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Frequency of Opioid Dispensing After Vaginal Delivery

Prabhu, Malavika, MD; Garry, Elizabeth M., MPH; Hernandez-Diaz, Sonia, MD, DrPh; MacDonald, Sarah C., ScM; Huybrechts, Krista F., MS, PhD; Bateman, Brian T., MD, MSc

doi: 10.1097/AOG.0000000000002741
Contents: Opioids: Original Research

OBJECTIVE: To describe nationwide patterns in outpatient opioid dispensing after vaginal delivery.

METHODS: Using the Truven Health Analytics MarketScan database, we performed a large, nationwide retrospective cohort study of commercially insured beneficiaries who underwent vaginal delivery between 2003 and 2015 and who were opioid-naive for 12 weeks before the delivery admission. We assessed the proportion of women dispensed an oral opioid within 1 week of discharge, the associated median oral morphine milligram equivalent dose dispensed, and the frequency of opioid refills during the 6 weeks after discharge. We evaluated predictors of opioid dispensing using multivariable logistic regression.

RESULTS: Among 1,345,244 women undergoing vaginal delivery, 28.5% were dispensed an opioid within 1 week of discharge. The most commonly dispensed opioids were hydrocodone (44.7%), oxycodone (34.6%), and codeine (13.1%). The odds of filling an opioid were higher among those using benzodiazepines (adjusted odds ratio [OR] 1.87, 95% CI 1.73–2.02) and antidepressants (adjusted OR 1.63, 95% CI 1.59–1.66), smokers (adjusted OR 1.44, 95% CI 1.38–1.51), and among those undergoing tubal ligation (adjusted OR 3.77, 95% CI 3.67–3.87), operative vaginal delivery (adjusted OR 1.52, 95% CI 1.49–1.54), and higher order perineal laceration (adjusted OR 2.15, 95% CI 2.11–2.18). The median (interquartile range, 10th–90th percentile) dose of opioids dispensed was 150 (113–225, 80–345) morphine milligram equivalents, equivalent to 20 tablets (interquartile range 15–30, 10th–90th percentile 11–46) of 5 mg oxycodone. Six weeks after discharge, 8.5% of women filled one or more additional opioid prescriptions.

CONCLUSION: Opioid dispensing after vaginal delivery is common and often occurs at high doses. Given the frequency of vaginal delivery, this may represent an important source of overprescription of opioids in the United States.

Opioids are dispensed, frequently in high quantities, to more than one fourth of women undergoing vaginal delivery.

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, and the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Science, Aetion Inc, New York, New York; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.

Corresponding author: Malavika Prabhu, MD, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit Street, Founders 460, Boston, MA 02114; email: malavika.prabhu@gmail.com.

Supported by the National Institute on Drug Abuse (R01 DA044293-01A1). One of the authors (K.F.H.) was supported by a career development grant K01MH099141 from the National Institute of Mental Health.

Financial Disclosure Ms. Garry is an employee of Aetion, Inc, a software and data analytics company, of which she holds stock options. Dr. Hernandez-Diaz is an investigator on grants to the Harvard T.H. Chan School of Public Health from GSK, Lilly, and Pfizer for unrelated work; she receives salary support from the North American AED Pregnancy Registry and is a consultant to UCB, Teva, and Boehringer-Ingelheim; her institution received training grants from Pfizer, Takeda, Bayer, and Asisa. Dr. Huybrechts is an investigator on grants to Brigham and Women's Hospital from Lilly, GSK, Pfizer, and Boehringer Ingelheim, unrelated to this study. Dr. Bateman is an investigator on grants to Brigham and Women's Hospital from Lilly, GSK, Pfizer, Baxalta, and Pacira, unrelated to this study. He is also a consultant to Aetion, Inc. The other authors did not report any potential conflicts of interest.

Presented as a poster at the Society for Maternal-Fetal Medicine meeting, February 1, 2018, Dallas, Texas.

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

Received February 21, 2018

Received in revised form May 01, 2018

Accepted May 10, 2018

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