Women who undergo cesarean sections are being prescribed far too many opioid medications, according to a new study from researchers at Harvard Medical School, Columbia University and the University of Michigan.
C-Section Patients Get Double The Necessary Painkillers
In an article published in the journal Obstetrics and Gynecology, a team of doctors and anesthesiologists at six academic medical facilities conducted a simple survey, calling 720 women by phone two weeks after discharge from the hospital. All 720 women had undergone c-sections; the majority had been prescribed some form of opiate pain medication to help them recover.
But as the surveyors soon found, most of the women didn’t seem to need all of the painkillers they were prescribed. Around 15% of the patients never filled their prescriptions, leaving 85% who did, bringing home an average of 40 opioid pills. The average woman, however, only took 20 of those pills, suggesting that, to adequately control their post-surgical pain, most patients only require about half of the painkillers they’re actually being dispensed.
After she stopped taking the pills, the average patient was left with 15 unused pain tablets, but very few women threw them out. In fact, more than 95% of the women who had leftover pills kept them, at least two weeks after their discharge from the hospital.
More Pills Equal More Use, Regardless Of Pain
While many women chose to stop taking their painkillers after their pain had subsided, that wasn’t always the case. One particularly troubling finding shows that patients who receive larger opioid prescriptions tend to take more painkillers, regardless of individual patient characteristics, including self-reported pain levels. Likewise, smaller prescriptions appeared to encourage less opioid use, but without a corollary increase in pain scores.
Even worse, the number of pills that a woman was prescribed had no relationship to a patient’s pain control needs or satisfaction levels. No relationship. These are disturbing results, especially for a country in which drug overdose is the leading cause of accidental death.
Drawing their conclusions, the researchers write, “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.” Doctors, at least those whose prescribing practices were implicated in this study, appear to err on the side of overprescription, sending women home with about double the painkillers they will actually need.
Leftover Pills Create Risks For Children, Family
It should be obvious that the overprescription of painkillers creates a major risk for fostering addiction. Patients at heightened risk for opioid addiction, of course, will be tempted, if not compelled by their disease, to take more painkillers than are medically-necessary.
Those who only take the pills when they need them for pain, on the other hand, are left with a surplus of painkillers, which could be in reach of other children or their loved ones. As the National Survey on Drug Use and Health has found, around one-half of people who abuse prescription pain pills get them, at least at first, from a friend or relative with a legitimate prescription.
Patient-Driven Decisions May Be More Realistic
How do we tackle this problem? The same group of researchers from Harvard and Columbia is also looking into solutions. In a follow-up study published the same month, the team found that including patients as active participants in the decision-making process could have major benefits. In effect, women who have undergone c-sections, when given an overview of how most patients fare after their surgeries, tend to choose lower prescription levels than doctors do.
After being consulted on “typical trajectories of pain resolution” after cesarean delivery, the average patient (out of 51 women) chose to receive 20 5-milligram oxycodone tablet, half the standard 40-pill prescription used in most medical facilities. The wisdom of patients, it seems, is not to be overlooked.
C-Section Rates Continue To Climb
In 2015, nearly one-third of all live births in the country were facilitated through surgical intervention, according to data compiled by the National Center for Health Statistics. That’s far more c-sections than are medically necessary, and likely far more than are medically appropriate, experts say. A large analysis of cesarean delivery rates in 54 countries found that, to reach the lowest maternal and infant death rates, a nation’s rate of c-section should sit around 19%.
Higher c-section percentages, the Harvard-based women’s health researchers, appeared to correlate with higher rates of death among both mothers and their children, as did rates lower than 19 in 100 live births.