Postpartum women filled more opioid prescriptions during pandemic

Women who gave birth during the COVID-19 pandemic filled significantly more prescriptions for opioid medications, according to new research from the University of Georgia.

Published in the Journal of the American Medical Association’s JAMA Network Open, the study found that 38% of more than 460,000 women who gave birth from July 2018 through December 2020 were prescribed opioids for postpartum pain management.

But there was a significant increase in the number of prescriptions filled for women giving birth during COVID. And the opioids they were prescribed were also higher strength than those given to women who gave birth prior to the pandemic.

“A lot of women receive opioids for treatment of pain during the postpartum period, but they are a particularly vulnerable group because many of them haven’t used opioid medications before,” said Emily Lawler, co-author of the study and an assistant professor in the School of Public and International Affairs. “That makes them high risk for potential opioid abuse.”

The findings are especially concerning given the uptick in opioid overdose deaths during the pandemic, when they surpassed 100,000 deaths annually, the researchers said.

Opioids typically last resort for pain management but may not have been during COVID-19

The American College of Obstetrics and Gynecology recommends health care providers use a stepwise approach to pain management for postpartum mothers. First, they start with a basic pain reliever like ibuprofen or acetaminophen. If that doesn’t alleviate the pain, physicians move to a low strength opioid, such as codeine or tramadol.

But the association also recommends that those prescribed opioids not take them for extended periods and be switched to over-the-counter pain medications as soon as possible.

“Prior to the pandemic, opioid prescriptions were decreasing not only in terms of the number of women prescribed opioids but also the strength of the opioids being prescribed and the number of days covered by each prescription,” said Shelby Steuart, lead author of the study and a doctoral candidate in the School of Public and International Affairs.

“But right after the COVID-19 lockdowns happen in March 2020, we saw a sharp spike in opioid prescription fills,” she continued. “We don’t know whether physicians were writing more opioid prescriptions or if more women were just taking their prescriptions to the pharmacy and filling them, but it is concerning.”

It’s possible physicians were concerned that they wouldn’t see their patients as frequently during the lockdown and COVID surges and were attempting to compensate for that, the researchers said. But it’s also possible that the anxiety from the pandemic exacerbated women’s feelings of pain, prompting them to fill their prescriptions when they may not have prior to the COVID-19 outbreak.

“It’s really critical for this population to be in continued contact with health care providers because they are at high risk of chronic pain,” Lawler said. “It is important to appropriately manage pain, but postpartum women who do develop opioid use disorder are much harder to connect to treatment. And we need to be aware that there is potential for this group to become addicted to opioids, and we need to be on the lookout to connect them to treatment if needed.”

The study was co-authored by the UGA College of Public Health’s Grace Bagwell Adams and the School of Public and International Affairs’ Amanda Abraham. Additional co-authors include Hailemichael Shone of the University of Indiana.