Opioid Use, Storage, and Disposal Among Pediatric Patients After Surgery
Opioid Use, Storage, and Disposal Among Pediatric Patients After Surgery
Opioids are an important component of post-operative pain management among children, but are
 often prescribed in excess and rarely disposed of appropriately. The lack of prompt and
 proper opioid disposal after recovery from surgery is contributing to the opioid crisis in
 Ohio by placing children at risk of accidental ingestion of opioids remaining in the home and
 allowing for unused opioids to be diverted for non-medical use. The investigators propose to
 reduce the burden of the opioid crisis in Ohio by testing a strategy to increase proper
 opioid disposal by families of children undergoing outpatient surgery. The investigators will
 test the impact of a novel opioid disposal mechanism, the Deterra® drug deactivation system,
 after pediatric surgical operations. This system deactivates pills, liquids, or patches,
 allowing for their disposal in the home garbage. The investigators propose to evaluate the
 effectiveness of providing Deterra® bags to families of children having surgery on their
 disposal of excess opioids. The investigators will perform a randomized controlled trial
 (RCT) to test the effectiveness of Deterra® to improve opioid disposal among families of
 children having outpatient surgery at Nationwide Children's Hospital.
Opioids are an important component of post-operative pain management among children, but are
 often prescribed in excess and rarely disposed of appropriately. The lack of prompt and
 proper opioid disposal after recovery from surgery is contributing to the opioid crisis in
 Ohio by placing children at risk of accidental ingestion of opioids remaining in the home and
 allowing for unused opioids to be diverted for non-medical use. The investigators propose to
 reduce the burden of the opioid crisis in Ohio by testing a strategy to increase proper
 opioid disposal by families of children undergoing outpatient surgery. The investigators will
 test the impact of a novel opioid disposal mechanism, the Deterra® drug deactivation system,
 after pediatric surgical operations. This system deactivates pills, liquids, or patches,
 allowing for their disposal in the home garbage. The investigators propose to evaluate the
 effectiveness of Deterra® for opioid disposal among families of Ohio children having surgery.
 The investigators will perform a randomized controlled trial (RCT) to test the effectiveness
 of Deterra® to improve proper opioid disposal among families of children having outpatient
 surgery at Nationwide Children's Hospital.

 The goal of this project is to evaluate the impact of providing the Deterra® drug
 deactivation system on the excess opioid disposal rate among families of children having
 outpatient otolaryngologic or urologic surgery at NCH. A second objective of this study is to
 evaluate whether the impact of the Deterra® drug deactivation system varies by
 parent/guardian health literacy level or signing of an "opioid consent form" acknowledging
 that they will follow appropriate dosing recommendations, not give opioids if their child
 appears sleepy, not give Tylenol concurrently with Tylenol-containing opioid medications,
 dispose of unused opioids safely and responsibly, and contact their child's surgeon's office
 or the on-call physician with any questions. To accomplish these objectives, the
 investigators will perform a randomized controlled trial comparing groups of patients who
 receive either 1) a Deterra® bag along with brief instruction on how and why to use it along
 with routine postoperative instructions or 2) routine postoperative instructions.

 The investigators plan to enroll 202 caregivers of children having outpatient surgery. All
 families will receive a 1-page pain journal to record the child's opioid and non-opioid
 adjunct pain medication administration. In addition to the instructions provided by the care
 team as described above, families randomized to the intervention arm will additionally
 receive a Deterra® bag and instructions on its use by a research team member.

 In order to minimize disruption to the clinical work flow, minimal data will be collected at
 baseline directly from enrolled families. This will include the contact information required
 for follow-up, a limited set of research related questions, and a brief assessment of
 parent/guardian health literacy. Baseline demographic and clinical characteristics of the
 child, such as their primary payer, residential address, age, and comorbidities at the time
 of surgery will be extracted from the electronic medical record.

 Parents/guardians will be contacted by their preferred method of email survey or phone call
 at 2 weeks postoperatively, at which time they will be surveyed on their child's
 postoperative opioid and non-opioid medication use, opioid storage location, quantity of
 opioid remaining, disposal method, and any barriers to disposal. If the child continues to
 require opioids, they will be contacted again at 4 weeks postoperatively. If the parent
 believes that their older child or adolescent can assist in answering the survey questions,
 they will be encouraged to complete the survey together. The primary outcome of this trial is
 the proper disposal of unused opioids. Secondary outcomes include the quantities of opioid
 used and leftover after surgery, opioid storage location, disposal by any method, and
 barriers to disposal.
Inclusion Criteria:

 -  Parent or legal guardian of a child having outpatient otolaryngologic or urologic
 surgery at Nationwide Children's Hospital

 -  Child's age is between 1 and 17 years

 -  Child is expected to receive a discharge opioid prescription

 Exclusion Criteria:

 •Unable or unwilling to track pain medication use or complete a follow-up survey