Effects of State Law Limiting Postoperative Opioid Prescription in Patients After Cesarean Delivery

Abstract

BACKGROUND: The impact of the Florida State law House Bill 21 (HB 21) restricting the duration of opioid prescriptions for acute pain in patients after cesarean delivery is unknown. Our objective was to assess the association of the passage of Florida State law HB 21 with trends in discharge opioid prescription practices following cesarean delivery, necessity for additional opioid prescriptions, and emergency department visits at a large tertiary care center. METHODS: This was a retrospective cohort study conducted at a large, public hospital. The 2 cohorts represented the period before and after implementation of the law. Using a confounder-adjusted segmented regression analysis of an interrupted time series, we evaluated the association between HB 21 and trends in the proportions of patients receiving opioids on discharge, duration of opioid prescriptions, total opioid dose prescribed, and daily opioid dose prescribed. We also compared the need for additional opioid prescriptions within 30 days of discharge and the prevalence of emergency department visits within 7 days after discharge. RESULTS: Eight months after implementation of HB 21, the mean duration of opioid prescriptions decreased by 2.9 days (95% confidence interval [CI], 5.2–0.5) and the mean total opioid dose decreased by 20.1 morphine milligram equivalents (MME; 95% CI, 4–36.3). However, there was no change in the proportion of patients receiving discharge opioids (95% CI of difference, −0.1 to 0.16) or in the mean daily opioid dose (mean difference, 5.3 MME; 95% CI, −13 to 2.4). After implementation of the law, there were no changes in the proportion of patients who required additional opioid prescriptions (2.1% vs 2.3%; 95% CI of difference, −1.2 to 1.5) or in the prevalence of emergency department visits (2.4% vs 2.2%; 95% CI of difference, −1.6 to 1.1). CONCLUSIONS: Implementation of Florida Law HB 21 was associated with a lower total prescribed opioid dose and a shorter duration of therapy at the time of hospital discharge following cesarean delivery. These reductions were not associated with the need for additional opioid prescriptions or emergency department visits.

The risk of serious opioid-related events associated with common opioid prescribing regimens in the postpartum period after cesarean delivery

“…29 In a separate study of a tertiary academic medical center, the median prescribed total opioid dose was 110.7 MME in 2018, even after the passage of HB 21 that restricted opioid prescriptions to a 3-day supply (or 7-days with exemption request). 30 Further, we observed variations in the initial prescribed opioid dose after cesarean by geographic region.…”

Interventions to Reduce Inpatient and Discharge Opioid Prescribing for Postpartum Patients: A Systematic Review

“…Results showed a significant decrease in the number of opioid tablets prescribed at discharge. Another study by Potnuru et al evaluated the impact of Florida Law House Bill 21, which restricts the duration of opioid prescriptions for acute pain to a limit of 3 days 39 . The study showed a significant reduction in the number of patients discharged with an opioid prescription following implementation of the law.…”

“…These interventions were composed of enhanced counseling and shared decisionmaking, 19,27,[32][33][34][35] the elimination of opioids prescriptions at discharge, 36,37 individualized opioid prescriptions at discharge, 38 and legislative changes. 39 (Table 2 )…”

The research frontier of cesarean section recovery: A bibliometric analysis

“…(2) Systematic blood count immediately after CS is not recommended in the general population. (3) The analgesic regimen developed by the medical team should be appropriate for each patient, and early feeding and drinking under regional or general anesthesia is recommended after elective or emergency CS ( 17 , 18 ). (4) Indwelling bladder catheter should be inserted before operation and maintained during operation; The bladder catheter should be removed preferentially within 12 h after CS; It is recommended to check for spontaneous urination within 4–6 h after removal of the bladder catheter.…”