Surgery patients are hoarding excess strong painkillers: study
Australian patients are routinely discharged after surgery with a box of addictive opioid tablets such as oxycodone, a new study has revealed.
Weeks later, most are still holding on to excess pills.
It is a finding, combined with a rise of accidental painkiller overdoses, that has prompted calls for an overhaul in the prescribing habits of hospital doctors.
It could result in a new recommended limit of 12 oxycodone pills on discharge, if they are prescribed at all.
The study followed 581 surgical patients discharged from a stay in four major hospitals in Victoria including the Royal Melbourne Hospital and Royal Women’s Hospital. It found 60 per cent were given opioids when they left hospital, mostly a 20 pack of 5 milligram oxycodone.
Two weeks later, only a quarter of patients were still taking the drugs – but 70 per cent had stockpiled the remaining tablets.
Lead author of the study, anaesthetist Dr Megan Allen, said many patients were being given too many painkillers, without consideration of their individual circumstances.
“What we are doing is sending patients home with a standard box, whether they need it or not,” said Dr Allen, who is based at the Royal Melbourne Hospital.
“We don’t want the patients to be in pain, [so] the intent is good, but we are concerned about the result.”
There are fears that the stashed drugs could be diverted to family members or the blackmarket, but Dr Allen said she was more concerned that the excess painkillers could serve as a gateway to long-term use by the former patients.
Prescription painkillers now cause more deaths than illicit drugs, and the nation’s drug regulator has warned Australia is “trending down a similar path” to countries such as the United States, where tens of thousands of people are dying each year in opioid overdoses.
The problem in Australia is smaller, but growing. More than 3600 Australians died in accidental overdoses in the four years to 2015, up from about 2000 in the lead up to 2005.
The Australian and New Zealand College of Anaesthetists recently wrote to 34 other medical groups warning them about the risks associated with the prescription of oxycodone and similar drugs for surgery pain.
The college’s president Professor David Scott said doctors should prescribe them more thoughtfully and with a clear treatment plan.
“We know of cases where relatively fit patients have gone into hospital to have routine surgery to repair, for example, a knee or shoulder injury and have been prescribed slow-release opioids to manage their pain,” said Professor Scott.
“They have subsequently become drowsy and difficult to wake. There can be fatal consequences in extreme cases.”
Dr Tamsin Short, a psychologist who manages the Medication Support and Recovery Service in Melbourne, said it was relatively common for people who later developed addiction problems to receive a large batch of opioids after major surgery, but also after minor procedures such as wisdom teeth removals.
She said patients would stick excess medication in their medicine cabinet for future use.
“The patients don’t seem to have a good understanding once they are discharged from hospital about the addictive nature of the medication,” Dr Short said.
The study, led by Dr Allen, has recommended that routine surgery patients be given a maximum of a dozen 5 milligram oxycodone tablets on discharge, and called for better communication with GPs so that they are aware the drugs are not meant to be continually prescribed.
Dr Allen said it was not safe for people to take other people’s prescription medication.
“No one has considered [your other] medications, no one is monitoring you for side-effects,” she said.
“In the most catastrophic circumstances, that could result in an overdose”.
Aisha Dow travelled to Sydney for the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists courtesy of the college.