Distribution of Medication Disposal Packets - Acute Opioid Prescribing

NCT ID: NCT05169281

Last Updated: 2023-06-02

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

657 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-24

Study Completion Date

2021-05-26

Brief Summary

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Many prescription opioids following surgery are left unused and are at risk of being misused or diverted. Encouraging proper disposal is important, yet motivating this behavior remains challenging as patients must understand the risks of opioids, the benefits of disposal, and identify opportunities and places to dispose of them safely. Alternative disposal techniques can improve disposal rates but may be lost or forgotten. Applying behavioral economics techniques may lower the barriers and promote disposal. The objective is to test the effect of a specifically timed, mailed, at-home kit on disposal rates following surgery.

Detailed Description

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A pragmatic, cluster-randomized quality improvement study embedded in an existing automated, post-operative text messaging program to capture patient-reported outcomes (e.g., pain score, opioid use, ability to manage pain) and disposal as part of usual care. It was approved by the University of Pennsylvania Institutional Review Board with a waiver of informed consent.

All patients, 18 years or older, undergoing an orthopedic or urologic procedure and prescribed an opioid were approached and consented via text messaging. Patients without access to a text message capable device or non-English speaking were excluded. Participants were block randomized to usual care or a mailed at-home disposal packet. Usual care consisted of a text message hyperlink to nearby disposal locations. Intervention participants were mailed an at-home disposal packet timed to arrive between post-operative days four and seven based on prior data collection on reported use. The disposal packet (DisposeRx Inc.) contains a powder that sequesters unused opioids in a polymer gel. Patients self-reported disposal via the automated system.

Conditions

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Orthopedic Surgery Neurosurgery Surgery Opioid Use Opioid Misuse

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Participants
Participant will be blinded to their random assignment into the control or treatment (medication disposal packet) group

Study Groups

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Control

Usual care consisted of a text message hyperlink to nearby disposal locations.

Group Type NO_INTERVENTION

No interventions assigned to this group

Intervention

Intervention participants were mailed an at-home disposal packet timed to arrive between post-operative days four and seven based on prior data collection on reported use.

Group Type EXPERIMENTAL

Medication Disposal Packet

Intervention Type OTHER

The disposal packet (DisposeRx Inc.) contains a powder that sequesters unused opioids in a polymer gel. The kits reached patients four days following their surgery based on prior data to leverage availability bias, or a tendency to think or act on things that are most present in one's mind, and provided patients with a disposal technique when they were likely to be finished with their opioids. The process of mailing the disposal packet is simple, low cost (\~$1.50/ mailed packet) and scalable.

Interventions

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Medication Disposal Packet

The disposal packet (DisposeRx Inc.) contains a powder that sequesters unused opioids in a polymer gel. The kits reached patients four days following their surgery based on prior data to leverage availability bias, or a tendency to think or act on things that are most present in one's mind, and provided patients with a disposal technique when they were likely to be finished with their opioids. The process of mailing the disposal packet is simple, low cost (\~$1.50/ mailed packet) and scalable.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Adults 18 or older
* Undergoing an orthopedic or urologic procedure
* Prescribed an opioid
* SMS capable mobile device
* English speaking

Exclusion Criteria

* Under 18
* Does not own a text message capable mobile phone
* non-English speaking
Minimum Eligible Age

18 Years

Maximum Eligible Age

99 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Pennsylvania

OTHER

Sponsor Role lead

Responsible Party

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Anish Agarwal, MD, MPH, MS

Assistant Professor & Chief Wellness Officer | Department of Emergency Medicine

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Anish Agarwal, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Daniel Lee, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Zarina Ali, MD

Role: PRINCIPAL_INVESTIGATOR

University of Pennsylvania

Locations

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University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

Countries

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United States

References

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Hill MV, McMahon ML, Stucke RS, Barth RJ Jr. Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Ann Surg. 2017 Apr;265(4):709-714. doi: 10.1097/SLA.0000000000001993.

Reference Type BACKGROUND
PMID: 27631771 (View on PubMed)

Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription Opioid Analgesics Commonly Unused After Surgery: A Systematic Review. JAMA Surg. 2017 Nov 1;152(11):1066-1071. doi: 10.1001/jamasurg.2017.0831.

Reference Type BACKGROUND
PMID: 28768328 (View on PubMed)

Kennedy-Hendricks A, Gielen A, McDonald E, McGinty EE, Shields W, Barry CL. Medication Sharing, Storage, and Disposal Practices for Opioid Medications Among US Adults. JAMA Intern Med. 2016 Jul 1;176(7):1027-9. doi: 10.1001/jamainternmed.2016.2543. No abstract available.

Reference Type BACKGROUND
PMID: 27295629 (View on PubMed)

Brummett CM, Steiger R, Englesbe M, Khalsa C, DeBlanc JJ, Denton LR, Waljee J. Effect of an Activated Charcoal Bag on Disposal of Unused Opioids After an Outpatient Surgical Procedure: A Randomized Clinical Trial. JAMA Surg. 2019 Jun 1;154(6):558-561. doi: 10.1001/jamasurg.2019.0155.

Reference Type BACKGROUND
PMID: 30916733 (View on PubMed)

Agarwal Anish K., Ali Zarina S., Sennett Brian, et al. An Automated Text Messaging Program to Inform Postoperative Opioid Prescribing. NEJM Catal [Internet] [cited 2021 Feb 18];2(3). Available from: https://doi.org/10.1056/CAT.20.0440

Reference Type BACKGROUND

Agarwal AK, Lee D, Ali Z, Sennett B, Xiong R, Hemmons J, Spencer E, Abdel-Rahman D, Kleinman R, Lacko H, Horan A, Dooley M, Hume E, Mehta S, Delgado MK. Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System. JAMA Netw Open. 2021 Mar 1;4(3):e213243. doi: 10.1001/jamanetworkopen.2021.3243.

Reference Type BACKGROUND
PMID: 33764425 (View on PubMed)

Other Identifiers

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827461_1

Identifier Type: -

Identifier Source: org_study_id

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