Opioids after childbirth: Researchers recommend only small quantities and using a shared decision-making approach

Ensuring the smallest dose of postpartum opioid for adequate pain relief, combined with healthcare providers and patients working together to make the best individualized decision, will help reduce persistent opioid use following childbirth.

That’s the takeaway from a new study published in Obstetrics and Gynecology which looked at 118,694 deliveries in Ontario from 2013 to 2021 where opioids were prescribed after caesarean and vaginal births. Persistent opioid use was defined as one or more additional opioid prescriptions in the 90 days following the initial date prescribed and at least one additional prescription between 91 and 365 days thereafter.

Of the total number, 1,282 patients or roughly one per cent met the definition of persistent opioid use in the year following delivery. Each additional 30 morphine milligram equivalents of opioid (morphine, oxycodone, codeine, tramadol and hydromorphone) prescribed was associated with an increased risk of new persistent use. Patients who also filled a prescription for benzodiazepines had a markedly increased risk of persistent opioid use, particularly following caesarean delivery.

“This comes down to health care providers having conversations with patients about balancing pain relief after childbirth with potential safety concerns associated with postpartum opioid use,” says Dr. Jonathan Zipursky, principal investigator and staff physician and scientist at Sunnybrook Health Sciences Centre. “Standardized guidelines would also be an enormous help in guiding both clinicians and patients.”

Currently guidelines suggest the use of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in a stepwise fashion. However, existing guidelines do not outline specific information about opioid selection, the appropriate amount of opioids to prescribe in the postpartum period or the potential risks of prescribing if the patient is taking other drugs like benzodiazepines.

“Having clearly defined guidelines would be an important step in ensuring a balance of pain relief with safety after patients deliver their baby,” adds Dr. Zipursky.