Through the support of a grant from AAOS to the Virginia Orthopaedic Society (VOS), Carilion Clinic Orthopaedics and the Virginia Tech Carilion School of Medicine completed an investigational study of the beliefs, perceptions, and practices regarding opioid medication disposal among orthopaedic patients and providers in southwestern Virginia, which is commonly considered the area west of Roanoke, Va., to Tennessee and south to North Carolina, comprising the “economically depressed coal industry dependent or former textile- and furniture-producing regions of the state.”

The primary goal of the study was to collect data on patient perceptions regarding opioid disposal, which would lead to the development of patient education materials detailing the rationale for safe disposal of unused opioids. Comparable provider surveys were used to assess and align patient beliefs and provider perceptions toward a common best practice goal.

Notably, the study revealed a disconnect between provider perceptions of patient intent for storage/
disposal of unused opioids and documented patient desires for safe practices to remove opioids and minimize risk of inadvertent diversion. Providers felt that patients were most likely to store, save, or dispose of opioids inappropriately, whereas patient desires or beliefs more closely aligned with provider beliefs of best practice (Fig. 1).

Although the Centers for Disease Control and Prevention offers a variety of educational materials and the recent bipartisan opioid bill addresses needs in treatment of opioid use disorders, local institutional and community-based education and resource availability for the safe disposal or return of unused opioid medications are limited. This negatively impacts point-of-contact education and facility-based options for the return of unused opioids.

Lack of patient and provider education is commonly referenced as a deficiency in care. When surveyed, only 28 percent of patients and 40 percent of providers responded that they had ever received defined or formal education on opioid management and disposal.

To address this deficiency and in recognition of the fact that patient needs and intent aligned with best practice perceptions, a patient-friendly, wallet-sized, institution-specific, educational handout was developed by Carilion Clinic Orthopaedics and provided to VOS for general membership use (Fig. 2). The information card is provided to and reviewed with all orthopaedic patients when they receive an opioid prescription, schedule elective surgery, and are discharged from outpatient or inpatient orthopaedic care. The card is also a part of current staff and mandatory physician education programs provided by Carilion Clinic Orthopaedics as part of institutionally supported provider education. The programs also have been made available to community action groups in Roanoke, Va., and the surrounding communities, as well as provided to VOS and distributed to membership for use or adaptation.

Fig. 1 Opioid disposal options: comparison of patient and provider preferences and provider expectations of patient disposal
Courtesy of Carilion Clinic

Fig. 2 Educational resources, including (A) a patient-friendly handout and (B) a general model for different membership use and adaptation
Courtesy of Carilion Clinic

These education materials have been coupled with the expansion of secure medication disposal sites throughout Carilion Clinic Orthopaedics’ healthcare system (including remote sites of care that never had reliable access to a prescription drug disposal center) and provision of activated charcoal opioid neutralization/deactivation bags at the time of opioid dispensing at all Carilion-affiliated pharmacies, as well as a web-based education option.

Thanks to support from AAOS, these findings may serve as an example of how understanding the perspectives and practices of patients can assist providers and healthcare systems in developing relevant interventions for the communities they serve.

T.K. Miller, MD, is a professor of orthopaedic surgery at the Virginia Tech Carilion School of Medicine and vice-chair of orthopaedic surgery and section chief of sports medicine at Carilion Clinic in Roanoke, Va.

Malek Bouzaher, BS, MS, is an MS3 student at the Virginia Tech Carilion School of Medicine.

Susan Giampalmo, BS, is an MS3 student at the Virginia Tech Carilion School of Medicine.

Joseph T. Moskal, MD, is a professor of orthopaedic surgery at the Virginia Tech Carilion School of Medicine and chair of orthopaedic surgery and section chief of adult reconstruction at Carilion Clinic in Roanoke, Va.

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