Bateman, Brian T. MD, MSc; Cole, Naida M. MD; Maeda, Ayumi MD; Burns, Sara M. MS; Houle, Timothy T. PhD; Huybrechts, Krista F. MS, PhD; Clancy, Caitlin R. BA; Hopp, Stephanie B. MS, MHS; Ecker, Jeffrey L. MD; Ende, Holly MD; Grewe, Kasey MD; Raposo Corradini, Beatriz MS; Schoenfeld, Robert E. BS; Sankar, Keerthana BS; Day, Lori J. MD; Harris, Lynnette BSN; Booth, Jessica L. MD; Flood, Pamela MD, MA; Bauer, Melissa E. DO; Tsen, Lawrence C. MD; Landau, Ruth MD; Leffert, Lisa R. MD
OBJECTIVE: To define the amount of opioid analgesics prescribed and consumed after discharge after cesarean delivery.
METHODS: We conducted a survey at six academic medical centers in the United States from September 2014 to March 2016. Women who had undergone a cesarean delivery were contacted by phone 2 weeks after discharge and participated in a structured interview about the opioid prescription they received on discharge and their oral opioid intake while at home.
RESULTS: A total of 720 women were enrolled; of these, 615 (85.4%) filled an opioid prescription. The median number of dispensed opioid tablets was 40 (interquartile range 30–40), the median number consumed was 20 (interquartile range 8–30), and leftover was 15 (interquartile range 3–26). Of those with leftover opioids, 95.3% had not disposed of the excess medication at the time of the interview. There was an association between a larger number of tablets dispensed and the number consumed independent of patient characteristics. The amount of opioids dispensed did not correlate with patient satisfaction, pain control, or the need to refill the opioid prescription.
CONCLUSION: The amount of opioid prescribed after cesarean delivery generally exceeds the amount consumed by a significant margin, leading to substantial amounts of leftover opioid medication. Lower opioid prescription correlates with lower consumption without a concomitant increase in pain scores or satisfaction.
A certain degree of “over-prescribing” is probably practiced by most physicians. We don’t want our patients to have uncontrolled pain and we also don’t want to be called at any moment when our mind may not be 100% “in the game” with instant access to the patients chart, clinical information and a host of other variables to try to figure a way to refill controlled medications for a patient that we may be covering “on-call” for another physician. Perhaps we do this as much as a courtesy to those physicians who cover for us after hours. Unfortunately, addicts also know this and will often try the “after-hours” phone call trying to scam some opiates from a covering physician with a “soft heart” (soft mind?).