Many Cesarean Patients Discharged with More Opioids Than Needed
More than three-quarters of new mothers who had c-sections were sent home with opioids they didn’t end up needing, and a majority were kept in unlocked cabinets.
More than 75 percent of new mothers who have C-sections will be sent home with opioids they don’t actually need, according to a new study. Researchers found 2,540 unused oxycodone tablets—roughly 10 tablet per patient—among a sample of 2,540 women who had recently given birth via C-section, suggesting that hundreds of thousands of opioid tablets are being prescribed every year to women who probably won’t use them. Given the sheer number of Americans who suffer from opioid addiction and die from overdoses, the findings cast doubt over the practice of prescribing the often unnecessary pills to new moms.
“As an obstetric anesthesiologist for the past 23 or so years, I’m aware of the fact that opioids aren’t necessarily among the greatest relievers of post-cesarean pain,” coauthor on the study Dr. Michael G. Richardson, professor of anesthesiology at Vanderbilt University, told Fatherly. Richardson says women often don’t want to take their pills because of their desire to feel present and not sedated around their new babies. Many women say they’d prefer to take a non-opioid drug with fewer side effects, to manage their post C-section pain. “Yet,” Richardson says. “Many heathcare and medical systems rely on prescribing them.”
Ninety-one Americans die every day from opioid overdoses, according to the Centers for Disease Control and Prevention. And prescription opioids have had plenty to do with pushing the problem into an epidemic. There has been legislation to limit abuse, and lawsuits against pharmaceutical companies, but the opioid epidemic rages on in American nonetheless. For people suffering from certain conditions, prescribing a certain amount of opioid drugs may be unavoidable. But if C-section patients don’t need them, and every prescription runs the risk of contributing to the problem, can we justify sending new moms home with Oxy?
To find out whether C-section patients feel they need opioids in the first place, Richardson and his team recruited 179 cesarean patients, excluding those with drug abuse histories and more serious post-surgical problems such as hysterectomies. Women were asked weekly about the number of pills they used, the amount remaining, and their overall pain levels. Richardson and his team found 2,540 unused 5-mag oxycodone tablets, or a median of 10 tablets per patient, at the end of the experiment. If these rates are typical, Richardson says, Vanderbilt alone may be prescribing more than 90,000 excess tablets each year. “Multiply that by institutions across the country, you’re talking about a huge excess of opioids,” Richardson says.
Richardson notes that the incidence of mothers who can become addicted in these cases is extremely low, but “it’s not zero.” Given the sheer number of C-sections in the United States, “this turns out to be a real number and public health issue,” he says.
It’s important to note the sample size was relatively small and partially dependent on self-reporting, but this isn’t the first time this has been studied. Additional recent research, also published in Obstetrics and Gynecology, followed 720 women and found a median of 15 unneeded tablets per mother. “If you’re prescribed a large amount of a medication, then you think you should be taking a large amount,” study co-author Dr. Brian Bateman, chief of obstetric anesthesia at Brigham and Women’s Hospital, told Forbes. Bateman also observed that the women who took more pills weren’t successful with pain management. They were more likely to suffer side effects like drowsiness, and in both studies, leave excess pills in unlocked cabinets.
Richardson stresses that the takeaway is not for doctors to stop prescribing opioids, or that moms should stop taking them even if they feel they need them to manage their pain. But Richardson says women who don’t need opioids shouldn’t have them, and should instead be prescribed acetaminophen or one of a number of nonsteroidal anti-inflammatory drugs, such as ibuprofen. The challenge is that doctors like Richardson fear overprescribing opioids, but also fear under-treating their patients’ pain.
“We’re trying to find the sweet spot,” he says. “Prescribing just about enough, not too much—but definitely not too little.”