Women who undergo vaginal delivery in the United States may frequently be prescribed opioid medications for pain within 1 week of hospital discharge, often dispensed at high doses and in significant quantities, according to a study published in Obstetrics & Gynecology.
Despite experiencing only mild to moderate pain post-delivery, many women are given prescriptions for opioids after discharge, even when non-opioid analgesics are recommended as first-line treatment. There is however a lack of nationwide dispensing data in this population.
Using a retrospective cohort study, investigators analyzed data from the Truven Health Analytics MarketScan claims database recorded between 2003 and 2015 on all vaginal deliveries in opioid-naive women who were commercially insured. Multivariable logistic regression analyses were conducted to examine independent predictors of opioid dispensing.
A total of 1,345,244 women (mean age, 29) who delivered vaginally were included in the study. Of these women, 383,374 (28.5%; 95% CI, 28.4-28.6%) filled a prescription for opioids within a week following discharge. Dispensing frequency was found to increase from 26.7% (95% CI, 26.2-27.1%) to 29.3% (95% CI, 29.0-29.6%) between 2003 and 2015 (P <.001). Hydrocodone (44.7%), oxycodone (34.6%), and codeine (13.1%) prescriptions were the most common, with a median dose of 150 morphine mg equivalent (MME; interquartile range, 113-225 MME), which was considered equivalent to 20 oxycodone 5-mg tablets (interquartile range, 15-30).
Compared with the Northeastern US, the adjusted odds ratio (aOR) for opioid dispensation was 4.70 (95% CI, 4.63-4.77) in the Southern US, 2.94 (95% CI, 2.90-2.99) in the Western US, and 2.77 (95% CI, 2.72-2.81) in the Midwestern US. Patients taking benzodiazepines (aOR, 1.87; 95% CI, 1.73-2.02) and antidepressants (adjusted odds ratio [aOR], 1.63; 95% CI, 1.59-1.66) were at increased risk for filling a prescription, as were smokers (aOR, 1.44; 95% CI, 1.38-1.51). Tubal ligation (aOR, 3.77; 95% CI, 3.67-3.87), higher order perineal laceration (aOR, 2.15; 95% CI, 2.11-2.18), and operative vaginal delivery (aOR, 1.52; 95% CI, 1.49-1.54) were also associated with greater odds of filling an opioid. At 6 weeks post-discharge, 8.5% of patients had filled ≥1 additional prescription(s).
Study limitations include sole assessment of prescription drug benefit usage (excluding unfilled and out-of-pocket prescriptions), lack of information about actual consumption quantities, limited generalizability, and International Classification of Diseases codes biased toward specificity vs sensitivity.
“Given the large number of vaginal deliveries each year, curbing unnecessary opioid prescribing in this clinical situation could have a significant public health effect,” noted the authors.
Ms. Garry is an employee of Aetion, Inc, a software and data analytics company, of which she holds stock options. Dr. Hernandez-Diaz is an investigator on grants to the Harvard T.H. Chan School of Public Health from GSK, Lilly, and Pfizer for unrelated work; she receives salary support from the North American AED Pregnancy Registry and is a consultant to UCB, Teva, and Boehringer- Ingelheim; her institution received training grants from Pfizer, Takeda, Bayer, and Asisa. Dr. Huybrechts is an investigator on grants to Brigham and Women’s Hospital from Lilly, GSK, Pfizer, and Boehringer Ingelheim, unrelated to this study. Dr. Bateman is an investigator on grants to Brigham and Women’s Hospital from Lilly, GSK, Pfizer, Baxalta, and Pacira, unrelated to this study. He is also a consultant to Aetion, Inc. The other authors did not report any potential conflicts of interest.
Prabhu M, Garry EM, Hernandez-Diaz S, Macdonald SC, Huybrechts KF, Bateman BT. Frequency of opioid dispensing after vaginal delivery. Obstet Gynecol. 2018;132(2):459-465. doi:10.1097/aog.0000000000002741