Unused opioid analgesics and drug disposal following outpatient dental surgery: A randomized controlled trial.
Individuals who abuse prescription opioids often use leftover pills that were prescribed for friends or family members. Dental surgery has been identified as a common source of opioid prescriptions. We measured rates of used and unused opioids after dental surgery for a pilot program to promote safe drug disposal.



We conducted a randomized controlled trial of opioid use patterns among patients undergoing surgical tooth extraction at a university-affiliated oral surgery practice. The primary objective was to describe opioid prescribing and consumption patterns, with the number of unused opioid pills remaining on postoperative day 21 serving as the primary outcome. The secondary aim was to measure the effect of a behavioral intervention (informing patients of a pharmacy-based opioid disposal program) on the proportion of patients who disposed or reported intent to dispose of unused opioids. (NCT02814305) Results: We enrolled 79 patients, of whom 72 filled opioid prescriptions. On average, patients received 28 opioid pills and had 15 pills (54%) left over, for a total of 1010 unused pills among the cohort. The behavioral intervention was associated with a 22% absolute increase in the proportion of patients who disposed or reported intent to dispose of unused opioids (Fisher's exact p=0.11).



Fifty-four percent of opioids prescribed in this pilot study were not used. The pharmacy-based drug disposal intervention showed a robust effect size but did not achieve statistical significance. Dentists and oral surgeons could potentially reduce opioid diversion by moderately reducing the quantity of opioid analgesics prescribed after surgery.
Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: bmaughan@gmail.com.
Brandon C
BC
Maughan
Departments of Oral & Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia PA, USA. Electronic address: evhersh@upenn.edu.
Elliot V
EV
Hersh
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: frances.shofer@uphs.upenn.edu.
Frances S
FS
Shofer
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: kathryn.wanner@uphs.upenn.edu.
Kathryn J
KJ
Wanner
Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: Elizabeth.Archer@uphs.upenn.edu.
Elizabeth
E
Archer
Departments of Oral & Maxillofacial Surgery and Pharmacology, University of Pennsylvania School of Dental Medicine, Philadelphia PA, USA. Electronic address: Lee.Carrasco@uphs.upenn.edu.
Lee R
LR
Carrasco
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: krhodes@northwell.edu.
Karin V
KV
Rhodes
D000328:Adult; D000701:Analgesics, Opioid / Q000600:supply & distribution / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000209:etiology* / Q000517:prevention & control; D010045:Outpatients; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D010865:Pilot Projects; D010818:Practice Patterns, Physicians'; D063487:Prescription Drug Misuse / Q000517:prevention & control / Q000706:statistics & numerical data*; D014081:Tooth Extraction / Q000009:adverse effects / Q000379:methods
D000701:Analgesics, Opioid
Drug disposal; Drug diversion; Opioid analgesic; Text message; Tooth extraction