Newswise — New research published in the Canadian Medical Association Journal (CMAJ) indicates that postpartum prescriptions for oxycodone did not show an increased risk of prolonged opioid use when compared to codeine prescriptions.
Over the past decade, there has been a noticeable shift in medical practice, with a decrease in codeine prescriptions and a rise in prescriptions for more potent opioids like hydrocodone, hydromorphone, and oxycodone for postpartum patients.
Dr. Jonathan Zipursky, affiliated with Sunnybrook Health Sciences Centre, ICES, and the University of Toronto, Ontario, along with coauthors, notes that this shift occurred partly due to safety concerns associated with codeine use during breastfeeding, which have since been questioned. However, the consequences of this shift in prescription patterns on postpartum health have not been extensively studied but are potentially worrisome for several reasons. One major concern is that patients tend to prefer oxycodone over other prescription opioids, which could increase the risk of nonmedical use.
In order to investigate the potential connection between the increased prescription of stronger opioids and prolonged opioid use following childbirth, researchers examined data from 70,607 individuals who were given opioid prescriptions upon discharge from an Ontario hospital between 2012 and 2020. Among them, 49,299 (70%) received oxycodone, and 21,308 (30%) received codeine. The majority of patients (56,485 [80%]) underwent cesarean deliveries.
After analyzing the data, the researchers found that compared to codeine, the use of oxycodone was not linked to a higher likelihood of persistent opioid use after delivery, with a relative risk of 1.04 and a 95% confidence interval of 0.91–1.20.
In additional analyses, the researchers made an interesting discovery. They observed a 60% higher risk of persistent opioid use among individuals prescribed oxycodone compared to codeine after vaginal delivery. However, this association was not evident for those who underwent cesarean deliveries. This specific finding raises the need for further investigation into the reasons why individuals who give birth vaginally might be more susceptible to prolonged opioid use following oxycodone prescriptions.
Furthermore, the study revealed that higher dosages and longer durations of opioid prescriptions were linked to an increased risk of persistent opioid use. This finding suggests that postpartum prescriptions containing large quantities of morphine milligram equivalents could serve as an additional risk factor for long-term opioid use. As a potential preventive measure, the authors propose the consideration of limiting the initial quantity of opioid prescriptions to help reduce the risk of new, persistent opioid use after childbirth. More research is necessary to fully understand and address this important issue.
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