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Persistent opioid use following cesarean delivery: patterns and predictors among opioid naïve women
Abstract Number: T-49
Abstract Type: Original Research
Background: The incidence of opioid-related death in women has increased 5-fold over the past decade (1). For many women, their initial opioid exposure will occur in the setting of routine medical care. Approximately 1 in 3 deliveries in the U.S. is by cesarean and opioids are commonly prescribed for post-surgical pain management. The objective of this study was to determine the risk that opioid naïve women prescribed opioids after cesarean delivery will subsequently become consistent prescription opioid users in the year following delivery, and to identify predictors for this behavior.
Methods: We identified women in a database of commercial insurance beneficiaries who underwent cesarean delivery and who were opioid naïve in the year prior to delivery. To identify persistent users of opioids, we used trajectory models, which identify groups of patients with similar patterns of medication filling during follow-up (2), based on patterns of opioid dispensing in the year following cesarean delivery. We then constructed a multivariable logistic regression model to identify independent risk factors for membership in the persistent user group.
Results: 285 of 80,127 (0.4%), or approximately 1 in 300, opioid naïve women became persistent opioid users following cesarean delivery. Persistent users could be accurately predicted using demographics, baseline comorbidity and characteristics of the index prescription (c statistic=0.74). Compared to patients whose initial prescription was for ≤3 days supply, those with a days supply of either 4-5 days or ≥6 days had a higher risk of persistent use (adjusted odds ratio (aOR), 95% confidence interval (CI) of 1.43 (95% CI, 1.07 - 1.93) and 1.92 (95% CI, 1.33 - 2.77), respectively). Compared to patients receiving an initial prescription for total daily dose of <81 mg of morphine equivalent, those with a daily dose of >112.5 mg of morphine equivalent were also significantly more likely to become persistent users (aOR 1.42 (95% CI, 1.03 - 1.96)). Other significant predictors included a history of substance abuse, tobacco use, back pain, migraines, and antidepressant or benzodiazepine use in the year prior to cesarean delivery.
Conclusions: A small but important and identifiable proportion of opioid naïve women become persistent prescription opioid users following cesarean delivery. Characteristics of the initial opioid prescription, including days supply and dose, were strong and potentially modifiable risk factors for persistent use.
(1) CDC, Morbidity and mortality weekly report 2013;62:537-42.
(2) Franklin et al, Med Care. 2013 Sep;51(9):789-96.