Are Painkillers After Childbirth a Prescription for Addiction?
Many women are prescribed opioid painkillers after giving birth, and it may in some cases lead to addiction and overdose, a new study finds.
Looking at data on more than 200,000 births in Tennessee, researchers found that nearly all women who had a C-section were prescribed an opioid like oxycodone (OxyContin). The drugs were also prescribed in 59% of vaginal births.
Experts said the numbers are surprisingly high, particularly for vaginal deliveries, which can generally be managed with painkillers like ibuprofen (Advil, Motrin).
Even more concerning were the consequences: Nearly 4,600 women had what the researchers call a serious opioid-related event -- persistent use of the drug, opioid dependence or an overdose.
The findings raise concerns about overprescribing to new mothers, especially those who deliver vaginally, according to lead researcher Dr. Sarah Osmundson.
"For those women, it's probably not necessary," said Osmundson, an assistant professor of obstetrics and gynecology at Vanderbilt University Medical Center in Nashville, Tenn.
That point was echoed by Dr. Eleazar Soto, a maternal-fetal medicine specialist at UT Physicians/UTHealth in Houston.
"We typically don't prescribe a narcotic after a vaginal delivery," said Soto, who was not involved in the study. He called the 59% rate in this study "very high."
The findings, published June 8 in the Annals of Internal Medicine, are based on data from Tennessee's Medicaid program, which covers the state's poor residents.
It's not clear if the patterns would hold true more generally. But, the researchers write, almost half of all U.S. births are covered by Medicaid, and understanding what's happening in that "vulnerable population" is important.
For the study, Osmundson's team analyzed state records from 2007 to 2014, which included 209,215 births. Over 30% were cesarean deliveries, and doctors prescribed an opioid in 91% of cases. One-quarter of the time, women ended up getting a refill.
Refills were less common after vaginal delivery, but they happened with more than 10% of births.
"We don't know why second prescriptions were made," Osmundson said, noting that post-childbirth pain would be expected to improve with the first prescription.
The finding suggests doctors need to better monitor new mothers' ongoing pain-relief needs, Osmundson said.
Overall, 4,582 women went on to have serious complications related to opioids. For 69%, that meant persistent use (filling more than a 90-day supply of the prescription). Another 18.5% were diagnosed with a substance use disorder, while 2% suffered an opioid overdose and 0.2% died.
The findings are based on relatively old data. But, Osmundson said, opioids are still commonly prescribed after a C-section in the United States.
Yet there's evidence that even after those surgical deliveries, women's pain can be effectively treated with non-opioid options, Soto said. In a study reported last year, he and his colleagues randomly assigned women to receive either opioids or ibuprofen/acetaminophen after having a C-section.
Overall, women given ibuprofen/acetaminophen had better pain control and fewer side effects.
Soto said there are some women who may need an opioid after giving birth -- when a difficult vaginal delivery causes tissue damage, for example. "But," he added, "I believe that with good counseling and setting some expectations with the patient, the use of [opioids] can be reduced significantly after discharge from the hospital."
Osmundson agreed. "I think it's important to set up expectations," she said. "We can talk about the number of days [women] can expect to be in the hospital, and say, here's what we usually do for pain management, and you can refuse [the medication] or ask for more."
As for non-drug options, Soto said that some women who undergo a C-section find pain relief from wearing an abdominal binder for a time afterward.
"I also recommend plenty of hydration and to avoid constipation, as this may aggravate the pain," he said.
The March of Dimes has more on pain after childbirth.
SOURCES: Sarah Osmundson, M.D., M.S., assistant professor, obstetrics and gynecology, Vanderbilt University Medical Center, Nashville, Tenn.; Eleazar Soto, M.D., maternal-fetal medicine specialist, UT Physicians and McGovern Medical School at UTHealth, Houston; June 9, 2020, Annals of Internal Medicine, online
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