Oral Opioid Use during Vaginal Delivery HospitalizationsFunding A.M.F. 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.
07 August 2018
12 January 2019
12 February 2019 (online)
Objective This study aimed to determine the receipt of short-acting opioid medications during vaginal delivery hospitalizations.
Study Design The Perspective database was analyzed to evaluate patterns of short-acting oral opioid use during vaginal delivery hospitalizations from January 2006 to March 2015. Unadjusted and adjusted models evaluating the role of demographic and hospital factors were created evaluating use of opioids. Hospital-level rates of opioid use were evaluated. Opioid receipt among women with opioid abuse or dependence was evaluated based on overall hospital rates of opioid use.
Results Of 3,785,396 vaginal delivery hospitalizations from 2006 to 2015, 1,720,899 (45.5%) women received an oral opioid for pain relief. Opioid use varied significantly among the 458 hospitals included in the analysis, with one-third of hospitals providing opioids to <38% of patients, one-third to 38 to <59% of patients, and one-third to ≥59% of patients. When hospitals were stratified by overall opioid administration rates, women with opioid abuse or dependence were less likely to be given opioids in hospitals with low overall opioid rates.
Discussion The use of opioid pain medications during vaginal delivery hospitalizations varied significantly among hospitals, suggesting that standardization of pain management practices could reduce opioid use.
All authors fulfilled all conditions required for authorship and approved this submission. Specifically, A.M.F. and M.M. conceived the study question and study design. Z.S. performed the data analysis. M.M., A.M.F., and R.L. drafted the manuscript. J.D.W., C.R.D., A.R.K., and M.E.D. made substantial contributions to the conception and design of the study, as well as interpretation of the data. They also made substantial contributions in drafting the article and revising it critically.
This study was presented as an abstract at the 2018 Society for Maternal–Fetal Medicine Pregnancy Meeting in Dallas, TX.
Given that the Perspective database is publicly available and identified, the Columbia University Institutional Review Board granted a waiver for this analysis.
- 1 Epstein RA, Bobo WV, Martin PR. , et al. Increasing pregnancy-related use of prescribed opioid analgesics. Ann Epidemiol 2013; 23 (08) 498-503
- 2 Desai RJ, Hernandez-Diaz S, Bateman BT, Huybrechts KF. Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstet Gynecol 2014; 123 (05) 997-1002
- 3 Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morb Mortal Wkly Rep 2011; 60 (43) 1487-1492
- 4 Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers and other drugs among women--United States, 1999-2010. Morb Mortal Wkly Rep 2013; 62 (26) 537-542
- 5 U.S. Food & Drug Administration. FDA Drug Safety Communication: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. April 20, 2017. Available at: https://www.fda.gov/Drugs/DrugSafety/ucm549679.htm . Accessed February 20, 2018
- 6 The American College of Obstetricians and Gynecologists. Practice Advisory on Codeine and Tramadol for Breastfeeding Women. April 27, 2017. Available at: https://www.acog.org/Clinical-Guidance-and-Publications/Practice-Advisories/Practice-Advisory-on-Codeine-and-Tramadol-for-Breastfeeding-Women . Accessed February 20, 2018
- 7 Madadi P, Koren G, Cairns J. , et al. Safety of codeine during breastfeeding: fatal morphine poisoning in the breastfed neonate of a mother prescribed codeine. Can Fam Physician 2007; 53 (01) 33-35
- 8 Madadi P, Moretti M, Djokanovic N. , et al. Guidelines for maternal codeine use during breastfeeding. Can Fam Physician 2009; 55 (11) 1077-1078
- 9 Madadi P, Ross CJ, Hayden MR. , et al. Pharmacogenetics of neonatal opioid toxicity following maternal use of codeine during breastfeeding: a case-control study. Clin Pharmacol Ther 2009; 85 (01) 31-35
- 10 Sachs HC. ; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013; 132 (03) e796-e809
- 11 Smolina K, Weymann D, Morgan S, Ross C, Carleton B. Association between regulatory advisories and codeine prescribing to postpartum women. JAMA 2015; 313 (18) 1861-1862
- 12 Carvalho B, Butwick AJ. Postcesarean delivery analgesia. Best Pract Res Clin Anaesthesiol 2017; 31 (01) 69-79
- 13 Thiels CA, Anderson SS, Ubl DS. , et al. Wide variation and overprescription of opioids after elective surgery. Ann Surg 2017; 266 (04) 564-573
- 14 Hill MV, McMahon ML, Stucke RS, Barth Jr RJ. Wide variation and excessive dosage of opioid prescriptions for common general surgical procedures. Ann Surg 2017; 265 (04) 709-714
- 15 Li Z, Armstrong EJ, Parker JP, Danielsen B, Romano PS. Hospital variation in readmission after coronary artery bypass surgery in California. Circ Cardiovasc Qual Outcomes 2012; 5 (05) 729-737
- 16 Fang MC, Maselli J, Lurie JD, Lindenauer PK, Pekow PS, Auerbach AD. Use and outcomes of venous thromboembolism prophylaxis after spinal fusion surgery. J Thromb Haemost 2011; 9 (07) 1318-1325
- 17 Kulik A, Rassen JA, Myers J. , et al. Comparative effectiveness of preventative therapy for venous thromboembolism after coronary artery bypass graft surgery. Circ Cardiovasc Interv 2012; 5 (04) 590-596
- 18 Prabhakaran S, Herbers P, Khoury J. , et al. Is prophylactic anticoagulation for deep venous thrombosis common practice after intracerebral hemorrhage?. Stroke 2015; 46 (02) 369-375
- 19 Ritch JM, Kim JH, Lewin SN. , et al. Venous thromboembolism and use of prophylaxis among women undergoing laparoscopic hysterectomy. Obstet Gynecol 2011; 117 (06) 1367-1374
- 20 Wright JD, Lewin SN, Shah M. , et al. Quality of venous thromboembolism prophylaxis in patients undergoing oncologic surgery. Ann Surg 2011; 253 (06) 1140-1146
- 21 Zacharia BE, Youngerman BE, Bruce SS. , et al. Quality of postoperative venous thromboembolism prophylaxis in neuro-oncologic surgery. Neurosurgery 2017; 80 (01) 73-81
- 22 Stulberg JJ, Delaney CP, Neuhauser DV, Aron DC, Fu P, Koroukian SM. Adherence to surgical care improvement project measures and the association with postoperative infections. JAMA 2010; 303 (24) 2479-2485
- 23 Kuklina EV, Whiteman MK, Hillis SD. , et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12 (04) 469-477
- 24 Koren G, Cairns J, Chitayat D, Gaedigk A, Leeder SJ. Pharmacogenetics of morphine poisoning in a breastfed neonate of a codeine-prescribed mother. Lancet 2006; 368 (9536): 704
- 25 Madadi P, Shirazi F, Walter FG, Koren G. Establishing causality of CNS depression in breastfed infants following maternal codeine use. Paediatr Drugs 2008; 10 (06) 399-404
- 26 The Drug and Lactation Database (LACTMED), a database of the National Library of Medicine's TOXNET system. Oxycodone. Available at: http://toxnet.nlm.nih.gov/ . Accessed on March 15, 2018
- 27 Bateman BT, Cole NM, Maeda A. , et al. Patterns of opioid prescription and use after cesarean delivery. Obstet Gynecol 2017; 130 (01) 29-35
- 28 Osmundson SS, Schornack LA, Grasch JL, Zuckerwise LC, Young JL, Richardson MG. Postdischarge opioid use after cesarean delivery. Obstet Gynecol 2017; 130 (01) 36-41
- 29 Prabhu M, McQuaid-Hanson E, Hopp S. , et al. A shared decision-making intervention to guide opioid prescribing after cesarean delivery. Obstet Gynecol 2017; 130 (01) 42-46