Trends in Postpartum Opioid Prescribing: A Time Series Analysis

Abstract

Opioids are commonly prescribed following childbirth, but data are lacking on trends in postpartum opioid prescribing over time. We examined whether a highly publicized 2006 case report questioning the safety of codeine during lactation was associated with changes in postpartum opioid prescribing. We conducted a cross‐sectional time series analysis of all publicly funded prescriptions for opioids to postpartum women in Ontario, Canada, from April 1, 2000, to March 31, 2017. The intervention was the publication of a case report in 2006 attributing the death of a breastfeeding neonate to maternal codeine use. The primary outcome was the rate of opioid prescribing to postpartum women. Among postpartum women eligible for prescription drug coverage, 17.5% filled an opioid prescription in the third quarter of 2006 (immediately prior to the intervention), with codeine representing 89.8% of all prescriptions. By the fourth quarter of 2010, only 12.2% of postpartum women filled an opioid prescription, representing a decline of 30% (P < 0.01), with codeine representing 71.9% of all prescriptions. During this period, we observed sizeable relative increases in the proportion of opioid prescriptions filled for morphine, hydromorphone, and oxycodone. By 2017, among women prescribed opioids post partum, 39.0% filled a prescription for codeine, while the remainder filled prescriptions for oxycodone (18.6%), morphine (25.5%), and hydromorphone (16.9%). A highly publicized case report questioning the safety of maternal codeine use during breastfeeding was associated with significant changes in opioid prescribing to postpartum women, including a decline in overall opioid prescribing and a shift from codeine to stronger opioids.

New Persistent Opioid Use After Childbirth

“…Prescriptions for opioids are uncommon after vaginal delivery in our region, and we hypothesize that those who fill a prescription may constitute a group at higher risk for persistent opioid use. 27,28 Some of the factors that might be associated with this higher risk likely remain unmeasured in our analyses.…”

“…These databases were linked at ICES in an anonymous fashion using encoded health insurance numbers and have been used extensively to study drug safety. 3,[22][23][24][25][26][27] ICES (formerly the Institute for Clinical Evaluative Sciences) is an independent, nonprofit research institute permitted by law to collect and analyze health care and demographic data, without consent, for health system evaluation and improvement.…”

“…Opioid prescriptions were converted to approximate MME with a commonly used opioid conversion algorithm (Appendix 2, available online at http:// links.lww.com/AOG/D461) 30 that has been used in other studies. 3,27,28 We stratified all analyses by mode of delivery for several reasons. First, postpartum opioid use is less common after vaginal deliveries.…”

“…Opioid prescriptions were converted to approximate MME with a commonly used opioid conversion algorithm (Appendix 2, available online at http://links.lww.com/AOG/D461) 30 that has been used in other studies. 3,27,28…”

Temporal Trends in Postpartum Opioid Prescribing, Opioid Use, and Pain Control Satisfaction

“…However, a cross-sectional time series analysis of postpartum opioid prescriptions in Canada demonstrated a decreasing trend. 7 Labor and delivery is the most common reason for hospitalization in the United States, 8 and is thus a common reason for exposure to opioids. Over 80% of postpartum patients are prescribed an opioid during their inpatient hospitalization and nearly 40% are discharged with an opioid prescription.…”