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

Autor: Wiese AD; Departments of Health Policy (Dr Wiese, Mr Mitchel, and Drs Adgent, Patrick, and Grijalva), Vanderbilt University Medical Center, Nashville, TN. Electronic address: andrew.d.wiese.1@vumc.org., Osmundson SS; Obstetrics and Gynecology (Dr Osmundson), Vanderbilt University Medical Center, Nashville, TN., Mitchel E Jr; Departments of Health Policy (Dr Wiese, Mr Mitchel, and Drs Adgent, Patrick, and Grijalva), Vanderbilt University Medical Center, Nashville, TN., Adgent M; Departments of Health Policy (Dr Wiese, Mr Mitchel, and Drs Adgent, Patrick, and Grijalva), Vanderbilt University Medical Center, Nashville, TN., Phillips S; Biostatistics (Ms Phillips and Dr Spieker), Vanderbilt University Medical Center, Nashville, TN., Patrick SW; Departments of Health Policy (Dr Wiese, Mr Mitchel, and Drs Adgent, Patrick, and Grijalva), Vanderbilt University Medical Center, Nashville, TN; Pediatrics (Dr Patrick), Vanderbilt University Medical Center, Nashville, TN; The Center for Child Health Policy, Vanderbilt University Medical Center, Nashville, TN (Dr Patrick)., Spieker AJ; Biostatistics (Ms Phillips and Dr Spieker), Vanderbilt University Medical Center, Nashville, TN., Grijalva CG; Departments of Health Policy (Dr Wiese, Mr Mitchel, and Drs Adgent, Patrick, and Grijalva), Vanderbilt University Medical Center, Nashville, TN; Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, US Department of Veterans Affairs, Nashville, TN (Dr Grijalva).
Jazyk: angličtina
Zdroj: American journal of obstetrics & gynecology MFM [Am J Obstet Gynecol MFM] 2021 Nov; Vol. 3 (6), pp. 100475. Date of Electronic Publication: 2021 Aug 26.
DOI: 10.1016/j.ajogmf.2021.100475
Abstrakt: Background: Opioid analgesics are commonly prescribed to women after cesarean delivery. There is a growing effort to prescribe opioids judiciously; however, the risk of serious opioid-related events associated with specific prescribing patterns after cesarean delivery remains unclear.
Objective: We examined the association between the dosage of the first opioid prescription filled after cesarean delivery and the risk of serious opioid-related events.
Study Design: We identified opioid-naïve women with a cesarean delivery enrolled in Tennessee Medicaid (2007-2014). Pharmacy prescription fill data characterized opioids filled within 5 days after delivery. Patients were followed up from day 5 after delivery to the earliest of the following: serious opioid-related event (persistent opioid use, evidence of opioid use disorder [diagnosis or methadone or buprenorphine fill], overdose, or opioid-related death), non-opioid-related death, enrollment loss, or 365th day. We estimated the adjusted hazard ratios and 95% confidence intervals for the serious opioid-related event outcomes based on the dosage (morphine milligram equivalents) 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 delivery was 3.0 per 100 person-years. Compared with women who did not fill an opioid prescription, the rate of serious opioid-related events was higher among women who filled an opioid prescription, although only significantly higher among women who filled a total dosage of ≥100 morphine milligram equivalents (97.1% of opioid prescriptions). In the secondary analyses, women with a low prescribed daily opioid dosage and women with a low prescribed number of oxycodone (5 mg) tablets (<10 tablets) were not at increased risk of serious opioid-related events compared with women who did not fill an opioid prescription.
Conclusion: Opioid-naïve women who filled a postpartum opioid prescription at commonly prescribed doses after cesarean delivery had an increased risk of serious opioid-related events compared to women who did not fill a postpartum opioid prescription. Low opioid doses were not associated with a significant increase in the risk of serious opioid-related events.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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