Disposal of Opioids Following Wisdom Teeth Removal May Help Reduce Drug Abuse

Small financial incentives coupled with prescription drug disposal kiosks may increase the proper disposal of opioids by more than 20%.

More than half of prescription painkillers given to patients following the extraction of wisdom teeth go unused, equating to approximately 100 million prescriptions a year.

The findings, published in Drug and Alcohol Dependence, were particularly concerning to researchers, because evidence has shown that abusers of prescription opioids often steal leftover pills prescribed to family or friends.

“When translated to the broad US population, our findings suggest that more than 100 million opioid pills prescribed to patients following surgical removal of impacted teeth are not used leaving the door open for possible abuse or misuse by patients, or their friends or family,” said lead study author Brandon C. Maughan, MD, MHS, MSHP. “Given the increasing concern about prescription opioid abuse in the United States, all prescribers — including physicians, oral surgeons, and dental clinicians – have a responsibility to limit opioid exposure, to explain the risks of opioid misuse, and educate patients on proper drug disposal.”

For the study, researchers examined prescription opioid use for 79 patients after dental impaction surgery, and how a small financial incentive and information about a pharmacy-based drug disposal program would affect patients’ willingness to properly dispose of unused medications. Additionally, researchers tested the effectiveness of a text message-based platform that collects pain and prescription medication use data.

During the enrollment period, study participants were give a debit card preloaded with $10. Each day, surveys that assessed pain levels and medication use were delivered via text message for the first week following surgery, and again on days 14 and 21 following surgery.

Every time a participant completed a survey, they would receive an additional $3 credit on their debit card, a possible $27 total. Any participant who completed a follow-up health interview was given an additional $10.

The results of the study showed that 24 hours after having undergone surgery, participants reported an average pain score of 5 out of 10 while taking pain medication. By the second day, however, 51% reported a low pain score of 0 to 3 out of 10. By the fifth day, nearly 80% reported a low pain score.

For pain management, 94% of patients were given a prescription for opioid medication, with 82% also receiving a prescription-strength nonsteroidal anti-inflammatory drug (NSAID), and 78% who received a prescription antibiotic.

On average, 93% of participants who did not have post-surgical complications received prescriptions that contained 28 opioid pills, but 3 weeks post-surgery had only used 13, leaving 1000 unused opioid pills. There were only 5 participants who used all of the prescribed pills.

“Results of our study show within 5 days of surgery, most patients are experiencing relatively little pain, and yet, most still had well over half of their opioid prescription left,” said study co-author Elliot V. Hersh, DMD, MS, PhD. “Research shows that prescription-strength NSAIDs, like ibuprofen, combined with acetaminophen, can offer more effective pain relief and fewer adverse effects than opioid-containing medications. While opioids can play a role in acute pain management after surgery, they should only be added in limited quantities for more severe pain.”

Some additional findings from the study revealed that offering information specific to a drug disposal program led to a 22% increase in the number of patients who either properly disposed of, or planned to properly dispose of their leftover opioids.

In the control arm, participants received routine postoperative instructions with a controlled substance information sheet, which included details about the risks of holding onto unused opioids, and a study hotline was available for information on proper drug disposal. In the intervention arm, participants received the same instructions as the control, as well as a 1-page overview of a pharmacy-based drug disposal program.

“Expanding the availability of drug disposal mechanisms to community locations that patients regularly visit — such as grocery stores and retail pharmacies – may substantially increase the use of these programs,” Maughan said. “By providing a 1-page information sheet coupled with a small financial incentive, patients were significantly more interested in proper disposal of unused opioid pills. The results suggest that future trials might also use similar low-intensity and low-cost interventions to reduce the misuse of opioid medications.”