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Patterns of opioid use following discharge after cesarean delivery
Abstract Number: F-25
Abstract Type: Original Research
Introduction: Prescription opioid abuse has emerged as a significant public health issue in the U.S., with leftover medications representing a major source of misused or diverted opioids. With over 1.3 million cesarean deliveries (CDs) performed annually in the U.S, it is imperative to align the amount of post-discharge opioids that are prescribed and consumed. Currently, the amount of opioids typically required following discharge from CD is not known. We therefore designed a study to evaluate patterns of oral opioid use after CD.
Methods: This study and its associated survey was conducted at 6 academic medical centers in the U.S. from 9/2014 to 1/2016. Women undergoing a CD were contacted by phone two weeks after discharge and answered a standardized interview about their use of oral opioids. Clinical variables were abstracted from the women’s medical records.
Data were summarized as proportions or medians with interquartile ranges. Differences in proportions were compared across groups using chi-square and in continuous variables using the Kruskal-Wallis test. Independent predictors of the number of pills consumed were defined using negative binomial regression.
Results: A total of 667 women were enrolled; of these, 576(86.4%) filled an opioid prescription. Oxycodone was the most commonly prescribed opioid (85.4%), followed by hydrocodone (7.4%) and hydromorphone (7.2%).
The median number of dispensed tablets was 40 (IQR 30 to 40), the median number of consumed tablets was 20 (IQR 8 to 30), and median number of leftover tablets once the patient finished taking opioid was 15 (IQR 3 to 28). Of those with leftover opioids, 93.2% had not disposed of the excess medication at the time of the interview.
Tertiles were defined corresponding to the number of pills dispensed (≤30, 31 to 40, >40). The median number of pills consumed varied in these groups: the median for ≤30 was 15 (IQR 5 to 23), for 31 to 40 was 20 (IQR 10 to 36), and for >40 was 30 (IQR 10 to 50), p<0.001. However, the proportion of patients in each group who reported being very satisfied/satisfied with their pain regimen was similar across the 3 groups (86%, 87%, and 86%, respectively; p=0.99).
Independent predictors for consuming higher numbers of pills included a pain score ≥4 at the time of hospital discharge (p<0.05) and increasing number of pills dispensed (p<0.01).
Conclusion: The amount of opioid prescribed following CD generally exceeds the amount consumed by a significant margin, leading to substantial amounts of leftover medication which patients generally retain. To minimize the risk of misuse or diversion from medication leftover after CD, strategies to reduce the amount of opioid medication prescribed should be pursued. Patients should be informed about the importance of properly disposing of leftover medication.
 Morbidity and mortality weekly report 2011; 60:1487-92
 J Adolesc Health 2013; 52:480-5