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Master of Public Health

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

AUTHORS

Wiese AD , Osmundson SS , Mitchel E , Adgent M , Phillips S , Patrick SW , Spieker AJ , Grijalva CG , . American journal of obstetrics & gynecology MFM. 2021 8 26; (). 100475

ABSTRACT

BACKGROUND: Opioid analgesics are commonly prescribed to women after cesarean. There is a growing effort to prescribe opioids judiciously, yet the risk of serious opioid-related events (SOREs) associated with specific prescribing patterns after cesarean remains undefined.

OBJECTIVE: We examined the association between dose of the first opioid prescription filled after a cesarean delivery and the risk of SORE.

STUDY DESIGN: We identified opioid naïve women enrolled in Tennessee Medicaid with a cesarean delivery (2007-2014). Pharmacy prescription fill data characterized opioids filled within 5 days of delivery. Mothers were followed from day 5 post-delivery to the earliest SORE (persistent opioid use, evidence of opioid use disorder [OUD: diagnosis or methadone/buprenorphine fill], overdose or opioid-related death), non-opioid related death, enrollment loss, or 365 day. We estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for the SORE outcome based on the dose [morphine milligram equivalents (MME)] of the first filled opioid prescription, adjusting for baseline sociodemographic characteristics, delivery complications, multiple deliveries, comorbidities and medication use. Secondary analyses examined the role of commonly prescribed opioid strengths and quantities.

RESULTS: The overall incidence rate of serious-opioid related events among women after cesarean was 3.0 per 100 person-years. Compared with women not filling an opioid prescription, the rate of SOREs among women who filled opioid prescriptions at any dose was higher among women who filled an opioid prescription, though only significantly higher among women who filled a total dose ≥100 MME (97.1% of opioid prescriptions). In secondary analyses, only women with a low prescribed daily opioid dose and women with a low prescribed number of oxycodone (5 mg) tablets (<10 tablets) were not at increased risk of SOREs compared to women who did not fill an opioid.

CONCLUSIONS: Opioid-naïve women who filled a postpartum opioid prescription at commonly prescribed doses after cesarean had an elevated risk of SORE compared with women who did not fill a postpartum opioid. Low opioid doses were not associated with a significant increase in risk of SOREs.

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