Esha Afreen, MS2; Zachary Colvin, DO; Anna Palatnik, MD; Erika Peterson, MD
Opioid-related deaths have been steadily rising to alarming levels in the United States over the past twenty years. In fact, deaths resulting from opioid overdose accounted for 68% of all drug overdose deaths in 20171. The dangers of overprescribing opioids for pain management include chronic opioid dependence, pill diversion, and accidental ingestion by children due to storage in unsecured locations, further fueling the worsening opioid epidemic2,3.
Cesarean sections are one of the most common surgical procedures performed. Current data reflects that following cesarean delivery, opioids are often prescribed in excess of the amount necessary for sufficient analgesia3,4. Furthermore, recent studies have accentuated a lack of standardization of opioid prescribing practices for postpartum women, which calls for increased efforts to educate providers on safe prescribing practices2.
One of the efforts made by the state of Wisconsin to combat opioid overprescribing is a new state law, Wisconsin Act 266, which went into effect April 1, 2017. This law was intended to discourage providers from overprescribing opioids by mandating a search of the prescription drug monitoring program (PDMP) database if prescribing opioids for greater than three days duration. The objectives of our study were to examine whether opioid prescribing patterns and postpartum health care utilization were changed after this new law was enacted.
We hypothesized that Wisconsin Act 266 decreased opioid prescribing without compromising effective post-Cesarean pain control through two aims:
- Determining whether there was a decrease in the total amount of opioids prescribed at discharge following Cesarean delivery after the law was enacted, and
- Determining whether there was a significant difference in postpartum encounters for pain after the law was enacted.
A total of 1,316 women met criteria for analysis. There were no statistically significant differences in characteristics between patients in two study periods. There was a significant decrease in number and total amount of opioids prescribed at discharge in the year after the provisions were enacted. A multivariate linear regression was performed controlling for race, labor, previous cesarean deliveries, prior opioid use, and body mass index. Both outcomes remained statistically significant. There was no difference in percentage of patients who had additional encounters for postpartum pain control, or additional opioid prescriptions.
The study concluded that the amount of opioids prescribed decreased in the year following enactment of Wisconsin Act 266 compared to the year prior, while postpartum encounters for pain did not increase. This demonstrates that opioids were previously being overprescribed and that the law has been effective at reducing opioid prescribing without compromising postoperative pain control after discharge. Future mandates such as this should be considered in other states to decrease opioid overprescribing on a national level.
Acknowledgments:
The student would like to thank Dr. Erika Peterson, Dr. Zachary Colvin, DO, and Dr. Anna Palatnik, MD for their continued mentorship and support for this project, as well as the Waukesha County Medical Society for their generosity in funding the fellowship that made this project possible.
References:
1. Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and Opioid-Involved Overdose Deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2018;67(5152). doi:10.15585/mmwr.mm6751521e1
2. Badreldin N, Grobman WA, Chang KT, Yee LM. Opioid prescribing patterns among postpartum women. Am J Obstet Gynecol. 2018;219(1):103.e1-103.e8. doi:10.1016/j.ajog.2018.04.003
3. Osmundson SS, Schornack LA, Grasch JL, Zuckerwise LC, Young JL, Richardson MG. Postdischarge opioid use after cesarean delivery. Obstet Gynecol. 2017;130(1):36-41. doi:10.1097/AOG.0000000000002095
4. Bateman BT, Cole NM, Maeda A, et al. Patterns of opioid prescription and use after cesarean delivery. Obstet Gynecol. 2017;130(1):29-35. doi:10.1097/AOG.0000000000002093
