Evaluation of a Drug Deactivation System for Safe Disposal of Opioids After Ambulatory Surgery.

BACKGROUND: Prescription opioids are commonly prescribed postoperatively and increase the risk of diversion or misuse when left unused and accessible. Despite awareness of the risks associated with unused opioids, harm reduction strategies like safe storage and drug take-back events may be limited by inconvenience and patient-specific barriers to access. OBJECTIVES: To evaluate a quality improvement project designed to facilitate at-home disposal of unused opioids after day surgery. METHODS: An observational, prospective quality improvement project was conducted in patients undergoing elective outpatient surgery at Newton-Wellesley Hospital from December 2019 to June 2020. Upon discharge, eligible patients received a Deterra® drug disposal packet, which deactivates unused medication. Follow-up surveys assessed packet use and reasons for nonuse one to two weeks after surgery. RESULTS: 106 participants received a disposal packet and responded to the survey. Among the 67 respondents with unused medication, 30% used the packet. Women were more likely to use the packet than men (predicted probability 30.2% vs. 10.4%, p = .033), and patients aged 18-25 were more likely to use the packet than those aged 26-40 (40.0% vs. 9.5%, p = .049). The most common reasons for packet nonuse included procrastination, holding onto prescriptions in case of future pain, and waiting to dispose of multiple medications. CONCLUSION: The majority of patients surveyed had unused opioids one to two weeks after surgery, and approximately one in three patients with unused doses utilized the disposal packet. Common reasons for nonuse included procrastination and concerns about needing future medication for pain. Going forward, safe drug disposal efforts may emphasize improved patient education, partial prescription fill options, or alert systems to remind patients to safely dispose of unused medication.

Assessing pharmacists' readiness to dispense naloxone and counsel on responding to opioid overdoses.

OBJECTIVES: The United States declared the opioid crisis a Public Health Emergency in 2017 and recommended increasing access and availability of naloxone, a reversal agent for opioid overdose. In Massachusetts, there is a statewide standing order for naloxone, which allows pharmacists to dispense it without a prescription to any person at-risk of experiencing an opioid overdose or other persons who can assist individuals at-risk. The objective of this study was to determine whether pharmacists in Massachusetts have sufficient education and training to fulfill the duties associated with dispensing naloxone in community pharmacy settings. The researchers investigated the pharmacists' ability to counsel patients both on naloxone and management of patients with an opioid overdose. METHODS: At the time of the study, pharmacies could elect to have a standing order for naloxone. A randomized sample of 100 pharmacies was generated from the 792 pharmacies with a standing order. From this sample, 79 of the 100 pharmacies were visited on the basis of convenience and distribution in eastern and central Massachusetts. At each pharmacy, a validated 25-item survey was administered to pharmacists. RESULTS: Fewer than half of participants knew that different formulations of naloxone possess different quantities. Although 52% of pharmacists indicated the need to call 9-1-1 when witnessing an opioid overdose, 8% knew to start rescue breathing, and 4% knew to place patients in the recovery position. CONCLUSION: Despite regulations requiring all pharmacies with a standing order to provide training on naloxone, many of the pharmacists surveyed did not have a strong understanding about naloxone products or its pharmacology. The level of education Massachusetts pharmacists possess on naloxone products and administration is not sufficient to counsel patients regarding this medication. Increasing training requirements in pharmacy schools and continuing education offers potential solutions to the lack of knowledge in the community pharmacy setting.

Confounding Issues in Cancer Progress-The Impact of Investor Requirements on Senior Management Compensation and Regulatory Decisions: Tivozanib and Aveo Pharmaceuticals.

Previous research has demonstrated that profits are a key requirement in private pharmaceutical development. We sought to examine the extent that pressure of financial incentives exerted by investors and the board of directors, including senior management financial rewards, have on regulatory decisions made by senior management. Our selected case study involved Aveo Pharmaceuticals Inc (Aveo). The specific question was to what extent the terms of financing, particularly the corporate governance goals which determined executive bonus compensation, may have dictated Aveo's regulatory approach in the drug application process for tivozanib. These corporate governance goals emphasized quantitative over qualitative goals for the executive team. Aveo did not conduct the second arm of the randomized crossover trial, whose results could possibly have demonstrated a favorable clinical profile or a superior competitor's product. Arguably, as a result of this decision, the participating research subjects were denied an opportunity for improvement, and progress in the study of renal cell cancer was curtailed.