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PPhysicians planning to prescribe opioid painkillers to women at the time of delivery should think twice, according to a new study, as some opt for a "persistent" use of opioids.
A report released Friday in the JAMA Open Network examined opioid prescriptions in more than 300,000 women who gave birth between 2008 and 2016. Nearly half received an opioid prescription shortly before or after l & # 39; childbirth. Of the women who performed the prescriptions, about 2% showed signs of "persistent" use of opioids, defined as two consecutive renewals in the year following delivery. These prescriptions are short, on average about one to two weeks of medication.
During the study period, the percentage of women who completed their prescriptions and the rate of persistent opioid use decreased.
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But as many women give birth each year, even 2% of persistent opioid use is significant from a public health perspective, said Rishi Desai, epidemiologist at Brigham and Women's Hospital, who did not participate in the study.
Dr. Alex Peahl, an OB-GYN from the University of Michigan who led the study, said she was surprised to see so many women prescribe opioids at the time of delivery. The research team expected that fewer women would need later replacements because the pain badociated with delivery usually disappears between four and six weeks after delivery.
"This is a topic that concerns many people because pregnancy is one of the most common reasons why many young women without any health problems come into contact with the health care system," said Desai.
Persistent opioid use was observed in 1.7% of women who gave birth badlly and 2.2% of those who delivered by caesarean section.
The narrow difference between persistence after badl birth or caesarean section in women "makes us think that there is something inherent in the prescription rather than what women undergo, resulting in persistent use," he said. Peahl.
The researchers chose to give birth because pregnancy and childbirth are often the first contacts many women have to be exposed to prescription opioids. This raises a concern, said Desai. Once you have started prescribing an opioid prescription to a pregnant woman, what is the likelihood that she will continue to use opioids in the longer term?
In this study, the most important factor badociated with an increased likelihood of developing persistent use of opioids is the first filling of a prescription, not the type of delivery.
The authors compared their findings to those of a recent study of equally young and healthy individuals who had never taken opioids before and whose wisdom teeth had been removed. This may also be a first exposure to opioids. After oral surgery, 1.3% of those who filled an opioid prescription showed persistent use of opioids, similar to the likelihood after delivery. Another study comparing major and minor surgical procedures showed similar results for first exposure to opioids.
Peahl and his colleagues studied insurance claims from companies, often through employers, covering half of the women in the United States during their pregnancy. In the United States, however, Medicaid covers more than 40% of deliveries. Using stricter definitions for persistent use, Desai and colleagues reported in a presentation to the Society for Epidemiologic Research of persistent opioid use rates of up to 4, 6% among women covered by Medicaid.
Painful conditions and complications can occur during badl deliveries. Tubal ligation was the main cause of the new persistent opioid use. However, the amount of opioids prescribed and the timing chosen to fill an opioid prescription prior to delivery have had even greater effects. Among women who gave birth by caesarean section, a single complication, a rare and urgent hysterectomy (removal of the uterus), was badociated with an increase in the rate of persistent new opioid use.
Other well-known factors, such as smoking, previous addiction-related disorders and previous pain disorders, were also related to persistent consumption.
"This study shows that there is always a chance to really intervene on the prevention side," said Marian Jarlenski, badistant professor of health policy and management at the Graduate School of Public Health in Toronto. 39, University of Pittsburgh, who did not participate in this study. . The decision to write an initial order is an easy point of intervention, she said.
The result used by Peahl and colleagues in their study, "new persistent use," is not the same as the persistent eating disorder, formerly known as substance abuse (term dropped by the Diagnostic and Statistical Manual of Mental Disorders in 2013). It is possible that using this definition overestimates the number of women who continued to consume opioids after delivery, Desai and Jarlenski said. The study team said the other problem was that they were unable to determine if the prescription pills had been taken.
"I think this first allows us to verify that what we find in this population is similar to other populations," said Peahl. "The pain can be very complicated and affected by various factors. Understanding how to prevent new persistent uses and, ultimately, abuse, requires a nuanced interdisciplinary approach to help patients cope with complex situations. "
For example, to help manage pain after a caesarean section, Peahl and her colleagues at the University of Michigan use opioid pain reduction protocols, which include steps to help patients prepare for pain control and shared decision-making before and during hospitalization.
The American College of Obstetricians and Gynecologists offers guidelines for the management of pain after childbirth, which include opioids and alternatives. According to a spokesperson, the college reviews its guidelines every 18 to 24 months, or more frequently from new information.
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