Nearly two-thirds of opioid pills prescribed to patients to relieve their pain were never used, according to a study conducted in Quebec and Ontario and published in the Canadian Medical Association Journal.
The study data showed that while 67% of patients took opioids on the first day, only 12% were still taking them fourteen days later. Half of the patients also swallowed five pills or less.
This means that tens of thousands of opioid pills are circulating unnecessarily, with all the risks that this entails.
“Before the publication of this study, […] there was no evidence to guide [les prescriptions d’opioïdes] “, explained Dr. Alexis Cournoyer, who is an emergency physician at the Sacré-Coeur-de-Montréal hospital and an assistant clinical professor at the Faculty of Medicine at the University of Montreal.
“For example, how many opioids do you need to relieve a patient with a fracture for the first week or two? So we see that doctors tend to prescribe higher amounts than what is needed, which leads to a lot of pills sitting in patients’ medicine cabinets.”
The study, he added, therefore aims to guide clinicians to minimise the amount of tablets that are prescribed unnecessarily.
The results of this study are based on the analysis of 2,240 patients, more than 90% of whom were recruited in Quebec.
The authors found that patients prescribed opioids for renal colic or abdominal pain had a higher percentage of unused opioids than patients prescribed them for fracture, back pain, neck pain, or other musculoskeletal problems.
“Clinicians choosing to prescribe opioids could tailor the amount of opioids prescribed to the specific pain condition, based on the amount of 5 mg morphine tablet equivalents to meet the needs of 80% of patients described in our results,” the authors write.
This implies, says Dr. Cournoyer, that 20% of patients will not get relief and will have to seek medical attention again. However, he emphasizes that it is impossible to accurately predict who will need what amount for relief, since there is “variability” between patients for the same condition.
He then admits that researchers were a little surprised by the percentage of opioid tablets that are never used.
“We are not talking about 3 or 4%,” he said. “But we must be aware, at the base, that the objective of the doctors who prescribe [des opioïdes] is to make sure that the patient gets relief and won’t have to come back to the emergency room in pain. They didn’t mean to do any harm.”
“Better than before”
That being said, continues Dr. Cournoyer, the figures would probably have been even more alarming if the same study had been conducted a few years ago, “because today, doctors are well aware that there are issues with opioids. What we are describing here is probably better than what would have been prescribed five or ten years ago.”
The study authors point out that pharmacists have the right to give patients only a portion of the prescribed tablets. Clinicians could therefore add a provision for this purpose to their prescription, and the patient would return to collect the rest of the tablets only if they need them.
They also suggest adding the anticipated duration of use of the medication to the prescription to limit the number of unused tablets in circulation. Pharmacists would not return the unused portion of the tablets after this duration.
To this end, the researchers point out that the law in several European countries limits the validity of an opioid prescription to a period ranging from five days to thirteen weeks.
It will also be necessary to find a way to convince patients to return their unused tablets to the pharmacy, said Dr. Cournoyer.
“That’s another issue,” he concluded. “People are afraid of having another painful episode. Someone who has had a kidney stone, well, the little jar in the pharmacy reassures them.”