A new report recommends the use of pre-written prescriptions to standardize opioid prescribing practices, based on age and type of surgery, as a strategy to combat the crisis surrounding the misuse of these medications.
Specifically, it recommends paying particular attention to the number of doses allowed on the prescription; ensuring that a validity period appears on the prescription; and adding a mention to return unused opioid doses for destruction.
“Pain after surgery normally doesn’t last for months,” said the report’s co-author, Élaine Pelletier, who is a pharmacist at CHU Sainte-Justine.
Unused tablets are therefore regularly found in circulation in nature, which opens the door to potential abuse.
Adding a sort of “expiration date” to prescriptions, a date after which it is no longer possible to use it to obtain medication, could partly stem the problem of misuse by preventing prescription holders from using it at any time and in any way.
“We know that adolescents in particular are at greater risk of re-using opioids that were prescribed to them, that they did not use and that they kept,” said Pelletier. “Or they will use their prescription a little later when they no longer need it, or they will find some at parents’ or friends’ houses who store them at home.”
This use that begins in adolescence could have harmful consequences in the short, medium and even long term for the young person, she pointed out.
The authors of the report, which deals exclusively with pediatric patients, chose to focus on postoperative pain relief because this is when patients will often be exposed to opioids for the first time, explained Pelletier.
“In general, our prescriptions are well written,” she said. “But we think that we may need to insist on the duration of the validity of the prescription, both at the level of prescribers and at the level of families and patients.”
This report from the Therapeutic Medication Management Program (PGTM) provides for the first time an overall picture of the situation in Quebec’s university hospitals, in addition to identifying several good practices to prevent inappropriate use of these substances.
The report “Descriptive analysis of opioid prescriptions given upon discharge following pediatric surgery in Quebec university hospitals” is a retrospective study of some 500 opioid prescriptions for postoperative pain management at home, that is, all those given to people under 18 between April 1 and Oct. 31, 2021, in the four Quebec university hospitals that perform pediatric surgery.
For example, the report recommends that young people and their parents be well informed about the expected benefits and risks associated with opioids, so that they are able to make informed decisions about the proper administration of these medications and their storage, it was stated in a press release.
It is also suggested that education programs be put in place for both health professionals and the general public. For example, the development of an electronic educational document is being considered to guide patients and their loved ones on pain management, the safe use of opioids and the proper disposal of unused quantities.
“Perhaps we could also consider a quick questionnaire or a text message that would ask the patient if they have taken opioids in the past two weeks and remind them to return the unused quantities,” said Pelletier.
Ultimately, she concluded, opioids remain a very effective tool for relieving pain “and we must not only look at the risk.”
“It is an effective medication when it is used properly, which has a utility,” she said. “But it is when the use is not correct and becomes non-medical that risks can appear.”
The PGTM is an initiative that brings together the five university hospital centres in Quebec and which focuses on the optimal use of medications.
–This report by La Presse Canadienne was translated by CityNews