COVID-19 associated with significant increases in postpartum opioid prescription fills

Key takeaways :

• Women who gave birth after COVID-19 began were more likely to fill an opioid prescription.
• Future research should assess changes in postpartum opioid prescription fills after COVID-19.

Onset of the COVID-19 pandemic was associated with significant increases in postpartum opioid fills, which may lead to increases in adverse outcomes, according to a retrospective cross-sectional study published in JAMA Network Open.

“The broad disruption to health care during the COVID-19 pandemic likely affected the receipt of appropriate care and pain management for postpartum women. During the first several months of the pandemic, overall use of non-COVID-19-related outpatient care decreased by approximately 40%,” Shelby R. Steuart, MPA, PhD candidate in the department of public administration and policy at the School of Public and International Affairs at the University of Georgia, Athens, and colleagues wrote. “In addition, evidence has shown that opioid prescribing patterns changed during the pandemic, with new prescriptions decreasing and the duration of prescriptions increasing.”

Researchers analyzed data from 460,371 privately insured postpartum women (mean age, 29 years) who delivered a singleton live newborn between July 2018 and December 2020. Postpartum opioid prescription fills prior to March 2020 were compared with those filled after the COVID-19 pandemic began.

The primary outcome was postpartum opioid prescription fills during the 6 months after delivery.

Among the cohort, those who gave birth after March 2020 had a higher likelihood of filling an opioid prescription than expected based on the preexisting trend (37.8% vs. 35%). Compared with the preexisting trends, during COVID-19, researchers also observed an association between the pandemic period and an increase in morphine milligram equivalents per day (35.8 vs. 34.1), number of opioid fills per patient (0.54 vs. 0.49) and percentage of patients filling a schedule II opioid prescription (31.5% vs. 28.7%).

Researchers observed no significant association with days’ supply of opioids per prescription or the percentage of patients filling a schedule III or higher opioid prescription. In addition, there were larger increases in opioid prescriptions among those who delivered via cesarean sections vs. vaginal deliveries.

“Future research should examine whether changes in postpartum opioid fills after the onset of the COVID-19 pandemic have continued and whether these changes have translated into increases in opioid misuse, opioid use disorder and opioid-related overdose among postpartum women,” the researchers wrote.