Preventing Opioid Misuse Through Safe Opioid Use Agreements in Surgery: A Randomized Clinical Trial.

BACKGROUND

Excess postoperative opioids contribute to diversion and misuse, yet safe disposal of unused medication remains uncommon. Although opioid agreements are widely used in chronic pain management, their effectiveness after surgery has not been prospectively evaluated.

STUDY

DESIGN

We conducted a prospective randomized clinical trial from December 2022 through January 2024 involving 450 adult general surgery patients at a multicenter academic health system comprising a county safety-net hospital and private surgical clinics. All patients received standard postoperative opioid education and counseling; patients randomized to the intervention additionally signed a safe opioid agreement. The primary endpoint was self-reported disposal of leftover prescription opioids at the postoperative visit. Secondary endpoints included disposal method, safe storage, child-safe container use, and diversion of unused opioids.

RESULTS

Among 450 enrolled patients, 143 (32%) had leftover opioid tablets. Overall, only 13 patients (9.1%) reported disposing of unused medication. Compared with standard care, patients receiving the opioid agreement were less likely to dispose of leftover opioids (6.7% vs 12%; RR 0.66, 95% CrI 0.28-1.57; Posterior Probability RR>1 = 17%). No differences were observed in disposal method, safe storage practices, or child-safe container use.

CONCLUSIONS

In this randomized trial, relatively few patients had leftover postoperative opioids, but disposal of unused medication remained rare. A structured opioid agreement did not improve opioid disposal or safe storage, suggesting that opioid agreements alone are unlikely to reduce postoperative opioid retention and that alternative strategies are needed.