Opioid Prescribing After Childbirth and Risk for Serious Opioid-Related Events: A Cohort Study
Authors: Sarah S. Osmundson, Jea Young Min, Andrew D. Wiese, Robert E. Hawley, Edward Mitchel, Stephen W. Patrick, Lauren R. Samuels, Marie R. Griffin, Carlos G. Grijalva
Journal: Annals of Internal Medicine (2020)

Letters1 September 2020Opioid Prescribing After Childbirth and Risk for Serious Opioid-Related Events: A Cohort StudySarah S. Osmundson, MD, MS, Jea Young Min, PharmD, PhD, Andrew D. Wiese, PhD, MPH, Robert E. Hawley, BS, Edward Mitchel, BS, Stephen W. Patrick, MD, MPH, MS, Lauren R. Samuels, PhD, Marie R. Griffin, MD, MPH, and Carlos G. Grijalva, MD, MPHSarah S. Osmundson, MD, MSVanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.), Jea Young Min, PharmD, PhDVanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.), Andrew D. Wiese, PhD, MPHVanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.), Robert E. Hawley, BSVanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.), Edward Mitchel, BSVanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.), Stephen W. Patrick, MD, MPH, MSVanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.), Lauren R. Samuels, PhDVanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.), Marie R. Griffin, MD, MPHVanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.), and Carlos G. Grijalva, MD, MPHVanderbilt University Medical Center and Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee (C.G.G.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-3805 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Although persistent opioid use after surgery, including cesarean birth, has been described, the risk for overdose and other serious opioid-related events (SOREs) after childbirth, specifically vaginal birth, remains unclear (1, 2).Objective: To assess risk for SOREs associated with postpartum opioid prescribing after childbirth, including both vaginal and cesarean births.Methods and Findings: We studied women aged 15 to 44 years enrolled in Tennessee Medicaid (TennCare) who were discharged after childbirth between 1 January 2007 and 20 August 2014. TennCare data were supplemented with birth certificate information and hospital discharge data from the Tennessee Hospital Discharge Data System. This ...References1. Bateman BT, Franklin JM, Bykov K, et al. Persistent opioid use following cesarean delivery: patterns and predictors among opioid-naïve women. Am J Obstet Gynecol. 2016;215:353.1-353.e18. [PMID: 26996986] doi:10.1016/j.ajog.2016.03.016 CrossrefMedlineGoogle Scholar2. Osmundson SS, Wiese AD, Min JY, et al. Delivery type, opioid prescribing, and the risk of persistent opioid use after delivery [Letter]. Am J Obstet Gynecol. 2019;220:405-7. [PMID: 30955527] doi:10.1016/j.ajog.2018.10.026 CrossrefMedlineGoogle Scholar3. Peahl AF, Dalton VK, Montgomery JR, et al. Rates of new persistent opioid use after vaginal or cesarean birth among US women. JAMA Netw Open. 2019;2:e197863. [PMID: 31348508] doi:10.1001/jamanetworkopen.2019.7863 CrossrefMedlineGoogle Scholar4. ACOG committee opinion no, 742: postpartum pain management. Obstet Gynecol. 2018;132:e35-e43. [PMID: 29781876] doi:10.1097/AOG.0000000000002683 CrossrefMedlineGoogle Scholar5. Martin JA, Hamilton BE, Osterman MJK. Births in the United States, 2016. NCHS Data Brief. 2017:1-8. [PMID: 29155684] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Vanderbilt University Medical Center, Nashville, Tennessee (S.S.O., J.Y.M., A.D.W., R.E.H., E.M., S.W.P., L.R.S., M.R.G.)Vanderbilt University Medical Center and Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), Nashville, Tennessee (C.G.G.)Note: Dr. Osmundson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.Disclaimer: The funders of the study had no role in the design of the study, analysis or interpretation of the data, or writing of the report. The corresponding author had final responsibility for the decision to submit the manuscript for publication.Acknowledgment: The authors thank the Tennessee Division of TennCare of the Department of Finance and Administration and the Tennessee Department of Health for providing data for the study.Financial Support: Dr. Osmundson was supported by grants K12HD04348317 from the National Institutes of Health and K23DA047476 from the National Institute on Drug Abuse. Dr. Min was supported by the Veterans Affairs Office of Academic Affiliations. Dr. Wiese was supported by the Vanderbilt Faculty Research Scholars program and a PhRMA Foundation Fellowship in Health Outcomes. Dr. Patrick was supported by grant K23DA038720 from the National Institute on Drug Abuse. The study was supported in part by the National Institutes of Health, National Institute on Aging, through grant R01AG043471.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-3805.Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Osmundson (e-mail, sarah.[email protected]org). Data set: Not available.Corresponding Author: Sarah S. Osmundson, MD, MS, 1161 21st Avenue, South B1118 MCN, Nashville, TN 37232; e-mail, sarah.[email protected]org.This article was published at Annals.org on 9 June 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMaternal opioid treatment after delivery and risk of adverse infant outcomes: population based cohort studyA retrospective study comparing postoperative opioid prescribing practices in an academic medical centreRisk of Death at 1 Year Following Postpartum Opioid ExposureDevelopment and Validation of a Model to Predict Postdischarge Opioid Use After Cesarean BirthThe risk of serious opioid-related events associated with common opioid prescribing regimens in the postpartum period after cesarean deliveryTrends in Postpartum Opioid Prescribing: A Time Series AnalysisPrescription Opioid Dose After Vaginal Delivery and the Risk of Serious Opioid-Related Events: A Retrospective Cohort StudyOpioid Use in BreastfeedingPrescription opioid use after vaginal delivery and subsequent persistent opioid use and misuseThe use of bilateral transversus abdominis plane blocks with liposomal bupivacaine on postoperative cesarean delivery patients during COVID-19 pandemic is associated with reduced narcotics use and reduced length of stayOpioid use in pregnancy: An emerging health crisisOpioid abuse after postpartum opioid use 1 September 2020Volume 173, Issue 5Page: 412-414KeywordsBirthCohort studiesDisclosureDrug abuseInformation technologyInstitutional review boardsOpioid use disorderOpioidsPregnancySurgery ePublished: 9 June 2020 Issue Published: 1 September 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. 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