Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women

Peahl, Alex; Dalton, Vanessa K.; Montgomery, John R.; Lai, Yen-Ling; Hu, Hsou Mei; Waljee, Jennifer F.

doi:10.1001/jamanetworkopen.2019.7863

Cited by 109 publications

(126 citation statements)

References 41 publications

(146 reference statements)

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“…The primary outcome was new persistent opioid use (NPOU) after vaginal or cesarean delivery, defined as at least 2 pharmacy claims after discharge: !1 opioid prescription between 4 and 90 days postdischarge and !1 prescription between 91 and 365 days postdischarge. 5,14 This definition of NPOU is consistent with prior work, and represents a time when patients are expected to have recovered from their initial delivery episode.…”

Section: Methodsmentioning

confidence: 81%

“…1e4 This increased focus is warranted, as 1 in 75 women in the United States who fill an opioid prescription in the peripartum period will continue filling prescriptions up to 1 year postpartum. 5 In fact, exposure to postpartum opioids has been linked to new persistent use after delivery, independent of the type of birth (vaginal vs cesarean delivery), suggesting that the risk is inherent to the opioid prescription. 5 Less is known, however, about the long-term consequences of acute opioid prescribing during pregnancy, outside of the delivery episode.…”

mentioning

confidence: 99%

“…5 In fact, exposure to postpartum opioids has been linked to new persistent use after delivery, independent of the type of birth (vaginal vs cesarean delivery), suggesting that the risk is inherent to the opioid prescription. 5 Less is known, however, about the long-term consequences of acute opioid prescribing during pregnancy, outside of the delivery episode. It is possible that opioid prescribing for pain in pregnancy could have an effect similar to that of postpartum opioid prescribing.…”

mentioning

confidence: 99%

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New persistent opioid use after acute opioid prescribing in pregnancy: a nationwide analysis

Peahl

Morgan

Dalton

et al. 2020

American Journal of Obstetrics and Gynecology

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To evaluate the association between opioid prescribing during pregnancy and new persistent opioid use in the year following delivery. MATERIALS AND METHODS: This nationwide retrospective cohort study included patients aged 12À55 years in Optum's deidentified Clinformatics Data Mart Database who were undergoing vaginal delivery or cesarean delivery from 2008 to 2016, with continuous enrollment from 2 years before birth to 1 year postdischarge. Women were included if they were opioid naive in pregnancy (ie, did not fill an opioid prescription 2 years to 9 months before delivery) and did not undergo a procedure within the year after discharge. The exposure was filling an opioid prescription in pregnancy. The primary outcome was new persistent opioid use, defined as a pharmacy claim for !1 opioid prescription between 4 and 90 days postdischarge and !1 prescription between 91 and 365 days postdischarge. Clinical and demographic covariates were included. Analyses included descriptive statistics and multivariable logistic regression, adjusting for clinical and demographic covariates. RESULTS: Of 158,425 childbirths identified, 101,013 (63.8%) were by vaginal delivery and 57,412 (36.2%) cesarean delivery. Among all patients, 6.0% (9429) filled an opioid prescription during pregnancy. The factors associated with filling an opioid in pregnancy were having a nondelivery procedure in pregnancy (adjusted odds ratio, 9.60; 95% confidence interval, 8.81À10.47) and having an emergency room visit during pregnancy (adjusted odds ratio, 2.48; 95% confidence interval, 2.37À2.59). Of women who received an opioid in pregnancy, 4% (379) developed new persistent opioid use. The factors most associated with new persistent opioid use were receiving an opioid prescription during pregnancy (adjusted odds ratio, 3.45; 95% confidence interval, 3.04À3.92) and filling a peripartum opioid prescription (1 week prior to 3 days postdischarge) adjusted odds ratio, 2.28, 95% confidence interval (2.02À2.57). Though having a procedure during pregnancy was associated with increased receipt of an opioid prescription, it was also associated with reduced new persistent opioid use (adjusted odds ratio, 0.72; 95% confidence interval, 0.52À0.99). CONCLUSION: Women who receive an opioid prescription during pregnancy are more likely to experience new persistent opioid use. Maternity care providers must balance pain management in pregnancy with potential risks of opioids.

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Section: Methodsmentioning

confidence: 81%

mentioning

confidence: 99%

mentioning

confidence: 99%

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New persistent opioid use after acute opioid prescribing in pregnancy: a nationwide analysis

Peahl

Morgan

Dalton

et al. 2020

American Journal of Obstetrics and Gynecology

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“…Maternal age, parity, body mass index (BMI), maternal race/ethnicity, insurance status, and history of cesarean section were selected because they have been demonstrated to be associated with postoperative opioid use in the literature. [11][12][13] Year of delivery was included in the model given the rapid secular changes in opioid prescription recommendations during this time, as well as the potential for evolution in PMP accuracy. 7,14 Finally, we included county of residence as women who resided close to the border may have been more likely to fill their prescription in an adjoining state, thus making them undetectable in the Illinois PMP.…”

Section: Methodsmentioning

confidence: 99%

How Reliable Is a Statewide Prescription Monitoring Program for Identifying Post-Cesarean Opioid Use?

Premkumar

Speedy

2020

AJP Rep

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Objective This study was aimed to estimate the percentage of women taking opioids post-cesarean who could be detected in a state prescription monitoring program (PMP) and characteristics of those not able to be detected. Study Design This observational cohort study included all women with an Illinois address who delivered via cesarean section and used opioids within 24 hours prior to discharge at a tertiary care hospital between August 21, 2017 and March 1, 2018. The Illinois PMP was queried for presence of an opioid prescription filled within the first 3 months postpartum. Sociodemographic and clinical factors associated with an undetectable PMP record were evaluated in bivariable and multivariable logistic regression analyses. Results A total of 517 women underwent a cesarean delivery during the study period, of whom 344 (66.5%) met inclusion criteria. Of these women, 169 (49%) did not have a detectable PMP record of filling any outpatient postpartum prescription opioid. On bivariable and multivariable logistic regression analysis, year of delivery (2018 vs. 2017) was significantly associated with a higher incidence of detectable postpartum prescription opioid record in the PMP with increasing relative risk of detectable records in the second year of analyses (n = 110/244 [45%] in 2017 vs. n = 59/100 [59%] in 2018, adjusted risk ratio [aRR] = 1.32, 95% confidence interval [CI]: 1.06–1.64, p = 0.013). No other sociodemographic or clinical characteristics was significantly associated. Conclusion Nearly half of women who underwent a cesarean section and who were administered opioids 24 hours prior to discharge did not have a detectable postpartum opioid prescription in the PMP. While identification of prescription filling improved with time, many of women were not detectable in the PMP system. These data call into question the accuracy of PMPs in identifying prescription opioid filling patterns in the postpartum setting.

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“…5 Overprescribing opioids is not without risk: 1.7% of patients who underwent vaginal delivery and 2.2% of cesarean deliveries had new persistent opioid use (>90 days after delivery) following initiation at delivery. 6 Numerous studies have shown signi cant racial and ethnic disparities in opioid prescribing practices. A Prescription Drug Monitoring Program (PDMP) study in California found 300% higher prescription rates in predominantly White communities compared to non-White communities.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Race on Postpartum Opioid Prescribing Practices: A Retrospective Cohort Study

McKinnish

Lewkowitz

Carter

et al. 2020

Preprint

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BackgroundTo identify the association between inpatient postpartum opioid consumption, race, and amount of opioids prescribed at discharge after vaginal or cesarean delivery. MethodsA total of 416 women who were prescribed an oral opioid following vaginal or cesarean delivery at a single tertiary academic institution between July 2018 and October 2018 were identified. Women with postoperative wound complications, third and fourth degree lacerations, cesarean hysterectomy, or a history of opioid abuse were excluded. The primary outcome was the number of oxycodone 5 mg tablets prescribed at discharge, stratified by race and mode of delivery. Only “Black” and “White” women were included in analyses due to low absolute numbers of other identities. Black women were compared to white women using multivariable logistic regression. Multiple sensitivity analyses were performed.ResultsThe median number of oxycodone tablets consumed during hospitalization following cesarean delivery was seven (IQR: 2.5–12 tablets) and following vaginal delivery was one (IQR: 0-3). White women were more likely to be older at delivery regardless of route (median 32 vs. 30 years for cesarean delivery, and 29 vs. 27 years for vaginal delivery; p<0.01 for both). White women undergoing cesarean delivery did so at a lower maternal BMI (31.6 vs. 34.5; p=0.02). White women were also significantly more likely to have private insurance and to experience perineal lacerations following vaginal delivery. The number of inpatient opioid tablets consumed, as well as the number prescribed at discharge, were not statistically different between Black and White women, regardless of mode of delivery. These findings persisted in sensitivity analyses.ConclusionAt our large, academic hospital the number of tablets prescribed at discharge had no association with patient race or inpatient usage regardless of mode of delivery.

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Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women

Cited by 109 publications

References 41 publications

New persistent opioid use after acute opioid prescribing in pregnancy: a nationwide analysis

New persistent opioid use after acute opioid prescribing in pregnancy: a nationwide analysis

How Reliable Is a Statewide Prescription Monitoring Program for Identifying Post-Cesarean Opioid Use?

The Impact of Race on Postpartum Opioid Prescribing Practices: A Retrospective Cohort Study

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