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12th Jun 2017

Doctors say mums are being ‘over-prescribed’ pain relief after c-sections

Although many of us who have had a Caesarean section birth might argue otherwise, a leading medical research centre in the US says that women are being sent home with more pain relief medications than they really need.

A new study from Vanderbilt University Medical Centre has shown that most women who have a c-section are prescribed more pain meds than are actually required when they are being released from hospital.

The study, recently published in Obstetrics and Gynaecology, looked at 179 patients over an eight-week period to examine the variation in opioid (morphine) prescribing and consumption after caesarean delivery, the most common major surgical procedure performed in the United States.

Lead researcher Dr Sarah Osmundson, an assistant professor of obstetrics and gynaecology, says that doctors are ‘overtreating’ new mums who’ve had a section:

“What we found is that prescribers, partly in order to expedite a patient’s release from the hospital, have kind of a one-size-fits-all prescription model for patients when they are discharged from the hospital. What we’ve learned is that this method may undertreat a few patients, but likely overtreats the vast majority of patients.”

Dr Osmundson says that over-prescribing raises addiction questions:

“There’s so much attention around excess opioids and the growing problem with opioid addiction, and the question came up, how much are patients really using when they go home.

Anecdotally, I was hearing that patients were using one to two tablets once they were home, but they went home with a prescription for thirty tablets. The big question for us is what is happening after discharge and can we modify that to reduce the amount of excess opioids prescribed.”

The United States is in the midst of an opioid abuse epidemic, with the number of overdose deaths having quadrupled over the last fifteen years. Experts say that the death toll correlates with a sharp increase in the amount of legal prescription opioids being dispensed. Most individuals using prescription opioids for non-medical purposes have obtained them from family members or friends who have been legitimately prescribed the medications.

Dr Michael Richardson, the study’s co-author and an associate professor of anaesthesiology, says that more attention needs to be paid to patients’ opioid use while they are still inpatients in the hospital to better predict their use after going home:

“Our data suggest that providers are not currently considering in-hospital opioid use to determine the amount prescribed at discharge. If the patient is not using very much in the hospital, why should they go home with a prescription for 30 oxycodone tablets?”

The study authors also found that many patients with a thirty-day prescription believe they are supposed to take the pills until they are all gone, when in fact, they only need to take them when absolutely needed. Normally over-the-counter pain relievers such as ibuprofen are sufficient in controlling post-caesarean pain.

The study found that most women (83 percent) used opioids after discharge for an average of eight days, and of the women who filled their prescriptions (92 percent) 74 percent had unused tablets. This amounted to about 2,540 unused 5 mg oxycodone tablets over the study period, and about 19,000 excess oxycodone per year from caesareans at VUMC alone.

Dr Osmundson says that the majority (63 percent) stored their pills in an unlocked location in their home, which is another cause for concern:

“Large studies show that the most common source for misused opioids are ones that are prescribed legally and to the appropriate person. We know that these are falling into the wrong hands and that people frequently use opioids prescribed to a friend or family member.

One way to tackle the opioid epidemic is not to have excess opioids around, which is unlikely to happen, or to minimise what we’re currently prescribing, which is doable.

If we can find a more nuanced way to prescribe, we can do a lot to reduce the excess opioids out there.”