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Am J Perinatol 2024; 41(S 01): e1459-e1462
DOI: 10.1055/s-0043-1767816
Short Communication

Postpartum Opioid Prescribing in Patients with Opioid Use Prior to Birth

Alex F. Peahl
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
2   Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
3   Department of Obstetrics and Gynecology, Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, Michigan
,
Emma Keer
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
,
Alexander Hallway
4   Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
5   Michigan Surgical Quality Collaborative, Ann Arbor, Michigan
,
Brooke Kenney
4   Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
,
Jennifer F. Waljee
3   Department of Obstetrics and Gynecology, Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, Michigan
4   Michigan Opioid Prescribing Engagement Network, Ann Arbor, Michigan
6   Department of Surgery, University of Michigan, Ann Arbor, Michigan
7   Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
,
Courtney Townsel
1   Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
3   Department of Obstetrics and Gynecology, Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, Michigan
› Author Affiliations Funding Research reported in this publication was supported by funding from the Centers for Medicare and Medicaid Services under subcontract award number: 253001 (22). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Health and Human Services. Funding for this research was also made available through the Michigan Institute for Clinical & Health Research (MICHR; grant no.: UL1TR002240).
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Abstract

Objective This study aimed to describe opioid prescribing patterns for pregnant patients with a history of or active opioid use to inform postpartum pain management strategies.

Study Design We conducted a retrospective cohort analysis of all patients with a history of opioid use disorder (OUD) or chronic pain seen at a single outpatient clinic specializing in opioid use and OUD in pregnancy from January 2019 to August 2021. Patient characteristics, delivery outcomes, and opioid prescribing information were collected through electronic health record fields. We used descriptive statistics to characterize differences in receipt of an opioid prescription, prescription size, and receipt of a prescription refill across three patient groups: patients with OUD on medication, patients with OUD maintaining abstinence, and patients with chronic pain using opioids. In the study period, the institutional average rate of opioid prescribing after cesarean and vaginal birth were 80.0 and 2.8%, respectively.

Results Of the 69 patients included in this study, 46 (66.7%) had a history of OUD on medication, 14 (20.3%) had a history of OUD maintaining abstinence, and 9 (13.0%) had a history of chronic pain. Receipt of an opioid prescription after childbirth was more common after cesarean birth (12/23, 52.2%) than vaginal birth (3/46, 6.5%). Refills were common in patients who received an opioid proscription (cesarean: 5/12, 41.7%; vaginal: 1/3, 33.3%).

Conclusion Compared with institutional averages, postpartum opioid prescribing rates for people with a history of OUD or chronic pain were 50 to 60% lower for cesarean birth and three times higher for vaginal birth. Future work is needed to balance opioid stewardship and harm reduction with adequate pain control in these high-risk populations.

Key Points

  • Opioid prescribing rates for patients with OUD/chronic pain were 60% lower for cesarean birth than institutional averages.

  • Opioid prescribing rates for patients with OUD/chronic pain were three times higher for vaginal birth than institutional averages.

  • Refill rates following birth were high overall for cesarean (40%) and vaginal (33%) birth.

  • More work is needed to balance opioid prescribing with adequate pain control in high-risk patients.

Keywords

opioid prescribing - chronic pain - opioid use disorder - postpartum pain management


Publication History

Received: 29 July 2022

Accepted: 23 February 2023

Article published online:
10 April 2023

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