E. Blay1, J. Thomas1, J. Stulberg1 1Northwestern University,Surgical Outcomes & Quality Improvement Center,Chicago, IL, USA
Introduction: Opioid analgesic therapy remains a cornerstone of post-operative pain management, yet the majority of pills dispensed at discharge are not consumed by patients. While there are myriad factors leading to the current opioid epidemic, there is mounting evidence to suggest that surgeons significantly contribute to the problem primarily through unused narcotics leading to diversion. While the Office of National Drug Control Policy’s 2011 Prescription Drug Abuse Prevention Plan has recommended the creation of opioid retrieval or take-back programs to help prevent diversion of opioids to the community, many barriers exist. We describe our experience and review of the legal and medical literature to help identify these barriers and discuss key elements to implementation of an Opioid Retrieval program.
Methods: A comprehensive literature review was performed using MEDLINE, Embase and Google Scholar for studies or articles describing clinic-based opioid retrieval program, and an extensive legal document search was performed with the help of our legal counsel to identify the federal and local legal barriers.
Results: In 2014, The Drug Enforcement Agency (DEA) released the “Final Rule” to provide guidance on the implementation of programs geared towards the disposal of controlled substances. The following components are necessary: 1) A hospital/clinic needs to first register through the DEA; 2) There must be an on-site pharmacy or retail pharmacy; 3) There must be a secured one-way collection receptacle, and 4) The rules governing collection are separate from those of destruction. The destruction of controlled substances must take place in an on-site incinerator or use of a reverse distributor approved by the DEA. We were unable to find medical articles which described the implementation of such programs into medical or surgical clinics, but did find a handful of studies that evaluated drug disposal programs within pharmacies and community events. It was found that while the creation of these disposal programs can decrease the risk of diversion in the community, and get more unused drugs out of individual’s homes, it was still necessary that these programs are combined with integrated proper disposal education to further increase knowledge and expand efforts.
Conclusion: Creation of a clinic-based drug take-back program is possible but legal barriers exist. There are federal laws that detail how this can occur but guidance for the medical community is lacking. Take-back programs have been successful public health tools in pharmacies and community-based programs suggesting they could have similar success in clinic-based programs, and offer greater opportunity as a location to provide disposal education. More research is needed to answer questions about the role surgeons’ play in the opioid epidemic and how various reduction efforts can benefit our patients and our communities.