Opioid information pamphlet increases postoperative opioid disposal rates: a before versus after quality improvement study

Peter Rose, Jenni Sakai, Ruth Argue, Kevin Froehlich, Raymond Tang

Half of postoperative patients are prescribed an opioid, but a majority do not store or dispose of them properly thus risking diversion. We examined the efficacy of an opioid educational pamphlet addressing opioid weaning, storage, and disposal. We hypothesized that the pamphlet would increase the rate of proper opioid disposal, storage, and weaning. This prospective before and after study was conducted at UBC Hospital in primary total hip or knee arthroplasty patients. Adults with American Society of Anesthesiologists physical class I-III, with no addiction history and consuming ≤ 30 mg of morphine equivalents daily were enrolled in the study. Two groups received similar standard management, except the intervention group additionally received the opioid education pamphlet. Patients were contacted four weeks postoperatively to complete a survey. The primary endpoint was to evaluate proper opioid disposal rates. Secondary endpoints were to evaluate opioid storage and weaning rates. Two hundred twenty-six patients were enrolled and 172 (76%) completed the survey. Among patients who had discontinued opioids, rates of proper disposal increased from 2/42 (5%) to 12/45 (27%) in those receiving the pamphlet (difference in proportions, 22%; 95% confidence interval (CI), 5 to 38; P = 0.005). Secure opioid storage did not improve in those receiving the opioid pamphlet [before, 18/86 (21%) vs after, 20/86 (23%); difference in proportions, 3%; 95% CI, -11 to 15; P = 0.713]. The proportion of patients weaned from opioids was unchanged by the pamphlet [before, 42/86 (49%) vs after, 45/86 (52%); P = 0.735]. The introduction of an education pamphlet significantly improved self-reported proper opioid disposal rates in postoperative patients.