Temporal Trends in Postpartum Opioid Prescribing, Opioid Use, and Pain Control Satisfaction

Objective The objective was to assess temporal trends in postpartum opioid prescribing, opioid use, and pain control satisfaction. Study Design This is a prospective observational study of postpartum patients who delivered at a large tertiary care center (May 2017-July 2019). Inpatient patients were screened for eligibility; those meeting eligibility criteria who used inpatient opioids were approached for prospective survey participation which probed inpatient and outpatient postpartum pain control. The amount of opioids used during inpatient hospitalization and the amount of opioids prescribed at discharge were obtained from medical records. The primary outcome was the difference in opioid prescribing at discharge over time, measured by (1) the proportion of participants who received an opioid prescription at discharge and (2) for those who received an opioid prescription, the total morphine milligram equivalents of the prescription. Additional outcomes were inpatient and outpatient opioid use and patient-reported satisfaction with postpartum pain control. Trends over time were evaluated using nonparametric tests of trend. Results Of 2,503 postpartum patients screened for eligibility, a majority (N = 1,425; 60.8%) did not use an opioid as an inpatient. Over the study period, there was a significant decline in the proportion of patients who used an opioid while inpatient (z-score = - 11.8; p < 0.01). Among these participants enrolled in the prospective survey study (N = 494), there was a significant decline over time in the amount of inpatient opioid use (z-score = - 2.4; p = 0.02), the proportion of participants who received an opioid prescription upon discharge (z-score = - 8.2; p < 0.01), and, when an opioid was prescribed at discharge, the total prescribed morphine milligram equivalents (z-score = - 4.3; p < 0.01). Both inpatient and outpatient satisfactions with pain control were unchanged over this time (z-score = 1.1, p = 0.27; z-score = 1.1, p = 0.29, respectively). Conclusion In this population, both the frequency and amount of opioid use in the postpartum period declined from 2017 to 2019. This decrease in opioid prescribing was not associated with changes in patient-reported satisfaction with pain control. Key Points From 2017 to 2019, there was a decrease in inpatient and outpatient postpartum opioid use. Both the proportion of postpartum patients receiving opioid prescriptions and the amount prescribed decreased. Patient satisfaction with postpartum pain control remained unchanged.