loading page

Characteristics, determinants, and frequency of persistent use among prescription opioid episodes initiated postpartum: a population-based cohort study from British Columbia, Canada
  • +9
  • L. Schummers,
  • James Wilton,
  • Amanda Yu,
  • Jennifer A. Hutcheon,
  • Jessica Liauw,
  • Margo Pearce,
  • Mei Chong,
  • Stanley Wong,
  • Younathan Abdia,
  • Roy Purssell,
  • Naveed Janjua Z,
  • Jane Buxton A
L. Schummers
The University of British Columbia Faculty of Pharmaceutical Sciences

Corresponding Author:[email protected]

Author Profile
James Wilton
BC Centre for Disease Control
Author Profile
Amanda Yu
BC Centre for Disease Control
Author Profile
Jennifer A. Hutcheon
The University of British Columbia Department of Obstetrics & Gynaecology
Author Profile
Jessica Liauw
The University of British Columbia Department of Obstetrics & Gynaecology
Author Profile
Margo Pearce
BC Centre for Disease Control
Author Profile
Mei Chong
BC Centre for Disease Control
Author Profile
Stanley Wong
BC Centre for Disease Control
Author Profile
Younathan Abdia
The University of British Columbia Faculty of Pharmaceutical Sciences
Author Profile
Roy Purssell
BC Centre for Disease Control
Author Profile
Naveed Janjua Z
BC Centre for Disease Control
Author Profile
Jane Buxton A
BC Centre for Disease Control
Author Profile

Abstract

Objective: To determine the characteristics, determinants, and persistent use for prescription opioid episodes initiated postpartum in British Columbia (BC), Canada. Design: Population-based cohort, 2008-2015. Setting: Linked administrative databases including outpatient and inpatient visits and outpatient prescription dispensations for all individuals in BC tested for hepatitis C or HIV. Population: Opioid-naïve individuals aged 13-49 with a delivery hospitalization record. Methods: We used modified Poisson regression to estimate risk ratios (RR) for pre-pregnancy characteristics and adjusted RR (aRR) for delivery characteristics adjusted for potential confounders. Main Outcome Measures: All and persistent (≥90 days) prescription opioid episodes initiated postpartum. Results: Among 292,684 eligible deliveries, 8.8% (95% CI: 8.7% to 8.9%) initiated a postpartum prescription opioid episode and 0.4% (0.4%- 0.5%) had a persistent episode. Persistent prescription opioid episodes were more frequent among cesarean vs. vaginal deliveries (1.0% vs. 0.2%, aRR 5.1 [4.6-5.8]). Opioid episodes varied regionally and declined from 12.8% in 2008 to 7% in 2012-2015. Persistent prescription opioid episodes were associated with pre-pregnancy: mental illness history (RR 2.4 [1.9-3.1]), psychotropic medication use (RRs 3.6-4.9), chronic pain (RR 2.7 [1.8-3.9]) and alcohol misuse (4.6 [2.2-9.7]), and delivery complications: intensive care unit admission (aRR 5.4 [3.3-8.9]), postpartum hospital readmission (aRR 3.9 [3.2-4.8]), and vaginal deliveries with hysterectomy (aRR 23.7 [6.1-91.8]) or tubal ligation/salpingectomy (aRR 14.6 [5.4-39.4]). Conclusions: Persistent prescription opioid episodes were initiated following 0.4% of deliveries. Postpartum pain management strategies should consider the strong associations between pre-pregnancy and delivery characteristics and persistent prescription opioid episodes initiated postpartum.