Self-reported Usage Patterns of Opioid Analgesic Medications After Surgery
Condition: Opioid Use
Study type: Observational

Summary: 
      The primary objective of this study is to better understand post-discharge utilization of
      prescribed opioid analgesic medications following surgery. A secondary objective of this
      study is to gain a better understanding of prevailing modes of storage for opioid
      medications.
    

Detailed description: 
      Hypothesis:

      Prescription of medications for analgesia after surgery frequently occurs on an empiric
      rather than individualized basis. The investigator will hypothesize that prescribed opioid
      medications for analgesia after discharge from the hospital / surgery center are frequently
      not taken.

      Aims:

      i) The descriptive first aim of this study is to define self-reported usage patterns of
      opioid analgesic medications at home following surgery.

      ii) The descriptive second aim of this study is to define prevailing modes of storage and/or
      disposal for opioid medications prescribed to patients after hospital discharge following
      surgery.

      iii) The analytical second aim of this study is to characterize patients who do not take
      significant amounts of their prescribed opioid medications.

      Background & Exploratory Objective (s):

      Accidents (unintentional injuries) were the 5th leading cause of death among the general
      population in the United States in 2010. Among persons 1-44 years of age accidents
      represented the leading cause of death. And, within this group, pharmaceuticals were the #1
      course of death. Of the 22,134 medication associated deaths in 2010, 75.2% included opioid
      analgesics. The trajectory of this development is alarming: Deaths from prescription opioid
      overdoses have more than tripled in recent years. Of special concern is that children are
      especially vulnerable to unintentional medication overdosing, accounting for 71,224 annual
      emergency room visits for this reason from 2004-2005 alone. In addition to the individual
      burden from morbidity and mortality, the costs of prescription opioid abuse to society are
      immense: The average health care costs for patients abusing opioids are 8 times higher than
      for non-abusers. In the United States alone, $55.7 billion were spent on sequelae in the
      workplace and in healthcare costs. Accordingly, prescription drug overdosing has been coined
      "An American Epidemic" and increasing resources to tackle this rapidly growing public health
      problem have been made available on a national (National Institutes of Health, U.S. Food and
      Drug Administration) and the state level as part of the Colorado Consortium for Prescription
      Drug Abuse created through Governor Hickenlooper's efforts with the National Governors
      Association.

      Additionally, the prescription of opioids following surgery usually occurs using a "one size
      fits all approach", leading potentially to many unused opioids that are then likely to be
      utilized in a fashion unintended by prescribing clinician.

      The goal of the proposed study is to assess self-reported intake relative to prescribed
      amounts of analgesic medications after surgery. Better knowledge of this relationship will
      permit the design of tools to individualize analgesic pharmacotherapy after hospital
      discharge. The goal is to reduce the amount of opioid prescriptions that are not needed and
      to improve non-opioid analgesia.

      These data will inform future studies to design more patient-centered opioid prescribing
      tools, which are based on anticipated need. This will likely decrease the amounts of
      prescribed opioids that are available for non-medical use. Future studies will be aimed to
      standardize their use to provide improved analgesia upon discharge following surgery.
    

Intervention name(s): Not applicable - no intervention
Intervention type(s): Other
Intervention description(s): Not applicable - no intervention, observational survey study.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Study Design/Methods:

        Survey population: Patients ages 18-89 undergoing surgery at the University of Colorado
        Hospital are eligible. We will focus on patients after Cesarean section surgery,
        gastrointestinal, and thoracic surgery.

        Following exclusion of all patients under the age of 18 years, patients who do not
        understand Spanish or English, and patients returning to institutional settings (e.g.
        prison, jail, mental health facility), pregnant women, and decisionally challenged
        patients, the investigators will include all remaining patients in the sample.

        The investigators will focus on adult patients after 1) Cesarean section, 2) thoracic
        surgery procedures, and 3) gastrointestinal surgery procedures.
      
Keywords: opioid use