According to a recent study conducted at Vanderbilt University Medical Center and published in the journal Obstetrics and Gynecology, women who undergo Cesarean sections have been routinely overprescribed opioid (narcotic) pain medications. The study looked at 179 patients who had undergone cesareans at VUMC over an eight-week period to examine opioid prescribing practices and consumption after a C-section, which is the most commonly performed surgical procedure in the U.S.
In a story in the VUMC Reporter, Sarah Osmundson, M.D., assistant professor of Obstetrics and Gynecology in the Division of Maternal-Fetal Medicine and the first author of the study said, “What we found is that prescribers, partly 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.”
The study, Post Discharge Opioid Use After Cesarean Delivery, examines how many opioid pills patients were taking home, how many of them they were actually taking, and what was being done with the unused pills. The answer to these questions would serve to help prescribers modify and reduce the excessive number of opioids being prescribed given the current climate of the opioid epidemic in the U.S.
In another study conducted at Brigham and Women’s hospital in Boston, and written about in HealthLine, researchers found that the more pill patients were prescribed, the more they would take regardless of their pain scores. Ninety-five (95) percent of the women in the study reported that they had excess pills that they did not need but had not thrown out two weeks after being discharged from hospital. Dr. Brian Bateman, chief of Obstetric Anesthesia at Brigham and Women’s Hospital, author of the second study examined a tablet-based tool that would allow participants to make an informed decision along with the support of a clinician, on how many pills they would like to be prescribed. The study found that using the tool cut the number of opioid pills prescribed in half.
The study also noted that patients who were prescribed more opioids did not see a difference in pain scores as compared with those who had been prescribed fewer pills. The patients who took high doses also experienced more opioid-related side-effects.
Dr. Osmundson said “We are the source of these excess opioids, and we need to do more to restrain that, but we really need to tailor that, so the individual gets what they need. Our take-home point is we don’t want one-size-fits-all prescribing.” The problem does not seem to lay in women becoming addicted to opioids after a C-section, rather that all those leftover pills are left in unlocked medicine cabinets. Dr. Osmundson recommends that prescribers counsel patients to take only the pills they need and to dispose of the unused pills with coffee grounds or discarded kitty litter in the trash or bring them to an approved drug disposal site.