Pandemic Saw Rise in Opioid Prescriptions Given After Childbirth
New mothers who gave birth early in the pandemic filled far more opioid prescriptions than American women did previously, raising concerns about the potential for narcotic misuse.
About 38% of more than 460,000 women who gave birth from July 2018 through December 2020 were prescribed opioids for postpartum pain management, according to the University of Georgia study.
But there was a nearly 3 percentage point increase in the number of opioid prescriptions filled after March 2020 — when a national emergency was declared in the United States — than before the health crisis began.
The opioids these mothers were prescribed were also higher strength, the researchers noted.
“A lot of women receive opioids for treatment of pain during the postpartum period, but they are a particularly vulnerable group because many of them haven't used opioid medications before,” said Emily Lawler, co-author of the study and an assistant professor in the School of Public and International Affairs.
“That makes them high risk for potential opioid abuse,” Lawler said in a university news release.
The findings were especially concerning because opioid overdose deaths increased during the pandemic, surpassing 100,000 deaths annually, the study authors said.
Opioids are typically a last resort for pain management after pregnancy.
The American College of Obstetricians and Gynecologists (ACOG) recommends health care providers use an approach for postpartum pain that starts with a basic pain reliever like ibuprofen (such as Motrin or Advil) or acetaminophen (Tylenol). If that doesn't alleviate the pain, physicians are advised to then move to a low-strength opioid, such as codeine or tramadol.
Patients prescribed opioids should not take them for extended periods and should be switched to over-the-counter pain medications as soon as possible, ACOG recommends.
“Prior to the pandemic, opioid prescriptions were decreasing not only in terms of the number of women prescribed opioids but also the strength of the opioids being prescribed and the number of days covered by each prescription,” said Shelby Steuart, lead author of the study and a doctoral candidate in the School of Public and International Affairs.
“But right after the COVID-19 lockdowns happened in March 2020, we saw a sharp spike in opioid prescription fills,” she continued. “We don't know whether physicians were writing more opioid prescriptions or if more women were just taking their prescriptions to the pharmacy and filling them, but it is concerning.”
Physicians may have worried they wouldn't see their patients as frequently during the pandemic, the study team suggested, because of COVID-19 surges and lockdowns. They may have been attempting to compensate for that, the researchers said.
Anxiety from the pandemic may also have exacerbated women's feelings of pain, causing them to fill those prescriptions.
“It's really critical for this population to be in continued contact with health care providers because they are at high risk of chronic pain,” Lawler said. “It is important to appropriately manage pain, but postpartum women who do develop opioid use disorder are much harder to connect to treatment. And we need to be aware that there is potential for this group to become addicted to opioids, and we need to be on the lookout to connect them to treatment if needed.”
The study findings were published online April 3 in JAMA Network Open.
The U.S. Centers for Disease Control and Prevention has more on opioids.
SOURCE: University of Georgia, news release, April 3, 2023