Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, and the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Science, Aetion Inc, New York, New York; and the Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Obstet Gynecol. 2018 Aug;132(2):459-465. doi: 10.1097/AOG.0000000000002741.
To describe nationwide patterns in outpatient opioid dispensing after vaginal delivery.
Using the Truven Health Analytics MarketScan database, we performed a large, nationwide retrospective cohort study of commercially insured beneficiaries who underwent vaginal delivery between 2003 and 2015 and who were opioid-naive for 12 weeks before the delivery admission. We assessed the proportion of women dispensed an oral opioid within 1 week of discharge, the associated median oral morphine milligram equivalent dose dispensed, and the frequency of opioid refills during the 6 weeks after discharge. We evaluated predictors of opioid dispensing using multivariable logistic regression.
Among 1,345,244 women undergoing vaginal delivery, 28.5% were dispensed an opioid within 1 week of discharge. The most commonly dispensed opioids were hydrocodone (44.7%), oxycodone (34.6%), and codeine (13.1%). The odds of filling an opioid were higher among those using benzodiazepines (adjusted odds ratio [OR] 1.87, 95% CI 1.73-2.02) and antidepressants (adjusted OR 1.63, 95% CI 1.59-1.66), smokers (adjusted OR 1.44, 95% CI 1.38-1.51), and among those undergoing tubal ligation (adjusted OR 3.77, 95% CI 3.67-3.87), operative vaginal delivery (adjusted OR 1.52, 95% CI 1.49-1.54), and higher order perineal laceration (adjusted OR 2.15, 95% CI 2.11-2.18). The median (interquartile range, 10th-90th percentile) dose of opioids dispensed was 150 (113-225, 80-345) morphine milligram equivalents, equivalent to 20 tablets (interquartile range 15-30, 10th-90th percentile 11-46) of 5 mg oxycodone. Six weeks after discharge, 8.5% of women filled one or more additional opioid prescriptions.
Opioid dispensing after vaginal delivery is common and often occurs at high doses. Given the frequency of vaginal delivery, this may represent an important source of overprescription of opioids in the United States.
描述阴道分娩后门诊阿片类药物配给的全国模式。
使用 Truven Health Analytics MarketScan 数据库，我们对 2003 年至 2015 年间接受阴道分娩且在分娩入院前 12 周内无阿片类药物使用史的商业保险受益人群进行了一项大型的全国性回顾性队列研究。我们评估了在出院后 1 周内开具口服阿片类药物的女性比例、开具的口服吗啡毫克当量中位数以及出院后 6 周内阿片类药物的补充频率。我们使用多变量逻辑回归评估了阿片类药物配给的预测因素。
在 1345244 名接受阴道分娩的女性中，有 28.5%在出院后 1 周内开具了阿片类药物。最常开具的阿片类药物是氢可酮（44.7%）、羟考酮（34.6%）和可待因（13.1%）。使用苯二氮䓬类药物（校正比值比[OR]1.87，95%CI1.73-2.02）和抗抑郁药（校正 OR1.63，95%CI1.59-1.66）、吸烟者（校正 OR1.44，95%CI1.38-1.51）以及行输卵管结扎术（校正 OR3.77，95%CI3.67-3.87）、阴道助产（校正 OR1.52，95%CI1.49-1.54）和更高程度会阴撕裂（校正 OR2.15，95%CI2.11-2.18）的女性，开具阿片类药物的可能性更高。开具的阿片类药物的中位数（四分位距，第 10-90 百分位数）剂量为 150（113-225，80-345）吗啡毫克当量，相当于 20 片（四分位距 15-30，第 10-90 百分位数 11-46）5 毫克羟考酮。出院后 6 周，8.5%的女性开具了一张或更多额外的阿片类药物处方。
阴道分娩后阿片类药物的配给很常见，且通常剂量较高。鉴于阴道分娩的频率，这可能代表了美国阿片类药物过度处方的一个重要来源。
