Opioid Wastes in Cancer Care: A Retrospective Electronic Health Record Review

BACKGROUND: Analyzing reasons for opioid wastes documented in the electronic health record (EHR), particularly instances of patient refusal, may offer insight into the prevalence of opiophobia as a potential proxy indicator. OBJECTIVES: The purpose of this study was to identify and classify reasons for wasting opioid analgesics as documented in the EHR for one year at a National Cancer Institute-designated comprehensive cancer center. METHODS: This descriptive study retrospectively reviewed nurse-documented opioid wastes from January 1 to December 31, 2023. Opioid wastes with reasons documented as missed, refused, returned to cabinet, on hold, held, or stopped were included. Investigators used directed content analysis to code wastes as intentional, accidental, or patient related. Patient-related wastes were further coded because of patient condition or refusal, with refusals subcoded by nurse comments. FINDINGS: Most opioid wastes were intentional and mandated by hospital policies, and 477 wastes were attributed to patient refusals. Future prospective research can attempt to clarify the reasons why patients and their family caregivers refrain from using opioids.