Society For Pediatric Urology

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Postoperative Opioid Storage and Disposal in Pediatric Urology
Brandon Garren, MD, Marley B. Lawrence, MD, Peggy P. McNaull, MD, Richard Sutherland, MD, Timothy P. Bukowski, MD, Matthew E. Nielsen, MD, Nathan Woody, CSSBB, Clark McCall, MHA, Karene Ricketts, MD, Brooke A. Chidgey, MD, Sherry S. Ross, MD.
UNC Chapel Hill, Chapel Hill, NC, USA.

BACKGROUND: We may be overlooking our most at-risk population in the now widely recognized opioid epidemic. As surgical providers and consequentially opioid prescribers, we are poised to impart potentially substantial short and long-term effects in our children. Our study examined post-operative opioid prescribing, usage, storage, and disposal practices in pediatric urology patients at a single institution.
METHODS: Pediatric urology patients undergoing surgery associated with specified CPT codes were identified and post-procedure prescribing habits were obtained within our pharmacy database. Patients’ guardians were contacted two weeks postoperatively via telephone to participate in a survey evaluating post-procedure opioid usage, storage, and disposal habits.
RESULTS: Of the 117 charts reviewed, 67 patients participated in a telephone survey. 66 of 67 (99%) patients were prescribed postoperative opioids. Forty-one of these patients (61%) had leftover opioids two weeks postoperatively. The most common storage locations were medicine cabinets (N=20), kitchen cabinets (N=19), out in the open (N=4), a closet (N=1) and unspecified (N=13). Of the patients prescribed opioids, 41 (61%) had leftover opioid medication two weeks postoperatively. Thirty-two of 41 (78%) patients did not dispose of their leftover medication. Nine patients (22%) disposed of their medications by flushing down the toilet (N=1), pouring down the sink (N=5), throwing in the trash (N=2) or emptying into a designated opiate drop box (N=1). Only 13 patients received peri-operative counseling on appropriate storage and disposal of opiates.
CONCLUSIONS: 61% of patients did not use all of their prescribed opioid medication. Preliminary data by our institution shows similar results in adult urology and general pediatric patients, estimating 70-75% of patients having unused opioid medication post-operatively. Of the 41 pediatric urology patients, less than 20% were educated on proper storage and disposal and unsurprisingly a majority of the group improperly handled the medication, resulting in a large pool of unsecured medication within the pediatric family home. Through data-driven efforts to guide opioid prescribing and education, the supply of opioids available for misuse can be minimized.

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