Study: Pandemic Shows Link to Increased Exposure of Opioids to Postpartum Women

Women who gave birth after March 2020 experienced an increase in exposure to opioids during their postpartum period, according to the results of a study published in JAMA Network Open.

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Investigators said that these increases in opioid prescriptions may be associated with an increased risk of opioid misuse, substance use disorder, and opioid-related overdose among postpartum women.

Approximately 460,371 women who gave birth to single live newborns were included in the study between July 1, 2018, and December 31, 2020. Investigators included postpartum opioid fills before March 1, 2020, which were compared with fills after March 2020.

All individuals were privately insured. Investigators conducted a statistical analysis between December 1, 2021, and September 15, 2022.

The main outcome was postpartum opioid prescriptions filled, which was defined as patient filled during the 6 months after birth. Investigators used 5 measures, including mean number of fills per individual, mean filled morphine milligram equivalents per day, mean days supplied, percentage of individuals filling a prescription for a schedule II opioid, and percentage of individuals filling a prescription for a schedule III or higher opioid.

Investigators found that the COVID-19 pandemic was also associated with an increase in mean filled morphine milligram equivalents per day, actual mean, number of fills per patient, and percentage of individuals filling a schedule II opioid prescription.

There was no significant association with days’ supply of opioids per prescription or the percentage of individuals filling a prescription for a schedule III or higher opioid.

Additionally, investigators found that there was a larger increase for individuals who delivered by cesarean birth than those who delivered vaginally.

They found that 38.1% of all women in the sample filled an opioid prescription in the postpartum period, including 23.8% with vaginal deliveries filling at least 1 opioid prescription and 67% with cesarean deliveries filling at least 1 prescription.

The mean of opioid prescriptions per patient was 0.5 for all women, with 0.3 for women with vaginal deliveries and 0.9 for women with cesarean deliveries.

Among those who filled an opioid prescription, women received a mean of 35 morphine milligram equivalents per day, including 32.7 for those with vaginal deliveries and 36.6 for those with cesarean deliveries.

For the mean days’ supply of opioids, women overall had a mean of 4.4 days, with 4.7 days for women with cesarean deliveries and 4.1 for those with vaginal deliveries.

Fills of schedule II opioids were more frequent than fills of schedule III or higher opioids. There were approximately 35.1% of all women for a schedule II opioid and 3.7% of women filling a schedule III or higher opioid.

For schedule II and schedule III, there was a higher number filled by women with cesarean deliveries at 63.2% and 4.7%, respectively, compared with women with vaginal deliveries at 21.1% and 3.2%, respectively.

A limitation of the study was that investigators could not differentiate between initial fills and refills.

Reference

Steuart SR, Lawler EC, Bagwell Adams G, Shone H, Abraham AJ. Comparison of postpartum opioid prescriptions before vs during the COVID-19 pandemic. JAMA Netw Open. 2023;6(4):e236438. doi:10.1001/jamanetworkopen.2023.6438