Dr-Alex Peahl

Risk Factors for Prolonged Opioid Use After Childbirth Identified

MedicalResearch.com Interview with:

Dr-Alex Peahl

Dr, Peahl

Alex Peahl, M.D.
Prenatal and post-partum care delivery
Institute for Health Care Policy and Innovation
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Almost 4 million women will deliver a baby each year, many of whom may receive an opioid prescription at the time of delivery. As a practicing Ob/Gyn, I have seen first-hand both the importance of good postpartum pain control and the negative impact opioid prescribing can have on women: many of my colleagues and I have unfortunately taken care of women with opioid abuse who report their first opioid exposure was a prescription they received at the time of delivery. We were interested in describing the long-term impact of opioid prescribing after vaginal and cesarean delivery to guide providers and patients making decisions about pain control in the postpartum period.

MedicalResearch.com: What should readers take away from your report?

Response: In this study, we found the rate of new persistent opioid use after delivery was 1 and 2% after vaginal and cesarean delivery. This means that of opioid-naive women in our study who delivered, 1-2 out of every 100 women continued to fill opioids up to a year after delivery.

Importantly, modifiable factors predicted new persistent opioid use: women who filled their prescription before delivery or received a larger prescription were more likely to continue to fill opioids after delivery. Additionally, younger women, women with pain disorders and mental health issues, and women who used tobacco were more likely to develop new persistent opioid use.

Finally, opioid prescribing and new persistent use are declining over time, with women less likely to fill prescriptions immediately after birth and in the months following delivery over the study period (from 2008-2016).

This work confirms the high prevalence of opioid prescribing demonstrated in prior studies and the long-term impact of this prescribing: new persistent opioid use. Some women may be more at risk of new persistent opioid use, and providers can consider specific risk factors when counseling their patients on postpartum pain management. As some of the strongest predictors of new persistent opioid use are modifiable, specifically the size and timing of the prescription, providers have an opportunity to decrease the risk of new persistent opioid use through limited prescribing. Luckily, many effective protocols for managing postpartum pain with opioid-sparing protocols have demonstrated success, suggesting minimizing postpartum opioid use is possible. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Further research is needed to best understand how to meet patient’s pain needs while minimizing the harms of opioid use: there has already been great work by our group and others to understand the impact of Enhanced Recovery After Surgery programs, opioid-sparing pain protocols, and shared decision making at the time of delivery to reduce postpartum opioid consumption. The long-term impacts of these programs on women are yet to be seen. Additionally, many women were excluded from our study because they filled an opioid in the year prior to delivery. We are currently doing work to understand which patients are filling opioids during pregnancy, and what long-term impact this acute prescribing may have. Finally, our data comes from patients who are privately ensured, who make up approximately half of births in the United States. Understanding rates of persistent use in Medicaid patients on the national level are important for completely understanding the impact of opioid prescribing in the US.

MedicalResearch.com: Is there anything else you would like to add?

 Response: Enhanced Recovery After Surgery protocols have shown promise in improving maternal  pain control with fewer opioids. These protocols include: 1) enhancing maternal education on cesarean delivery and recovery; 2) using scheduled non-narcotic pain medications to reduce baseline pain; and 3) limiting opioid use and using regional (i.e. epidural/spinal- the medication placed in patients’ backs for anesthesia) long-acting opioids to ensure more even pain control. Shared decision making at the time of discharge has also been shown to decrease the size of opioid prescriptions that patients are sent home with.

There are many great examples of opioid-sparing protocols to help women achieve good pain control while minimizing opioid use. At the University of Michigan, we have developed new patient materials including a handout and video which we hope will help women planning for and undergoing cesarean to feel better prepared and know their options for opioid-sparing pain management (see resources below).

Disclosures: unchanged from publication


Peahl AF, Dalton VK, Montgomery JR, Lai Y, Hu HM, Waljee JF. Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women. JAMA Netw Open. Published online July 26, 20192(7):e197863. doi:10.1001/jamanetworkopen.2019.7863

Childbirth & Obstetric Care Resources page. They are as follows (and appear in alpha order in the “Prenatal Care” section):

Improving C-Section Recovery: The ERAS Program Helps You Heal (Video)

Your Cesarean Delivery: A Guide to Your Birth Experience at Von Voigtlander Women’s Hospital

Peahl AF, Dalton VK, Montgomery JR, Lai Y, Hu HM, Waljee JF. Rates of New Persistent Opioid Use After Vaginal or Cesarean Birth Among US Women. JAMA Netw Open. Published online July 26, 20192(7):e197863. doi:10.1001/jamanetworkopen.2019.7863

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Last Updated on July 29, 2019 by Marie Benz MD FAAD