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Trends and Outcomes Associated With Using Long-Acting Opioids During Delivery Hospitalizations

Duffy, Cassandra R., MD; Wright, Jason D., MD; Landau, Ruth, MD; Mourad, Mirella J., MD; Siddiq, Zainab, MS; Kern-Goldberger, Adina R., MD; D’Alton, Mary E., MD; Friedman, Alexander M., MD, MPH

doi: 10.1097/AOG.0000000000002861
Opioids: Original Research: PDF Only

OBJECTIVE: To assess trends in use of long-acting opioids during delivery hospitalizations.

METHODS: The Perspective database, an administrative inpatient database that includes medication receipt, was analyzed to evaluate patterns of long-acting opioid use during delivery hospitalizations from January 2006 through March 2015. Medications evaluated included methadone, formulations including buprenorphine and extended-release formulations of oxycodone, morphine, fentanyl, and other opioids. Temporal trends in use of these medications were determined. Unadjusted and adjusted models evaluating the role of demographic and hospital factors were created evaluating both use of these medications and risk for severe morbidity. Risk for severe morbidity was determined based on Centers for Disease Control and Prevention criteria.

RESULTS: Our analysis included 2,994,630 delivery hospitalizations meeting study criteria. Over the entire study period, use of long-acting opioids increased significantly from 457 to 844 per 100,000 deliveries. Although buprenorphine and methadone use increased, use of other long-acting opioids decreased. In 2006, methadone and buprenorphine accounted for less than one third of all long-acting opioids used during delivery hospitalizations. By 2015, buprenorphine and methadone represented 73.5% of long-acting opioids used. In adjusted and unadjusted models, risk for severe morbidity was significantly lower with buprenorphine or methadone compared with other long-acting opioids. Restricting the cohort to only women with drug abuse or dependence, risk for severe morbidity was lower with methadone and buprenorphine than without any long-acting opioids.

CONCLUSION: Increased use of methadone and buprenorphine in this study supports the feasibility of use of these medications during pregnancy and uptake of clinical recommendations for women with opioid use disorder. Use of methadone and buprenorphine is associated with decreased maternal morbidity, although causation cannot be presumed from this study model.

Receipt of buprenorphine and methadone increased from 2006 to 2015, while receipt of other long-acting opioids decreased.

Departments of Obstetrics and Gynecology and Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, New York.

Corresponding author: Alexander M. Friedman, MD, MPH, Division of Maternal-Fetal Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, New York, NY 10032; email: amf2104@cumc.columbia.edu.

Dr. Friedman is supported by a career development award (K08HD082287) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.

Financial Disclosure Dr. Wright has served as a consultant for Tesaro and Clovis Oncology. The other authors did not report any potential conflicts of interest.

Presented at the Annual Meeting for the Society for Maternal-Fetal Medicine, January 29–February 3, 2018, Dallas, Texas.

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

Received April 11, 2018

Received in revised form June 26, 2018

Accepted July 05, 2018

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