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Dispose With Dish Soap: A Simple And Convenient Method To Increase Proper Opioid Disposal In Postoperative Pediatric Patients
Alexandra M. Keane, MD1, Ellen L. Larson, MD2, Rachael M. Payne, MD1, Samantha Cooke, BA3, Ema Zubovic, MD1, Kamlesh B. Patel, MD, MSc1, Susan E. Mackinnon, MD, FACS1, Alison K. Snyder-Warwick, MD, FACS1.
1Washington University School of Medicine, St. Louis, MO, USA, 2Mayo Clinic, Rochester, MN, USA, 3Carleton College, Northfield, MN, USA.

PURPOSE: The opioid abuse crisis is rampant in the United States. Overprescribing patterns and lack of patient education regarding safe opioid use and disposal have contributed to misuse, dependence, and diversion. Children and adolescents are unique risk groups in this crisis; age-specific concerns include accidental ingestion and association with high-risk behaviors. The majority of interventions focus on curbing overprescribing patterns, but educational initiatives targeting safe use, storage, and disposal are just as critical. Studies aimed at disposal are limited in pediatric patients. Therefore, we sought to determine if an educational brochure detailing a simple opioid disposal method using dish soap could enhance proper disposal in postoperative pediatric patients.
METHODS: A prospective survey study of plastic surgery patients at a pediatric hospital was performed from January to December 2020. Patients were randomly assigned to two groups: those who received the educational brochure at the time of surgery, and those who did not. In clinic, patient caretakers completed anonymous preoperative and/or postoperative surveys regarding opioid use and disposal. Families who were unable to read English, patients over the age of 18 years at the time of surgery, and patients taking opioids preoperatively were excluded.
RESULTS: Surveys of 326 patients were analyzed (188 preoperative, 120 pre/postoperative, 18 postoperative). Excess preoperative opioids were present in the homes of 6% of patients. Prescribed opioids were incompletely consumed by 81% of patients. Receiving the educational brochure significantly increased disposal of leftover opioid medications: 78% versus 35% (OR 6.52, 95%CI [2.03, 21.37], p < 0.001). Although not statistically significant owing to small sample size (p = 0.09), 71% of families with excess opioids in the home preoperatively retained unused postoperative opioids versus 32% without preoperative opioids.
CONCLUSION: Postoperative opioids are overprescribed for most pediatric plastic surgery patients. Patients with opioids in the home preoperatively may be at greater risk for retaining excess medication. No single approach will eradicate the current opioid epidemic; however, simplicity encourages compliance. Our educational opioid disposal brochure significantly increases proper postoperative opioid disposal, representing a simple, cost-effective, convenient, and risk-free method to decrease opioid misuse and accumulation in our communities.


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