Comparison of Postpartum Opioid Prescriptions Before vs During the COVID-19 Pandemic.
Comparison of Postpartum Opioid Prescriptions Before vs During the COVID-19 Pandemic.
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DOI：
10.1001/jamanetworkopen.2023.6438
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发表时间：
2023-04-03
影响因子：
13.8
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中科院分区：
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COVID-19大流行爆发后，产后妇女的阿片类药物处方量发生了怎样的变化？在这项对460371名私人保险的产后妇女进行的横断面研究中，2020年3月之后生下一个活的新生儿的患者比2020年3月之前生下的患者更有可能服用更有效和更频繁的阿片类药物处方。剖腹产患者的增加幅度大于阴道分娩患者。这项研究表明，2020年3月之后分娩的女性在产后期间暴露于阿片类药物的情况增加。COVID-19大流行严重扰乱了常规医疗保健，并加剧了现有的医疗保健障碍。尽管产后妇女经常经历干扰日常生活活动的疼痛，而且通常可以通过处方阿片类镇痛药成功治疗，但她们也面临阿片类药物滥用的高风险。比较二零二零年三月COVID-19疫情爆发后与疫情前的产后阿片类药物处方量。在这项对2018年7月1日至2020年12月31日期间分娩单胎活产新生儿的460371名私人保险产后妇女的横断面研究中，将2020年3月1日之前的产后阿片类药物填充与2020年3月1日之后的填充进行了比较。统计分析时间为2021年12月1日至2022年9月15日。2019冠状病毒病疫情于二零二零年三月爆发。主要结局是产后阿片类药物填充，定义为出生后6个月内阿片类药物处方的患者填充。阿片类药物处方在5个指标方面进行了探索：每人的平均填充次数，每天平均填充的吗啡毫克当量（MME），平均供应天数，填充II类阿片类药物处方的患者百分比，以及填充III类或更高阿片类药物处方的患者百分比。在460 371名产后妇女中，（平均[SD]分娩年龄，29.0 [10.8]岁），那些在2020年3月之后生下一个活的新生儿的人，根据先前存在的趋势，服用阿片类药物处方的可能性比预期高2.8个百分点。（预测值，35.0% [95% CI，34.0%-35.9%];实际值，37.8% [95% CI，36.8%-38.7%]）。COVID-19期间也与每天MME的增加有关（预测平均值[SD]，34.1 [2.0] [95% CI，33.6-34.7];实际平均值[SD]，35.8 [1.8] [95% CI，35.3-36.3]），每例患者的阿片类药物填充次数（预测值，0.49 [95% CI，0.48-0.51];实际值，0.54 [95% CI，0.51-0.55]），以及服用II类阿片类药物处方的患者百分比（预测值，28.7% [95% CI，27.9%-29.6%];实际值，31.5% [95% CI，30.6%-32.3%]）。与每次处方的阿片类药物供应天数或填写III级或更高阿片类药物处方的患者百分比没有显著相关性。按分娩方式分层的结果显示，剖宫产分娩的患者比阴道分娩的患者所观察到的增加更大。这项横断面研究表明，COVID-19大流行的爆发与产后阿片类药物填充的显著增加有关。阿片类药物处方的增加可能与产后妇女阿片类药物滥用，阿片类药物使用障碍和阿片类药物相关过量的风险增加有关。这项针对私人投保女性的横断面研究比较了2020年3月COVID-19大流行爆发后产后阿片类药物处方与大流行前的处方。
How did fills of opioid prescriptions change among postpartum women after the onset of the COVID-19 pandemic? In this cross-sectional study of 460 371 privately insured postpartum women, patients who gave birth to a single, live newborn after March 2020 were more likely to fill more potent and more frequent opioid prescriptions than patients who gave birth prior to March 2020. Increases were larger for patients delivering via cesarean birth than those delivering vaginally. This study suggests that women who gave birth after March 2020 experienced increased exposure to opioids during the postpartum period. The COVID-19 pandemic substantially disrupted routine health care and exacerbated existing barriers to health care access. Although postpartum women frequently experience pain that interferes with activities of daily living, which is often successfully treated with prescription opioid analgesics, they are also at high risk for opioid misuse. To compare postpartum opioid prescription fills after the onset of the COVID-19 pandemic in March 2020 with fills before the pandemic. In this cross-sectional study of 460 371 privately insured postpartum women who delivered a singleton live newborn between July 1, 2018, and December 31, 2020, postpartum opioid fills before March 1, 2020, were compared with fills after March 1, 2020. Statistical analysis was performed from December 1, 2021, to September 15, 2022. COVID-19 pandemic onset in March 2020. The main outcome was postpartum opioid fills, defined as patient fills of opioid prescriptions during the 6 months after birth. Opioid prescriptions were explored in terms of 5 measures: mean number of fills per person, mean filled morphine milligram equivalents (MMEs) per day, mean days supplied, percentage of patients filling a prescription for a schedule II opioid, and percentage of patients filling a prescription for a schedule III or higher opioid. Among 460 371 postpartum women (mean [SD] age at delivery, 29.0 [10.8] years), those who gave birth to a single, live newborn after March 2020 were 2.8 percentage points more likely to fill an opioid prescription than expected based on the preexisting trend (forecasted, 35.0% [95% CI, 34.0%-35.9%]; actual, 37.8% [95% CI, 36.8%-38.7%]). The COVID-19 period was also associated with an increase in MMEs per day (forecasted mean [SD], 34.1 [2.0] [95% CI, 33.6-34.7]; actual mean [SD], 35.8 [1.8] [95% CI, 35.3-36.3]), number of opioid fills per patient (forecasted, 0.49 [95% CI, 0.48-0.51]; actual, 0.54 [95% CI, 0.51-0.55]), and percentage of patients filling a schedule II opioid prescription (forecasted, 28.7% [95% CI, 27.9%-29.6%]; actual, 31.5% [95% CI, 30.6%-32.3%]). There was no significant association with days’ suppy of opioids per prescription or percentage of patients filling a prescription for a schedule III or higher opioid. Results stratified by delivery modality showed that the observed increases were larger for patients who delivered by cesarean birth than those delivering vaginally. This cross-sectional study suggests that the onset of the COVID-19 pandemic was associated with significant increases in postpartum opioid fills. Increases in opioid prescriptions may be associated with increased risk of opioid misuse, opioid use disorder, and opioid-related overdose among postpartum women. This cross-sectional study of privately insured women compares postpartum opioid prescription fills after the onset of the COVID-19 pandemic in March 2020 with fills before the pandemic.