How COVID-19 impacted opioid prescriptions in postpartum women

A significant rise in opioid prescriptions was seen in pregnant women following the onset of the COVID-19 pandemic, according to a recent study published in JAMA Network Open.

Opioid fills during the postpartum period, defined as the first 6 months following delivery, was the primary measure of the study. The intensity of opioid prescriptions was the secondary measure of the study, measured in morphine milligram equivalents (MMEs) per day supplied.

Opioid fills for 460,371 patients were analyzed. An opioid prescription in the postpartum period was seen in an average 38.1% of women, 23.8% of women with vaginal deliveries, and 67% of women with cesarean deliveries. Opioid prescriptions averaged at 0.5 for all women, 0.3 for women with vaginal deliveries, and 0.9 for women with cesarean deliveries.

A mean 35 MMEs per day was seen in women with an opioid prescription. The mean days’ supply of opioids was 4.4 days, with a higher mean supply among women with cesarean deliveries.

The risk of postpartum women filling an opioid prescription significantly rose during the COVID-19 pandemic. On average, the rate of filled opioid prescriptions among this population was 2.8 times greater than predicted in the months after March 2020, with an increase of 4.6 fills per 100 women observed in the COVID-19 period.

The difference between actual and forecasted prescription rates was greater among women with cesarean deliveries. Prescription strength in postpartum women increased by 1.7 MMEs per day during the COVID-19 period, though no differences between actual and forecasted values for the average days’ supply was observed.

Maternal care is critical during the postpartum period, with pain and other chronic conditions frequent during this time. Over 50% of deaths from maternal causes occur during postpartum period, with pain being one of the most common sources of morbidity in postpartum women.

Chronic pain is seen after delivery in up to 18% of women. A stepwise approach to treating pain in postpartum women is recommended by the American College of Obstetricians and Gynecologists, with high-potency opioids offered if needed.

COVID-19 likely affected the care offered to postpartum women, with non-COVID-19 care decreasing by 40% in the months following March 2023 and opioid prescribing patterns shifting throughout the pandemic. Investigators conducted a retrospective cross-sectional study to evaluate how COVID-19 affected opioid prescription rates in postpartum women.

Data on patients with pain medicine prescriptions was taken from Optum’s deidentified Clinformatics Data Mart system. About 15 million to 20 million individuals are included in the database annually, accumulating in over 62 million covered lives in a 12-year period.

There were 460,371 postpartum women and about 150,000 live birth per year included in the study, making up over 5% of births in the United States and 14% of births from women with private insurance. Medicaid-insured women were not included in the analysis.

Patient births from July 1, 2018, to December 31, 2020, were included. To be eligible, patients were required to have at least 6 months of continuous enrollment in their plan, a birth during the observation period, no more than 1 single live birth, and to be at least 18 years old.

Current Procedural Terminology and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes were used to determine births and delivery modality. Data on the date of service was also used to determine the date of delivery.

Reference

Steuart SR, Lawler EC, Bagwell Adams G, Shone H, Abraham AJ. Comparison of postpartum opioid prescriptions before vs during the COVID-19 pandemic. JAMA Netw Open. 2023;6(4):e236438. doi:10.1001/jamanetworkopen.2023.6438