(1004) Postpartum Discharge Opioid Prescribing in Nulliparous, Term, Singleton, Vertex Pregnancies in Opioid-Naive Birthing People

We conducted a retrospective cohort analysis of 89,721 opioid-naive, nulliparous, term, singleton, vertex (NTSV) births from 1/1/2020-1/1/2023, using registry data obtained from a Michigan statewide maternity care collaborative, the Obstetrics Initiative.  Patient demographics and clinical data were obtained from registry data. We assessed variation in postpartum prescribing by region. Then, using models adjusted for patient, prescribing provider, hospital, and regional characteristics, we assessed the factors most associated with receipt of a discharge opioid prescription following vaginal and cesarean birth. 

Results: Of the 89,721 opioid- naive birthing people, 24,317 (27%) received an opioid prescription at discharge. The prescription rates for Cesarean births was 88% and for vaginal births was 3%. For vaginal births, the prescription rate varied across regions from 0.14% to 6.9%. The regional variation in prescription rates for cesarean birth ranged from 76.4% to 92.8%. In adjusted models, region of childbirth was a predictor of opioid prescribing for vaginal births but not cesarean births. The strongest predictors of receiving an opioid prescription after vaginal birth were 3rd and 4th degree laceration (aOR 7.23, 95% CI 6.12-8.55) and hysterectomy (aOR 7.69, 95% CI 1.33-44.28). The strongest predictors of receiving an opioid prescription after cesarean birth were non-Hispanic Black (aOR 1.27, 95% CI 1.08-1.49) and Asian race (aOR 1.27, 95% CI 1.02-1.58) and postpartum hemorrhage (aOR 1.15, 95% CI 1.02-1.30).

Conclusion: Opioid prescribing after vaginal birth was low, and largely driven by delivery related morbidity. Prescribing after cesarean birth was high and variable, and driven in part by non-clinical factors. Future work is needed to identify and address discrepancies that result in inequitable prescribing patterns.