ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Extraction Patients Who Receive Additional Postoperative Information on Drug Disposal Programs Are More Likely to Dispose of Unused Opioid Pills
Clinical Question In healthy patients 18 years or older requiring surgical extraction of one or more teeth, is providing additional postoperative information on drug disposal programs, as compared to providing standard postoperative information, more likely to encourage patients to dispose of unused opioids?
Clinical Bottom Line Patients who receive additional postoperative information on drug disposal programs are more likely to dispose of unused opioids than patients who do not receive additional postoperative information on drug disposal programs. Additionally, over-prescription of opioids continues to contribute to the excess of opioid analgesics that are available to patients and others for abuse. These results are supported by a randomized control trial.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27663358Maughan/201679 adults with surgical extraction of one or more teethRandomized Controlled Trial
Key resultsIn this study, patients who received additional information on drug disposal programs were two-thirds more likely to dispose of unused drugs, compared to those who did not receive additional information on drug disposal programs. Furthermore, it was noted that patients were prescribed on average 28 opioid-containing pills yet only consumed 13 pills. Overall, 1,010 opioid-containing pills were leftover 21 days after surgery.
Evidence Search ("analgesics, opioid"[Pharmacological Action] OR "analgesics, opioid"[MeSH Terms] OR ("analgesics"[All Fields] AND "opioid"[All Fields]) OR "opioid analgesics"[All Fields] OR "opioid"[All Fields]) AND ("dental health services"[MeSH Terms] OR ("dental"[All Fields] AND "health"[All Fields] AND "services"[All Fields]) OR "dental health services"[All Fields] OR "dental"[All Fields])
Comments on
The Evidence
The study enrolled a total of 79 patients and had a completion rate of 90% (71/79). Patients completed surveys through text message on their smartphones, and 688/711 surveys were completed (97%). Many patients in the study received multi-modal pain therapy with NSAIDs, which could explain the low usage of the opioid-containing pills. Opioid quantities were standardized using the morphine milligram equivalents (MMEs).
Applicability This is applicable to all clinicians that perform surgical extractions and prescribe opioid-containing analgesics to manage postoperative pain. Clinicians have the ability to reduce the amount of excess opioids by decreasing the amount of opioid pills prescribed. Unless contraindicated, acetaminophen and NSAID combinations should be used as the first option for postoperative pain management. This is also applicable to public health officials that wish to curtail the abuse of excess opioids by instituting drug disposal programs.
Specialty/Discipline (Public Health) (General Dentistry) (Oral Surgery) (Periodontics)
Keywords opioids, surgical extractions, drug disposal, pain management, oral surgery
ID# 3131
Date of submission: 01/03/2017spacer
E-mail Elizondoe4@livemail.uthscsa.edu
Author Joel Elizondo
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ernie Luce, DDS
Faculty mentor/Co-author e-mail luce@uthscsa.edu
Basic Science Rationale
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