Evaluating a health system-wide opioid disposal intervention distributing home-disposal bags

Abstract

Objective: To evaluate a health system-wide intervention distributing free home-disposal bags to surgery patients prescribed opioids.

Data sources and study setting: We collected patient surveys and electronic medical record data at an academic health system.

Study design: We conducted a prospective observational study. The bags were primarily distributed at pharmacies, though pharmacists delivered bags to some patients. The primary outcome was disposal of leftover opioids (effectiveness). Secondary outcomes were patient willingness to dispose and factors associated with disposal (effectiveness), recalling receipt of the bag (reach), and recalling receipt of bags and disposal over time (maintenance). We used a modified Poisson regression to evaluate the relative risk of disposal. Inverse probability of treatment weighting, based on propensity scores, was used to account for differences between survey responders and non-responders and reduce nonresponse bias.

Data collection/extraction methods: From August 2020 to May 2021, we surveyed patients 2 weeks after discharge (allowing for home opioid use). Eligibility criteria were age ≥18, English being primary language, valid email address, hospitalization ≤30 days, discharge home, and an opioid prescription sent to a system pharmacy.

Principal findings: We identified 5134 patients with 2174 completing the survey (response rate 42.3%). Among respondents, 1375 (63.8%) recalled receiving the disposal bag. Among 1075 respondents with leftover opioids, 284 (26.4%) disposed, 552 (51.3%) planned to dispose, 79 (7.4%) did not plan to dispose, 69 (6.4%) had undecided, and 91 (8.5%) had not considered disposal. Recalling receipt of the bag (incidence rate ratio [IRR] 1.25, 95% confidence interval [CI] 1.13-1.37) was positively associated with disposal. Patients who used opioids in the last year were less likely to dispose (IRR 0.82, 95% CI 0.73-0.93). Disposal rates remained stable over the study period while recalling receipt of bags trended up.

Conclusions: A pragmatic implementation of a disposal intervention resulted in lower disposal rates than prior trials.

Keywords: health system intervention; implementation; opioids; prevention of opioid-related harms; surgery.

FIGURE 1

A theoretical framework of patient willingness to dispose based on the Precaution Adoption Process Model.

FIGURE 2

Disposal rates aggregated by month over the study period. The lower black dots and line indicate the monthly percentage of patient‐reported disposal and linear regression line, respectively. The upper light gray dots and line indicate monthly percentage of patients recalling receipt of the disposal bag and linear regression line, respectively.