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Opioid Knowledge and Prescribing Practices Among Obstetrician–Gynecologists

Madsen, Annetta, M., MD; Stark, Lauren, M., MPP; Has, Phinnara, MS; Emerson, Jenna, B., MD; Schulkin, Jay, PhD; Matteson, Kristen, A., MD, MPH

doi: 10.1097/AOG.0000000000002407
Contents: Original Research

OBJECTIVE: To describe obstetrician–gynecologists' (ob-gyns) knowledge and prescribing practices regarding opioid analgesics.

METHODS: We conducted a cross-sectional survey of a national sample of American College of Obstetricians and Gynecologists Fellows and Junior Fellows who are part of the Collaborative Ambulatory Research Network. We used a sequential mixed-method approach. We collected data on opioid knowledge and typical prescribing practices, including number, type, and indication for prescriptions. We determined adherence to four recommended practices: 1) screening for dependence, 2) prescribing the smallest amount required, 3) tailoring prescriptions, and 4) counseling on proper disposal. We also explored variables associated with prescribing practices.

RESULTS: Sixty percent (179/300) of sampled members responded. Respondents reported prescribing a median of 26 (5–80) pills per patient across all indications combined. Ninety-eight percent prescribed opioids after surgery and a smaller proportion for nonsurgical indications: vaginal birth (22%), ovarian cysts (30%), endometriosis (24%), and chronic pelvic pain of unknown cause (18%). The number prescribed varied only by indication for the prescription. Nineteen percent reported adherence to three or more (of four) recommended practices. There was no significant difference in the median number of pills prescribed between those who reported adherence to at least one compared with those who did not adhere to any recommended practices (25 [interquartile range 25–30] vs 28 [interquartile range 20–30], P=.58). Regarding knowledge, 81% incorrectly identified the main source of misused opioids, which is through diversion from a friend or family member, and 44% did not know how to properly dispose of unused prescription opioids.

CONCLUSION: Obstetrician–gynecologists reported prescribing a median of 26 opioid pills across all indications combined. Amount prescribed varied widely by indication but not by reported adherence to recommended prescribing practices. This study highlights an urgent need for increased efforts to improve ob-gyns' knowledge of opioid use, misuse, disposal, and best prescribing practices.

Obstetrician–gynecologists typically prescribe 5 to 80 opioid tablets for outpatient pain management; 19% report adherence to three or more (of four) recommended prescribing practices.

Department of Obstetrics and Gynecology, Women & Infants’ Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island; and the Research Department of the American College of Obstetricians and Gynecologists, Washington, DC.

Corresponding author: Annetta M. Madsen, MD, 347 Smith Avenue N, #203 St. Paul, MN 55102; email:

Supported by grant number UA6MC19010 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services.

Financial Disclosure The authors did not report any potential conflicts of interest.

Jay Schulkin was an employee of the American College of Obstetricians and Gynecologists (ACOG) when the study was conducted. All opinions expressed in this article are the authors' and do not necessarily reflect the policies and views of ACOG.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.