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Opioid prescribing after childbirth

overprescribing and chronic use

Osmundson, Sarah S.a; Min, Jea Youngb,c; Grijalva, Carlos G.b,c

Current Opinion in Obstetrics and Gynecology: April 2019 - Volume 31 - Issue 2 - p 83–89
doi: 10.1097/GCO.0000000000000527
MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode

Purpose of review Overprescribing opioids contributes to the epidemic of drug overdoses and deaths in the United States. Opioids are commonly prescribed after childbirth especially after caesarean, the most common major surgery. This review summarizes recent literature on patterns of opioid overprescribing and consumption after childbirth, the relationship between opioid prescribing and chronic opioid use, and interventions that can help reduce overprescribing.

Recent findings It is estimated that more than 80% of women fill opioid prescriptions after caesarean birth and about 54% of women after vaginal birth, although these figures vary greatly by geographical location and setting. After opioid prescriptions are filled, the median number of tablets used after caesarean is roughly 10 tablets and the majority of opioids dispensed (median 30 tablets) go unused. The quantity of opioid prescribed influences the quantity of opioid used. The risk of chronic opioid use related to opioid prescribing after birth may seem not high (annual risk: 0.12–0.65%), but the absolute number of women who are exposed to opioids after childbirth and become chronic opioid users every year is very large. Tobacco use, public insurance and depression are associated with chronic opioid use after childbirth. The risk of chronic opioid use among women who underwent caesarean and received opioids after birth is not different from the risk of women who received opioids after vaginal delivery.

Summary Women are commonly exposed to opioids after birth. This exposure leads to an increased risk of chronic opioid use. Physician and providers should judiciously reduce the amount of opioids prescribed after childbirth, although more research is needed to identify the optimal method to reduce opioid exposure without adversely affecting pain management.

aDepartment of Obstetrics and Gynecology

bDepartment of Health Policy, Vanderbilt University Medical Center

cVeterans Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee, USA

Correspondence to Sarah S. Osmundson, MD, MS, 1161 21st Avenue South, B-1118 MCN Nashville TN 37232, USA. Tel: +1 615 343 7869; e-mail:

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