Hoag Orthopedic Institute Prescribes Safe Disposal of Opioid Medications

Wednesday, August 25, 2021

Main News Photo

(Orange County Register)

At $1.10 apiece, they might seem like a trivial investment in the crucial fight against opioid abuse.

But given what that money buys — a medication disposal kit that can keep potentially dangerous drugs away from people who might misuse them — the spending is anything but trivial.

It’s why Hoag Orthopedic Institute in Irvine soon will begin sending medication disposal kits home with patients who are discharged but still have the need for pain drugs.

The problem the kits can help solve is huge. The misuse of prescription pain relief drugs accounted for about half of all opioid overdoses nationwide, according to the U.S. Centers for Disease Control and Prevention. From 1999 to 2019, overdose deaths involving prescription opioids more than quadrupled, the agency reports.

Closer to home, a study published in late 2019 found that Orange County had the highest rate of opioid-overdose deaths in Southern California, with prescription drugs accounting for nearly half of those fatalities.

So doing anything that might reduce the misuse of leftover prescriptions for commonly prescribed drugs such as hydrocodone (Vicodin) or oxycodone (OxyContin or Percocet) seemed like a no-brainer to Tanya Spates-Fluman, a registered nurse with 25 years of experience, 22 of them at Hoag Orthopedic.

Interested in the problem, Spates-Fluman researched the feasibility of distributing safe medication disposal kits. She also conducted a small trial study at Hoag Orthopedic, with nurses teaching patients about the safe disposal of medications and giving those patients free disposal kits to take home. The trial involved 100 people who had joint replacements — nearly 70% of whom went on to use the disposal kits.

“It’s a pretty big number of patients that used it,” Spates-Fluman said of the trial run.

“They said they wished they had more than one of the kits, for the other medications at home that they’d like to get rid of.”

Removing Risk

The results convinced Hoag Orthopedic Institute to do what Spates-Fluman discovered other large medical facilities in Southern California were not — making it routine to give discharged patients a kit for disposing their leftover drugs. The program is expected to roll out by the end of the year.

The kits employ a solution that renders opiate medications inactive. That means the drugs can be tossed out with household trash, and it could end the sometimes inconvenient or peculiar strategies that people now use when they try to get rid of their leftover medications. Old drugs often are flushed down the toilet (sometimes bad for the environment) or taken to designated drug-take back sites (not always convenient) or mixed up with things like cat litter or coffee grounds before they’re tossed, as a way to make them less attractive to abusers.  (The Federal Drug Administration publishes as “flush list” of medications that can be disposed of down a sink or into a toilet. Opioids are on that list.)

By making disposal safe and easy, the thinking goes, patients will be less likely to let a family member or friend use their prescription meds, or store them in a place that’s easy to access by abusers.

Spates-Fluman said she’s heard stories of teens pirating prescription pills from medicine cabinets at home and taking them to parties where they might be dumped into a free-for-all bowl with other pilfered medications.

Any of those scenarios can up the odds of someone becoming dependent on the drug, or overdosing, a point that was made in a hospital talk that inspired Spates-Fluman.

In 2019, Spates-Fluman, a member of her hospital’s performance improvement committee, heard orthopedic surgeon Dr. Vance Gardner, medical director for the nonprofit education and research arm of Hoag Orthopedic Institute, speak on the opioid crisis and safe drug disposal. She was determined to figure out how nurses, who closely observe patients and become their most trusted caregivers, could help.

Spates-Fluman deals with patients who have undergone surgery for total joint replacement, shoulder replacement, and spine surgery. Generally, those patients are prescribed a pain killer at discharge, usually, she said, “some type of opioid.”

Patients typically know enough to worry about that.

“Quite frequently,” she said, people would say “‘I’m not going to get that prescription filled,’ or ‘What do I do with them in the house?’” Spates-Fluman said. “It’s a very real concern.”

As part of her research, she called nurse stations at other large hospitals in the region, including Cedars-Sinai in Los Angeles, Scripps in San Diego County, and medical centers run by UCLA and USC. Her findings surprised her.

“I couldn’t find any hospital that had (a medication disposal system) in place, a product or kiosk or certified retrieval.”

She also brought up the subject at classes she attended at other hospitals around Orange County. Same results.

Her next step was the trial test and the disposal kits given to the 100 patients. Spates-Fluman oversaw kit distribution and made follow-up calls to the patients.

The 30 percent who reported not using their kit had either taken all their medication or hadn’t used them yet and were waiting until they finished physical therapy, she said.

Start of a Trend?

Technically, the $1.10 kits to be distributed are DisposeRX powder packets, a different type than the Deterra Drug Deactivation Pouches used in the trial study. The packets are about the size of packaged condiments and are intended to be poured into a prescription vial of oral medication (pills, tablets, capsules, liquids, and powders) and mixed with warm water. After the mix is shaken up with the drug, it’s safe to toss the vial in the trash, according to the company’s website.

Spates-Fluman sees the effort as a step toward protecting the patient along with their family members, friends, and the broader community. She suggested the effort at Hoag Orthopedic Institute might spark others to do something similar.

“My hope would be that every hospital would provide the education and provide a disposal product if they are able to, or when you go to the pharmacy to pick up medication (kits) were there and readily available.”

Hoag Orthopedic Institute is a silver-level Leaders Circle partner of the Greater Irvine Chamber.

Category: Leaders Circle, Greater Irvine Chamber, Hoag Orthopedic Institute, Irvine, Excellence in Healthcare, Health Care, Innovation