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Postoperative Opioid Prescribing Practices Following Cesarean Delivery
Abstract Number: S3B-4
Abstract Type: Original Research
Mortality from misuse of prescription opioids is a major issue, and the number of deaths continues to rise(1). A contributor to this epidemic has been physician prescribing. It is becoming clear that postoperative opioid prescriptions exceed patient needs(2). Unused opioids are a leading source of misuse. Therefore, the appropriate prescription for discharge and education about use and disposal are of utmost importance. We surveyed patients to ascertain how much of their opioid prescription they were using after discharge following cesarean delivery, as well as how they disposed of excess.
Following IRB approval, 246 women who underwent cesarean delivery from January through April 2017 were called by telephone. 63 patients consented to participate and completed our survey. The primary outcome was the amount of post-discharge opioid actually used. Secondary outcomes were opioid storage and excess opioid disposition.
Sixty-six percent of patients were discharged from the hospital with a 30 count of 5mg oxycodone tablets (40 count was second most common at 25%) and instructed to take 1 tablet q4-6h as needed. Reported patient usage of these prescriptions was strongly bimodal, with 33% of patients taking all of their prescription and 65% of patients using half or less. Some of those who used all of their prescription reported taking the opioids on a scheduled basis, rather than as needed. On average, patients used 18 fewer pills than prescribed. Only one patient reported keeping her oxycodone in a locked cabinet, with the rest storing it in either an unlocked cabinet or their purse. 4 out of 33 patients with unused opioids reported proper disposal.
Preliminary data show patients are using and disposing of their opioid prescription incorrectly and need less than prescribed. This stresses the importance of education and a need to change prescribing practices. Our next step is to implement an intervention to determine the appropriate amount of oxycodone for discharge. After this, a second survey will be done to determine whether prescriptions have changed without compromising analgesia.
1.Centers for Disease Control and Prevention. Vital Signs: Overdoses of Prescription Opioid Pain Relievers-United States, 1999—2008. MMWR 2011; 60(43);1487-1492
2.Hill, Maureen V. MD et al. Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Annals of Surgery:September 14, 2016