Preventing Opioid Misuse Through Safe Opioid Use Agreements in Surgery: A Randomized Clinical Trial
In brief
Post-surgical opioid agreements cut disposal of leftover pills from 12% to 7%
In a trial of 450 general surgery patients, only one-third had unused opioids and fewer than one-tenth disposed of them. Adding a signed safe-opioid agreement reduced disposal rates (6.7% vs 12%) and did not improve storage or child-proof container use, indicating agreements alone are insufficient to promote safe handling.
- Journal
- Journal of the American College of Surgeons (Q1)
- Published
- 10 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Jonah J Stulberg, Van Thi Thanh Truong, Willemijn L Schäfer, Cassandra B Iroz, Elias A Chamely, Julie K Johnson
- PMID
- 42573191
- DOI
- 10.1097/XCS.0000000000002121
Why clinicians should know about it
- Picked for Surgery (top studies of the week, 16 August 2026): Opioid agreement RCT in surgery, but focus on disposal not
Abstract
BACKGROUND: Excess postoperative opioids contribute to diversion and misuse, yet safe disposal of unused medication remains uncommon. Although opioid agreements are widely used in chronic pain management, their effectiveness after surgery has not been prospectively evaluated. STUDY DESIGN: We conducted a prospective randomized clinical trial from December 2022 through January 2024 involving 450 adult general surgery patients at a multicenter academic health system comprising a county safety-net hospital and private surgical clinics. All patients received standard postoperative opioid education and counseling; patients randomized to the intervention additionally signed a safe opioid agreement. The primary endpoint was self-reported disposal of leftover prescription opioids at the postoperative visit. Secondary endpoints included disposal method, safe storage, child-safe container use, and diversion of unused opioids. RESULTS: Among 450 enrolled patients, 143 (32%) had leftover opioid tablets. Overall, only 13 patients (9.1%) reported disposing of unused medication. Compared with standard care, patients receiving the opioid agreement were less likely to dispose of leftover opioids (6.7% vs 12%; RR 0.66, 95% CrI 0.28-1.57; Posterior Probability RR>1 = 17%). No differences were observed in disposal method, safe storage practices, or child-safe container use. CONCLUSIONS: In this randomized trial, relatively few patients had leftover postoperative opioids, but disposal of unused medication remained rare. A structured opioid agreement did not improve opioid disposal or safe storage, suggesting that opioid agreements alone are unlikely to reduce postoperative opioid retention and that alternative strategies are needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.