Preventing Opioid Misuse through Safe Opioid Use Agreements between Patients and Surgical Providers (PROMISE ME)

In 2017, 191 million opioid prescriptions were dispensed in the United States of which a significant portion were prescribed for acute pain management following surgical encounters. In addition, on average, 70% to 90% of prescribed opioid pills following surgery remain unused and over 70% of surgery patients do not dispose of their unused opioids. Unused pills are a common source of nonmedical use; 54% of people obtain their pills for nonmedical use through friends or relatives and 35% through their healthcare provider. Nonmedical use of opioids can lead to Adverse Drug Events (ADEs), and is frequently a pathway to the use of other, illicit, drugs such as heroin. Our research team is currently funded by the National Institute on Drug Abuse (NIDA) to develop methods for decreasing opioid prescribing in surgery, and through this ongoing research we have identified that even after decreasing the number of pills prescribed a large number of pills still go unused. Given the variation in individual patient use and the provider’s desire to provide adequate pain control to all of her patients, this will likely continue to be the case for the foreseeable future. Furthermore, very few patients safely store their opioid pills or dispose of them correctly, even when provided information on the importance and methods for taking appropriate action. As we consider the next phase of improving our opioid prescribing practices, decreasing the number of pills prescribed cannot be the end of our best practices recommendations but rather the beginning. Effective prevention of harm caused by prescription opioids requires patients to safely use pills; using only the minimum needed to control pain, safely storing them, and appropriately disposing of unused pills after acute pain treatment. This study, Preventing Opioid Misuse through Safe Opioid Use Agreements between Patients and Surgical Providers (PROMISE ME), will test the use of contractual agreements to improve safe opioid use to prevent misuse and opioid-related harm. We will (1) assess the barriers and facilitators to implementing opioid use agreements in the surgical setting, (2) measure implementation effectiveness outcomes and provide real-time improvement strategies while we (3) test the effectiveness of the intervention using a step-wedged cluster randomized trial. The study will have a significant impact on prescription abuse as it directly addresses the availability of excess prescription opioids within the community which is the primary source of misuse and harm. We will disseminate the new knowledge generated from this study throughout our 56-hospital learning collaborative.