Cesarean sections, more commonly called C-sections, are the most common inpatient surgery in American hospitals. Studies have shown that roughly 1.3 million expectant mothers have this procedure every year. Following this procedure, it’s not unusual for doctors to prescribe opioid painkillers for mothers recovering from surgery.
Prescriptions drugs like oxycodone and hydrocodone are the standard for managing discomfort following a C-section. However, the number of pills prescribed depends entirely on the provider. This means that the amount of opioid medication prescribed for pain management may be disproportional to what patients need.
Reports by the Centers for Disease Control and Prevention
Until recently, studies didn’t look for a connection between opioid prescriptions for post-C-section patients and the risk of opioid dependency. In mid-March of last year, however, the Centers for Disease Control and Prevention (CDC) discussed in their Morbidity and Mortality Weekly Report that patients who receive larger initial opioid prescriptions (i.e., more pills) had a much higher chance of continued opioid use and potential addiction.
This issue was explored shortly after this report in a series of three studies that were later published in Obstetrics & Gynecology, the official medical journal of the American College of Obstetricians and Gynecologists (ACOG). The teams of researchers involved in these studies found that the vast majority of study subjects—mothers recovering from C-section births— had received more opioid pills in their prescriptions than they actually needed. The researchers also found that the majority of the study participants kept the leftover painkillers. These factors, especially together, can potentially heighten the risk of addiction for anyone with access to them.
The Three Major Obstetrics & Gynecology Studies
Findings of the First Study
A team of researchers at Brigham and Women’s Hospital and Harvard Medical School in Boston conducted the first of the three studies. This study, which was by far the largest, focused on a total of 720 study participants. Each woman in c-section recovery had returned home from the hospital about two weeks before the start of the study.
Of the 720 women surveyed, 615 of them— about 85% of the study group— said they had been prescribed opioid painkillers to manage their post-C-section discomfort. Unsurprisingly, almost all of the prescriptions filled were for either oxycodone or hydrocodone.
The study also found that the mothers in C-section recovery received far too many pills in their prescriptions. In fact, they had nearly twice as many as they wound up using. On average, each study subject had about 15 pills from their prescription left over. Additionally, the women in the study who wound up using more pills reported that there wasn’t any notable difference in the amount of pain relief. As with the first study, the majority of women with leftover prescription opioids kept them for later use.
Findings of the Second Study
The second study, which was also subsequently published in Obstetrics & Gynecology, yielded similar results in a smaller sample of study participants. A team of researchers from Vanderbilt University in Nashville, Tennessee, analyzed a more modest total of 179 women. About 83% of the mothers in this study sample used opioids for an average of eight days after returning home from the hospital. Additionally, 75% of this group had unused medicine by the end of the first two weeks of C-section recovery. The majority of the study participants that had leftover painkillers after two weeks admitted to keeping them for future use.
Findings of the Third Study
The same team of researchers from Boston who oversaw the first study conducted the final study as well. This time, they investigated an approach to reducing the number of opioid tablets prescribed for post-C-section patients. During this study, clinicians spoke with the participants in a series of 10-minute meetings. At the same time, the clinicians showed the participants a presentation on a tablet. During these clinical meetings, the clinicians explained:
• how to get prescription refills from their physicians when necessary
• how to dispose of leftover pills after the end of the prescription period
• what kind of pain the patients should expect during C-section recovery
• what the risks and benefits were for both opioid and non-opioid painkillers
After this consultation, the patients in the study got to choose how many 5mg oxycodone tablets to include in their prescriptions when released from the hospital. The limit set was 40, which is the usual number that hospitals give. The median number of pills chosen by patients was 20, and an average of 4 pills was left over. Furthermore, 90% of the participants said that they were satisfied with their pain management. Nearly all of them said that the shared decision-making approach was helpful.
The Dangers of Keeping Leftover Opioid Prescriptions
In recent years, doctors have become more cautious about prescribing opioids for pain. Still, the amount of medication that is left over and later consumed is a major contributing factor to the ongoing opioids crisis. The first two studies found that the majority of post-C-section patients kept the opioids they didn’t use. This is a problem for three reasons.
The first is that keeping leftover prescription opioids increases the risk of post-C-section patients developing a dependence on them. In fact, women are already 40% more likely to develop an opioid addiction than men.
The second reason is that previous studies have shown that keeping leftover prescription pills at home increases the risk of opioid exposure to other household members. For example, if patients with unused opioids don’t secure them, children could potentially get their hands on them. Unfortunately, this has happened before— roughly 2% of children between ages 12 and 17 used painkillers non-medically back in 2014.
The third reason is that there’s always a chance that recovering patients with extra opioid pills might try to give them away to someone else. According to the National Survey on Drug Use and Health of 2013 and 2014, about half of the people who abused prescription opioids did not have their own prescriptions; instead, they got their drugs from a friend or a relative.
Opioid Addiction Help at TTC Outpatient Services
With the opioid crisis on the rise, the over-prescription of opioid pills puts everyone at risk for addiction— especially people who experience chronic pain after standard procedures like C-sections. Thankfully, we’ve been making progress in carefully limiting the amount of extra opioid pills that could potentially set off an addiction for prescription holders.
If you or someone you know has developed an addiction to opioid painkillers following a medical procedure, please contact The Treatment Center’s Outpatient Services at (844) 665-6834. Our programs and services can help you get your life back on track.