Geographic variation in postpartum prescription opioid use: Opportunities to improve maternal safety

Background: Obstetric delivery is among the most common in-hospital procedures experienced by reproductive-age women, yet there is little literature on patterns of postpartum opioid prescriptions after such episodes. Methods: We used claims data from 871,195 vaginal deliveries to 768,455 privately-insured women with an in-hospital delivery between June 2001 and July 2013 to examine the state- and census division-level proportions of women who filled an opioid prescription within four days of hospital discharge after vaginal delivery. Our primary outcome examined the proportion of women who filled an opioid prescription after uncomplicated vaginal delivery (e.g., without forceps extraction, vacuum extraction, or 3rd/4th degree perineal laceration). Secondary outcomes examined state- and census division-level variation in opioid prescription duration (proportion of prescriptions exceeding five days) and dose (proportion of prescriptions exceeding 280 morphine milligram equivalents). We also displayed national temporal trends in opioid prescribing rate and dose for uncomplicated vaginal delivery in comparison to complicated vaginal delivery. Results: Across states, we found a 7-fold variation in postpartum opioid prescription rates (7.6–53.4%), a 5-fold variation in opioid prescriptions for greater than five days' duration (5.1–25.7%), and a 19% absolute difference in opioid prescriptions for greater than 280 morphine milligram equivalents (0–19.3%) following uncomplicated vaginal delivery. Conclusions: These wide variations in postpartum opioid prescription practices suggest opportunities to develop guidelines on postpartum opioid use, to improve prescription safety, and to reduce opioid-related harms among women in the postpartum period.