Declining rates of persistent opioid use following peripartum opioid prescription
A new, retrospective study, assessing patients’ national insurance claims data, has observed that peripartum opioid prescription is linked with patients’ new, persistent opioid use following delivery and hospital discharge.
There is an association between opioid prescription for acute pain relief following medical procedures and patients' continued, prolonged opioid use. However, the strength of this association specifically regarding peripartum opioid administration – in the week prior to, and 3 days following, delivery – is unclear. A new, retrospective cohort study, conducted by researchers from the University of Michigan (MI, USA), could provide the answer.
The researchers assessed the national insurance claims data of 308,226 women between 2008 and 2016. Researchers observed that whilst peripartum opioid use was associated with higher rates of new, persistent opioid use following delivery, peripartum opioid prescription and new persistent opioid use after vaginal or cesarean delivery has decreased since 2008.
Eligible study participants were opioid-naïve women who possessed continuous medical and prescription drug records from at least 1 year prior to delivery, to 1 year after their hospital discharge.
Patients were excluded from the study if their delivery hospitalization period exceeded 30 days; this was not thought to reflect routine procedure. Additionally, individuals identified as substance abusers, those who had previously used opioids and those who underwent subsequent medical procedures in the year following delivery were excluded from the study.
New, persistent opioid use amongst women who filled a peripartum opioid prescription was defined by a pharmacy claim of at least one opioid prescription between four and 90 days after patients’ hospital discharge, as well as at least one additional opioid prescription filling between 91 and 365 days after discharge.
In 2008, 26.9% of women who experienced vaginal delivery filled peripartum opioid prescriptions, compared with 75.5% of women who had cesarean deliveries. By 2016, these percentages had fallen to 23.8% and 72.6% respectively.
Concurrently, over this same period, patients’ new, persistent opioid use following their receipt of peripartum opioids decreased from 2.2% amongst women who had vaginal delivery, and 2.5% for women who had cesarean delivery, to 1.1% and 1.3% respectively.
In the study, the authors noted: “The strongest modifiable factor associated with new persistent opioid use after delivery was filling an opioid prescription before delivery.” This association was dose dependent; researchers noted that higher doses of peripartum opioids corresponded to greater risk of persistent opioid use following delivery.
In the study, the authors commented: “Among women giving birth in the United States, new persistent opioid use was found in the present study to decrease.” This depreciation may reflect the growing awareness of the significant health risks associated with opioid use. Nonetheless, the authors continued: “1% to 2% of women in our cohort continued to fill opioid prescriptions for months following birth, particularly those women who received a larger prescription or a prescription prior to delivery.”
The authors concluded: “Maternity care clinicians can help decrease opioid harms by identifying risk, using opioid-sparing protocols, and providing close opioid stewardship in the peripartum period.”
Peahl AF, Dalton VK, Montgomery JR, Lai Y-L, Hu HM, Waljee JF. Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women. JAMA Netw. Open. 2(7):e197863. (2019);