Surplus unused opioid medication and variation in prescribing patterns following common hand surgeries

BackgroundExcess opioid prescriptions heavily correlate with substance abuse. This study investigates prescription patterns, self-reported records concerning opioid use, pain management, and disposal routes for unused medication after hand surgeries.MethodsThis retrospective observational study was conducted over a three-month period from October 1, 2018, to January 1, 2019. Patients undergoing six common hand surgery procedures were included. Surgeries were performed at one tertiary center by nine plastic surgeons. Prescription information was obtained through the provincial narcotic monitoring program. Telephone interviews were conducted to collect data about the use of post-operative opioids, pain scores and disposal. Patients who could not be reached or had incomplete data were excluded.ResultsThe study identified 62 patients, to which 1231 opioid pills were prescribed postoperatively over three months. Approximately 782 (63.6%) of these pills remained unused, and no refills of opioids was required. Patients who had undergone ligament reconstruction and tendon interposition had opioid pills prescribed most frequently (83.3%). On average, 36.1 dispensable tablets were prescribed per procedure, with Hydromorphone being the most commonly prescribed opioid. Large proportion of patients (77%) failed to discard left-over tablets properly. About 73% of patients required one or more analgesics, commonly acetaminophen. There was no significant variation found in both the self-reported pain score and total pain period between the patient groups who used opioids and those who did not.ConclusionsSurplus opioids were commonly prescribed following the analysed hand surgeries. These medications were often discarded improperly. Our results highlight a need to review opioid prescribing patterns for common hand surgeries, to reduce diversion and abuse.Level of Evidence Level III, therapeutic study.