Principal Scientist Scientific Research and Strategy; Aetion, Inc Boston, United States
Background: Management of patients with opioid use disorder (OUD) during the acute postpartum period remains clinically challenging as obstetricians aim to mitigate post-delivery pain while optimizing recovery support. Acute postpartum pain is associated with an increased risk of chronic pain and postpartum depression, and undertreated pain can be a trigger for return to non-prescribed use.
Objectives: To evaluate postpartum opioid consumption and opioids prescribed at discharge among patients with OUD treated with methadone, buprenorphine, and no medication for OUD, as compared with opioid naïve counterparts.
Methods: We conducted a retrospective cohort study of pregnant patients who underwent delivery >20 weeks gestation between May 2014 and April 2020 at a tertiary academic hospital. The primary outcome of this analysis was the mean daily quantity of oral opioids consumed after delivery while inpatient in milligrams of morphine equivalents (MME). Secondary outcomes included: 1) quantity of oral opioids prescribed at discharge, and 2) Rescue prescription for oral opioids in the 6 weeks after hospital discharge. Multiple linear regression accounting for age, non-opioid substance use, psychiatric diagnoses, and race/ethnicity was used to compare differences in the primary outcome.
Results: A total of 16,140 pregnancies were included. Patients with OUD (n=553) consumed 14 MME/d greater quantities of opioids postpartum than opioid-naïve patients (n=15,587), (95% CI 11, 17). Patients with OUD undergoing cesarean delivery consumed 30 MME/d greater quantities of opioids than opioid-naïve counterparts (95% CI 26, 35). Among patients who underwent vaginal delivery, there was no difference in opioid consumption among patients with and without OUD. Patients prescribed methadone, patients prescribed buprenorphine, and patients prescribed no medication for OUD all consumed similar opioid quantities postpartum following both vaginal and cesarean delivery. Among those undergoing cesarean delivery, opioid naïve patients were more likely to receive a discharge prescription for opioids than patients with OUD (77% versus 68%, p=0.002), despite lower pain scores and less in-hospital opioid consumption. Patients with OUD were more than twice as likely as opioid-naïve counterparts to receive a rescue prescription in the 6 weeks postpartum.
Conclusions: Patients with OUD, regardless of treatment with methadone, buprenorphine, or no medication for OUD consumed significantly greater quantities of opioids after cesarean delivery but received fewer opioid prescriptions at discharge and were more likely to require a rescue prescription after discharge.
