway through the study, narcotic disposal receptacles were introduced as an additive intervention. Postoperatively, participants were asked to self-report opioid disposal rates and complete the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Short Form to gauge pain control. Two sample z test of proportions and Fisher exact tests were used to compare disposal rates from both the isolated and combined interventions.

Analysis was restricted to 131 of 576 total patients: 44 (33.6%) disposed of unused narcotic medications and 87 (66.4%) did not. No notable difference was observed in disposal rates between those who received education or not (28/70 [40.0%] vs. 16/61 [26.2%], P > 0.05) and those who had bin access or not (18/59 [30.5%] vs. 26/72 [36.1%], P > 0.05). Furthermore, no notable difference was found between the control group and combination intervention group receptacles (6/25 [24.0%] vs. 8/23 [34.8%], P > 0.05) or the education only and combination intervention group (20/47 [42.5%] vs. 8/23 [34.8%], P > 0.05).

Neither preoperative education alone nor the addition of convenient disposal bins improved narcotic disposal rates following surgery.

Retention rates remained high despite either intervention. Therefore, efforts to decrease narcotic availability must be nuanced and multimodal. Further studies may investigate the role of longitudinal patient education to better influence risk perception and subsequent behavioral changes.