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Preventing Opioid Misuse Through Safe Opioid Use Agreements in Surgery: A Randomized Clinical Trial
Jonah J Stulberg1, Van Thi Thanh Truong2, Willemijn L Schäfer3
1. Department of Surgery, University of Texas Health Sciences Center of Houston, Houston, TX.
Journal of the American College of Surgeons
|August 10, 2026
Summary
Safe opioid agreements did not increase disposal of leftover postoperative medications. Most patients did not dispose of unused prescription opioids, indicating a need for alternative strategies to reduce opioid retention after surgery.
Area of Science:
- Pain Management
- Public Health
- Pharmacology
Background:
- Postoperative opioid use poses risks of diversion and misuse.
- Safe disposal of unused medications is infrequent.
- Effectiveness of opioid agreements post-surgery is not well-established.
Purpose of the Study:
- To prospectively evaluate the effectiveness of a structured opioid agreement on the disposal of leftover postoperative opioids.
- To assess the impact of opioid agreements on safe storage and diversion.
Main Methods:
- Prospective randomized clinical trial with 450 general surgery patients.
- Intervention group signed a safe opioid agreement alongside standard education.
- Primary endpoint: self-reported disposal of leftover opioids.
Main Results:
- 32% of patients had leftover opioids; only 9.1% reported disposal.
- Opioid agreements did not significantly improve disposal rates (6.7% vs 12%).
- No differences in disposal method, safe storage, or child-safe container use were observed.
Conclusions:
- Opioid agreements alone are insufficient to improve postoperative opioid disposal.
- Safe disposal of unused medications remains a significant challenge.
- Alternative strategies are necessary to address postoperative opioid retention.
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