Prescription Opioid Use After Supply and Elevated Threat for Persistent Opioid Use

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Childbirth is the most typical cause for hospitalization in america.  Ache after vaginal and caesarean supply is frequent, and opioids are generally prescribed on this setting.  About 25% to 30% of girls obtain an opioid prescription after vaginal supply and round 75% obtain an opioid prescription after vaginal supply.  There’s a rising physique of proof to point that use of prescription opioids could improve subsequent threat for persistent opioid use and opioid use dysfunction.  A number of latest research have examined patterns of opioid use in ladies receiving opioid prescriptions for ache administration after supply.  

Analyzing information from the Medicaid Analytic eXtract 2009-2014, researchers recognized a nationwide cohort of 459,829 pregnant Medicaid beneficiaries in america who delivered vaginally between 2009 and 2013. They recognized sufferers who had obtained prescription opioids inside 7 days of supply. They in contrast patterns of opioid use in ladies who obtained or didn’t obtain prescription opioids through the first week postpartum.

Persistent opioid use was outlined as 10 or extra opioid fills or better than 120 days’ provide allotted through the first yr postpartum.  In addition they recognized ladies with opioid use dysfunction and overdose throughout the identical interval of statement. 

Among the many 459,829 pregnancies with vaginal supply, 140,807 (30.62%) obtained an opioid prescription inside 7 days of supply. Girls who obtained an preliminary opioid prescription have been extra more likely to develop persistent opioid use through the first yr (4.10%) than ladies who didn’t obtain prescription opioids (0.84%).   After adjusting for potential confounding variables, the danger remained greater amongst ladies receiving an opioid prescription after supply, with a relative threat of two.57 (95% CI, 2.43-2.72).  

Threat for a newly recognized opioid use dysfunction or overdose was additionally elevated amongst ladies who obtained an opioid prescription after supply, with adjusted relative dangers of 1.48 (95% CI, 1.40-1.57) and 1.92 (95% CI, 1.20-3.09), respectively.

The findings derived from the Medicaid Analytic eXtract will not be generalizable to all populations of girls; nevertheless, the same examine inspecting patterns of postpartum opioid use in a cohort of 988,036 commercially insured ladies additionally demonstrated greater charges of persistent opioid use in ladies receiving opioids after supply.  On this cohort, peripartum opioid prescriptions have been crammed by 27.0% of girls with vaginal deliveries and 75.7% of girls with cesarean deliveries. Girls who obtained an preliminary opioid prescription have been extra more likely to develop persistent opioid use (1.7% of girls with vaginal deliveries and a couple of.2% with cesarean deliveries) in comparison with ladies who didn’t obtain prescription opioids after supply (0.5% with vaginal supply and 1.0% with cesarean supply). The general prevalence of persistent opioid use is decrease amongst commercially insured ladies; nevertheless, whether or not ladies have been on Medicaid or had industrial insurance coverage, receiving a prescription for opioids after supply was related to a 2-3 fold improve in threat of persistent opioid use.  

Primarily based on these findings of elevated charges of persistent opioid use, opioid use dysfunction, and overdose in ladies receiving prescription opioids for postpartum ache administration, the authors clearly state, “Opioid prescriptions to ladies after vaginal supply needs to be averted, besides in uncommon circumstances.”  The American School of Obstetricians and Gynecologists (ACOG) recommends a stepwise multimodal method to postpartum ache administration, urging clinicians to make use of opioids just for breakthrough signs, after different makes an attempt at analgesia have failed, and to rigorously weigh the advantages of initiating opioid remedy versus the dangers.

Ruta Nonacs, MD PhD

 

ACOG Committee Opinion No. 742: Postpartum Ache Administration Obstet Gynecol, July 2018.

Pharmacologic Stepwise Multimodal Strategy for Postpartum Ache Administration (ACOG Scientific Consensus, September 2021)

Peahl AF, Dalton VK, Montgomery JR, Lai YL, Hu HM, Waljee JF.  Charges of New Persistent Opioid Use After Vaginal or Cesarean Beginning Amongst US Girls.  JAMA Netw Open. 2019 Jul 3;2(7):e197863. Free article.

Zhu Y, Huybrechts KF, Desai RJ, Franklin JM, Hernandez-Diaz S, Krumme A, Straub L, Neuman M, Wunsch H, Levin R, Mogun H, Bateman BT.  Prescription opioid use after vaginal supply and subsequent persistent opioid use and misuse.  Am J Obstet Gynecol MFM. 2021 Mar;3(2):100304. 

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