Researchers to study opioid prescriptions, pain management following C-sections

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Public health researchers received federal funding to study how mothers manage pain after C-section deliveries.

Updated: October 8, 2019 at 11:08 a.m.

Researchers in the Milken Institute School of Public Health will contribute to a nationwide study on opioid prescription patterns and pain management women experience after cesarean section deliveries.

The National Institutes of Health awarded funding to researchers in the Biostatistics Center and the Maternal-Fetal Medicine Unit, a research institute focused on improving maternal and fetal health care for the next two years, according to a release last week. Opioid experts said health care providers must exercise more discretion about what dosage of opioids women need following C-sections to ensure excess capsules don’t exacerbate the opioid epidemic.

Rebecca Clifton, the principal investigator of the MFMU Network Data Coordinating Center and an associate research professor of epidemiology, said most women are given opioid prescriptions with at least 10 more opioid tablets than they need post-C-section.

The study is a segment of NIH’s “Helping to End Addiction Long-term Initiative,” which researches ways to mitigate the opioid epidemic.

“These tablets often go unused, unguarded and undisposed, which is worrisome because these tablets could be used by family members or others, or be sold, thus contributing to the opioid crisis,” Clifton said in an email.

She said Milken’s Biostatistics Center is the data coordinating hub for the MFMU. Clifton said public health researchers will collaborate with the MFMU to design the study, develop opioid prescription interventions, develop the researchers’ data management system, ensure researchers adhere to research integrity protocols, analyze data for the study and help write manuscripts.

Clifton added that the MFMU received a $9.9 million grant from NIH that will fund the research for two years. She said researchers hope the study’s results will include ways to reduce the number of “unnecessary” opioid tablets prescribed to patients.

“Less opioids prescribed unnecessarily can help combat the overall opioid crisis,” she said.

C-sections are one of the most common surgical procedures performed in the United States, according to the Johns Hopkins University School of Medicine’s website. Nearly one out of every three live births in the United States are delivered via C-section, according to the Centers for Disease Control website.

Two out of every three drug overdose deaths in the United States are attributed to opioids, according to Centers for Disease Control data. Deaths from overdosing on heroin, prescription opioids like OxyContin and Vicodin and synthetic opioids like fentanyl have increased six-fold since 1999, the data states.

More than 47,000 people died from opioid overdoses in 2017, and 36 percent of those deaths involved prescription opioids, according to the data.

A 2017 study from Vanderbilt University about opioid use among 179 women who underwent C-section deliveries shows that 75 percent of the women in the study who filled their initial opioid prescription had leftover, unused capsules. Postpartum women are often overprescribed opioids following C-sections, and physicians should avoid assigning a blanket dose of opioid capsules, according to the study.

Opioid addiction experts said exposing women to an “unnecessary” amount of opioid medication can increase their chances of becoming addicted to opioids.

Nevert Badreldin, an assistant professor of maternal-fetal medicine at the Northwestern University Feinberg School of Medicine, said the number of opioid tablets women have left over after recovering from C-sections contributes to the opioid crisis.

Badreldin said there is limited standardization on how opioids are prescribed, and the amount of opioid medication a patient receives depends on their individual health care provider. She said health care providers often do not individually tailor opioid prescriptions to patients’ needs.

Badreldin said a “straightforward” practice to decrease the number of leftover opioids is for health providers to teach patients how to correctly dispose of extra opioid tablets or keep the medication in a safe location away from potential abusers.

She added that health care providers must take care not to overprescribe opioids to women following C-sections to ensure that young children don’t “accidentally” ingest surplus opioid medication.

“Everybody knows someone who has had a baby or whose sister has had a baby,” she said. “It puts families really at risk because the tablets are available in houses with small children.”

Brian Bateman, an associate professor of obstetric anesthesia at Harvard Medical School, said learning how to better prescribe opioids for pain treatment post-C-section will help health care providers set prescription standards for patients recovering from other types of surgical procedures.

He said physicians can assess patients’ opioid use before patients are discharged to determine how much medication to prescribe and engage in “shared decision-making” with patients – which allows women to choose the number of tablets they need.

“We potentially can earn approaches that are internalizable to other surgical settings,” Bateman said.

Alex Friedman Peahl, a clinical lecturer in obstetrics and gynecology at the University of Michigan, said health care providers can turn to non-opioid pain management methods, like scheduling acetaminophen and ibuprofen dosages to decrease the amount of leftover opioid medication.

“Enhanced recovery after surgery protocols have been used in many surgical specialties to help patients get back on their feet even faster after surgery,” Peahl said in an email.

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