Postpartum Opioid Scripts Tied to Risk of Serious Events – MedPage Today

The number of opioid prescriptions that women filled after childbirth was associated with an increased risk of serious opioid-related events (SOREs), according to a Tennessee-based cohort study.

Women that filled one opioid prescription in the year after childbirth had a 40% increased risk of SOREs (adjusted hazard ratio 1.40, 95% CI 1.30-1.60), including persistent opioid use, opioid use disorder, buprenorphine or methadone prescription fills, opioid overdose, or death, reported Sarah Osmundson, MD, of the Vanderbilt University Medical Center in Nashville.

The number of postpartum prescription fills increased risk regardless of birth route, they wrote in Annals of Internal Medicine.

“With the number of prescriptions given during the postpartum period, this risk of severe outcomes increases,” Osmundson said in an interview with MedPage Today. While she said she anticipated that the risk for serious outcomes would be higher among women who delivered via cesarean section, there was not a major difference in risk between vaginal and C-section births.

The authors observed that routine opioid prescribing after vaginal birth was common in Tennessee, and Osmundson said that understanding this information allows practitioners to act more readily to change practice. “There should be more attention given to the routine prescribing of opioid medications after vaginal birth,” she stated.

Alex Peahl, MD, an ob/gyn at the University of Michigan in Ann Arbor, also noted routine opioid prescribing after vaginal delivery.

“These high rates of prescribing after vaginal birth — a non-surgical hospitalization — warrant further evaluation to understand the key drivers of prescribing,” said Peahl, who was not involved in the study, in an email.

Peahl added that while this study provides a comprehensive examination into the harms of routine opioid prescribing after childbirth, the data only include births up to 2014, so significant changes to clinical practice that resulted from a greater awareness of the opioid epidemic are missed in this analysis.

Nevertheless, the findings inform providers that they should “utilize opioid-sparing pain regimens for postpartum women to minimize the risks of opioid prescribing while ensuring patients’ pain is well controlled,” she stated.

Osmundson and colleagues included women who were enrolled in Tennessee’s Medicaid program, and TennCare, and supplemented these data with birth certificate information and hospital discharge data.

Study participants were between the ages 15 and 44, and were discharged after childbirth from 2007 to 2014. Women were followed up from the start of the postpartum period (42 days after hospital discharge) to at least 1 year.

Women included had no history of opioid prescription or opioid use disorder leading up to birth. The researchers adjusted for covariates including, but not limited to, age, parity, income, distance to birth hospital, race and ethnicity, Tennessee region, severe maternal morbidity, perineal lacerations, bilateral tubal ligation, and filling one opioid prescription during pregnancy.

Of more than 200,000 births to 161,000 women, 59% of vaginal births and 91% of C-section births filled at least one opioid prescription in the year after childbirth. Around 11% and 24% filled a second postpartum prescription, respectively.

Osmundson and colleagues identified SOREs in 4,582 participants. Nearly 69% had persistent opioid use, 19% had a substance use disorder, 10% filled prescriptions for buprenorphine or methadone, 2% had an opioid overdose, and 0.2% experienced an opioid-related death.

Among women who filled one postpartum opioid prescription, the adjusted HR was 1.50 (95% CI 1.30-1.70) for vaginal births, and 1.20 (95% CI 0.90-1.50) for C-sections. Women who filled two postpartum opioid prescriptions had an adjusted HR of 3.70 (95% CI 3.30-4.20) for vaginal births and 2.90 (95% CI 2.30-3.80) for C-sections. And the HRs among women who filled three or more prescriptions were 7.20 (95% CI 6.30-8.20) and 5.90 (95% CI 4.60-7.60), respectively.

Osmundson’s group acknowledged that the use of Medicaid data from the state of Tennessee may limit the generalizability of their results. Also, the state was strongly impacted by the opioid epidemic. Finally, the authors could not account for data on actual opioid use, including illicit opioid use.

Last Updated June 08, 2020

NashvilleAdmin

See author's posts