The Postpartum Period as a Point of Prevention for Opioid Misuse: A Commentary

Abstract

The nationwide increase in opioid use has led to an epidemic in the United States, resulting in an increase of opioid-related overdose deaths and opioid analgesic prescriptions over the last two decades. The risk of long-term opioid use post-surgery increases when patients are treated with opioid analgesics compared to their counterparts. Guidelines state that opioid analgesics are not always necessary and should be prescribed for the lowest effective dose only as long as pain is expected to be severe; however, over-prescription is common with general populations showing that half the amount of prescribed opioids do not get used by patients. Obstetric delivery is one of the most common procedures experienced among women who are pregnant. Recent evidence shows that many variations exist in opioid prescription rates during postpartum across states, ranging from 7% to 53% with differences in dosages for greater than 280 morphine milligram equivalents following uncomplicated vaginal delivery, indicating opportunities to develop guidelines on postpartum opioid use but also to improve prescription safety as well as to prevent an unnecessary increase in prescription opioid misuse among postpartum women. Telemedicine for monitoring substance use is increasingly common for substance use treatment programs and electronic technology is also being explored to screen and deliver brief interventions to treat substance use, drinking, and smoking in maternal populations. Given the myriad psychosocial risk factors associated with the postpartum period and the introduction of opioids to many opiate-naïve patients during this time, obstetric delivery may be an optimal time for upstream opioid misuse prevention using mobile technology. The objective of this commentary is to describe the prevalence of maternal opioid use and importance of addressing it with a study to prevent development of maternal opioid misuse.