Obstetrics role in the opiod epidemic: Understanding postpartum opiod prescribing patterns and patient utilization

Opiate abuse is a national epidemic that has been fueled by the surplus in prescribed opioid medications. The largest growing demographic affected by the epidemic is currently women of reproductive age. Furthermore, there is evidence that patients with Medicaid are more likely to be prescribed opioid medications inappropriately. This suggests that provider prescribing behaviors are unequally burdening vulnerable communities. Cesarean deliveries are the most commonly performed inpatient surgery in the country and women are commonly discharged with opioid prescriptions following surgery. Moreover, it is not known to what extent women undergoing vaginal delivery are also discharged with opioid prescriptions. The majority of women will experience delivery, yet there remains very little information to guide the postpartum prescribing practices of providers. Understanding this process is a crucial step in formulating evidence-based health policy designed to address the current opiate epidemic. Thus, we propose a two-part project aimed at understanding opioid use in the obstetric population. The objective of Phase 1 of this project is to characterize the postpartum analgesic prescribing practices of providers and assess patient and provider factors that may be associated with the number of opioid tablets prescribed. Phase 2 aims to prospectively assess the actual opioid usage of postpartum women following discharge. We hope to accomplish these objectives by first conducting a retrospective cohort study of approximately 12,000 postpartum patients at a large, academic institution. Secondly, we plan to conduct a prospective survey study of postpartum patients to assess opioid usage and further characterize factors that may be associated with high opioid intake. We anticipate this information will provide researchers, policy-makers and prescribers with foundational evidence-based information to guide the prescription of appropriate postpartum analgesia and avert opiate overprescribing.