Researchers seek to change opioid prescribing practices after childbirth.

Not only has the opioid crisis dramatically increased in recent years, but the pandemic has only intensified the problem. The United States is awash with deadly synthetic fentanyl as well as even more potent drugs. Dealerships are taking advantage of user vulnerability and the mental health consequences of the coronavirus. Now, a group of clinicians hope to promote a mindset change within the medical community regarding how opioids are prescribed to mothers who have given birth by C-section (C-section). They began their mission after it became apparent that doctors were automatically prescribing these potentially addictive drugs as the first line of treatment for pain management.

In research presented this month at the American College of Obstetricians and Gynecologists (ACOG) annual meeting in San Diego, Calif., “women undergoing cesarean section were randomly assigned to receive prescriptions of 10 or 20 oxycodone tablets upon discharge [from the hospital]. Interim data revealed that not only were 10-pill prescriptions correlated with significantly lower opioid consumption, but 35% of all women left their opioid scripts unfilled,” the researchers wrote.

These findings suggest physicians should stop “self-prescribing opioids for cesarean sections upon discharge and, instead, work on individualized prescribing,” said Amanda Selk, MD, associate professor of obstetrics and of Gynecology at the University of Toronto, Canada. She did not participate in the study. Selk added, “We need to move away from a culture that says a patient can’t go out without an opioid prescription.”

For the study, researchers at Virginia Tech Carilion School of Medicine in Roanoke, Va. wanted to know how the size of opioid prescriptions at the time of discharge impact overall opioid use. With no standard dose recommendation for doctors to follow when it comes to prescribing opioids for post-caesarean pain, the team also sought to help its own clinicians with their prescribing practices, according to the co-investigator Jaclyn Nunziato, MD, assistant professor of obstetrics and gynecology at Virginia Tech Carilion.

The researchers randomly assigned “134 women undergoing elective caesarean section to receive a prescription for 10 or 20 5mg oxycodone tablets at discharge.” Most have had one or more cesarean deliveries in the past. Data from “97 patients showed that 35% of women had not filled their opioid prescriptions 6 weeks after surgery.” Among those who did, the average use after six weeks was “6.6 tablets in the 10-tablet group and 13.3 tablets in the 20-tablet group”. No patient actively asked their prescribers to renew their medications, and both groups reported similar levels of pain throughout the six-week period.

“With an average of 9.2 tablets consumed in the two groups combined, the results indicate that a standard prescription of 10 tablets may be sufficient to manage postoperative pain for most patients,” Nunziato said. She hopes these findings will “break the stigma that opioids are the best treatment option for patients.”

There were more than 1.1 million cesarean deliveries in the United States in 2020, according to the Centers for Disease Control and Prevention (CDC), which means ending self-prescribing of opioids would be “extremely beneficial to individual patients and our larger community,” said Robyn Goodrich, a Virginia Tech medical student and first author of the study. She added, “The patient would receive a sufficient amount to control their pain and keep him comfortable, but didn’t put him at risk of developing tolerance and addiction.”

Sources:

Too much of a good thing? Impact of the initial size of the prescription in the management of post-cesarean pain

Study: more opioids on autopilot after cesarean section