Pharmacies Are Untapped Resources for Disposing Unused Drugs After Dental Surgery

About half of patients prescribed opioids for dental surgeries still have unused pills 3 weeks after their procedure.

Patients who abuse prescription opioids often receive them from friends or family members, according to the authors of a new study published in Drug and Alcohol Dependence.

“Our recent study estimated that 100 million opioid analgesic pills remain unused following dental surgery (tooth extraction) in the United States each year,” lead study author Brandon C. Maughan, MD, MHS, MSHP, an emergency physician and health services researcher at The Lewin Group, told Pharmacy Times. “These unused medications serve as a reservoir for potential drug diversion. Consequently, all members of a patient’s care team—including physicians, nurses, and pharmacists—have an obligation to educate patients on safe medication use, including disposal of unused opioids and other medications with high potential for abuse.”

The University of Pennsylvania’s Perelman School of Medicine and School of Dental Medicine researchers sought to uncover the rates of used and unused prescription pills following dental surgery. The randomized, controlled trial involved patients who were scheduled to have some teeth pulled.

The primary outcome was the number of unused pills 21 days following the surgery, and the secondary goal was to observe the effects of telling patients about a pharmacy-based opioid disposal program.

Of the 79 patients involved, 72 filled opioid prescriptions, and they typically received 28 pills but had 15 left over after 3 weeks postsurgery, meaning 54% weren’t used. This meant that there were around 1010 unused pills that could be left in bathroom cabinets or taken by friends or family members of the patient. Only 5 patients used all of the pills prescribed.

The patients involved in the study were incentivized to provide feedback on pain levels and medication use through debit cards that could be loaded with a maximum of $27 total.

One day after the surgery, patients reported a 5 out of 10 pain score on average. After 5 days, around 80% reported a low pain score.

In addition to the prescription opioids, patients were also given a prescription-strength nonsteroidal anti-inflammatory drug, and more than three-quarters of patients also received an antibiotic.

The researchers found that the intervention to tell patients about disposing unused pills at a pharmacy was associated with a 22% increase in the proportion of patients who disposed or showed intent to dispose of their unused opioids. However, the intervention didn’t have statistical significance.

Dr. Maughan said that pharmacists can help by reinforcing safe drug disposal methods.

“Discuss the potential harms of these medications with patients, including the risks of drug diversion, and remind them that these risks can be decreased by safely disposing of these medications,” he suggested.

He also advised pharmacists to raise awareness of National Prescription Drug Take-Back Days or tell patients about the option to mix pills with coffee grounds and toss them in the trash.

“Since late 2014, pharmacies have been permitted by the Drug Enforcement Administration to establish drug disposal tools, such as drug drop boxes, to provide another option for safe drug disposal,” he said. “Pharmacists should advocate for the installation of these drug disposal boxes in their pharmacies and educate patients on how to use them.”

Around 19,000 individuals died from opioid analgesic overdoses in 2014 alone, according to Dr. Maugan.

“By encouraging patients to dispose of unused opioids, we can improve prescription safety and reduce the risk of prescription drug abuse in our communities,” he said.

In addition, the researchers suggested that dentists and oral surgeons could do their part by reducing the number of pills prescribed following surgery.