Whether you’re an adult patient with children in your home or the parent of a pediatric patient, safely storing any medications – especially opioids – at home after surgery is an important issue to consider.
As the Director of Pediatric Anesthesiology at Hospital for Special Surgery (HSS), I know firsthand the importance of managing temporary pain after surgery (most commonly called ‘acute pain’) in children and teenage patients. Often, to address acute pain caused after orthopedic surgery, we turn to quick-acting opioids in tandem with other relief techniques to help maintain pain at a manageable level.
My colleague, Dr. Kanupriya Kumar, wrote a blog post detailing the role opioids play in recovering from orthopedic surgery, and one issue that is the same with adult patients and pediatric patients is the importance of safety and monitoring. In fact, even adult patients who return home with a short-course of opioid prescriptions need to be vigilant about use, storage, and safety of these narcotics – especially if there are children in the house.
Understanding Pediatric Dosing
If your child is coming in for surgery that will require post-surgical opioid therapy, there are several differences in care that all parents should know before discharge. Specifically, parents and their surgeon should review the exact regimen required based on your child’s age and weight to ensure both safety and effective pain relief.
If you’re unclear about the instructions, or something doesn’t add up (for instance, your surgeon’s instructions may not match what’s on your prescription instructions), call your surgeon’s office immediately to confirm the proper dosage for your child and then confirm those instructions and doses with your pharmacist. Use caution when using the Internet for information regarding your individual child’s medication dosing, as every situation is different, especially for pediatric patients.
Safety Tips for Parents & Adults
We receive many questions from parents and even pediatric patients (mostly teens) about opioid use after surgery. Here are a few of the suggestions we at HSS provide to parents about medication safety:
- Invest in a lock box or safe. Even parents of children and teens with no history of drug abuse or addiction should be locking away their prescriptions – it’s not about trust, it’s about safety. A child’s friends or classmates may stumble upon these medications and take them home. Additionally, if these medications are left out in the open, it’s more likely the bottle may get knocked over, making it easier for young children and toddlers to ingest a toxic level of these drugs accidentally, or to choke.
- Perform a pill count every day. Particularly in teens and young adults with a history of recreational drug or alcohol use (both of which are risk factors for developing addiction), parents should count each pill to make sure they are all accounted for. Parents should also examine the pills to make sure they are all the same size, shape, and color.
- Keep a medication journal. Taking note of how many pills you or your child took, and at what time, and keeping that journal inside the lock box has several benefits. Not only do you eliminate the risk of giving your child a double-dose (especially in children and homes with more than one caregiver), but you can keep track of how intense the pain is over time and share it with your surgeon’s office at your follow-up appointment and with your recovery team. Being able to measure pain after surgery accurately is key to helping you manage you or your child’s progress.
- Talk with your child about opioid risks. Opioid addiction can happen to anyone, and your child, especially a teen with more autonomy than a younger pediatric patient, needs to recognize the potent and harmful side effects of recreational opioid use. Teens specifically need to understand the danger of driving a car under the influence of opioids.
- Research disposal options. Once your child’s surgeon confirms the pain has subsided and opioid medications are no longer necessary, research where to dispose of these medications. Opioid medications cannot be flushed down the toilet, like many other prescription medication. You can use the DEA Disposal Locator to find a drop box or take back facility in your area.
Patients ask about the addictive properties of these drugs, wondering if the short-term course of opioids the surgeon prescribes will cause any addiction or misuse issues. Even opioid researchers cannot pinpoint the amount of exposure to these drugs that cause addiction – like many other mental health diseases, the mix of multiple risk factors, environment, and setting comes into play when developing an addiction. There have been reports that dependence can develop in as little as five days.
Before and after surgery, all patients – children and adults – will be provided with educational materials on opioid safety and management. Above all, patients need to be honest with their surgical team about any opioid use before surgery to create a customized approach to pain management afterward.
Reviewed on July 24, 2018.
Dr. Kate DelPizzo is the director of Pediatric Anesthesiology within the Department of Anesthesiology at Hospital for Special Surgery.