769: Patterns of opioid use by trimester in pregnancy

Abstract

To describe patterns of opioid use and discontinuation during preconception and pregnancy. This is a cross-sectional study of monthly opioid use among pregnant women age 18-45 years enrolled in Tennessee Medicaid from 90 days prior to the last menstrual period through 42 days postpartum (2006-2013). Monthly proportions of prevalent (>1 opioid prescription) and new opioid use (>1 opioid prescription among those without prior use) out of the total eligible population and the population eligible to be new users, respectively, were computed by pregnancy stage [preconception (PC), first trimester (1T), second trimester (2T), and third trimester (3T)]. Discontinuation of opioid use across pregnancy stage was defined as a proportion of pregnant women without opioid use in the current month among the eligible population with >1 opioid prescription during a previous pregnancy stage in the prior month. We used Joinpoint regression (National Cancer Institute v.4.0.4) to identify changes in trends of opioid use and discontinuation (alpha=0.05). The average monthly proportion of opioid use at any point during pregnancy was 8.6% (median n: 11,768 per month). The yearly monthly average of prevalent use across all trimesters increased significantly prior to 2010, but decreased significantly in PC (14%) and across all trimesters of pregnancy (1T 18%, 2T 16%, 3T 18% decrease) since 2010 (Figure 1a). The average monthly proportion of new use during pregnancy was 3.6%. The yearly average of new opioid use decreased significantly across all trimesters (1T 20%, 2T 28%, 3T 31%) (Figure 1b). A change in trend indicating a further decrease in new use was identified in 1T and 2T in late 2012 and early 2013, respectively. Yearly average discontinuation of opioid use was decreasing early in the study period, but increased significantly among women entering 1T (14% increase in late 2010) and 2T (4% increase in late 2011) (Figure 1c). Yearly average discontinuation decreased by 9% in the 3T, but no change in trend was identified. Opioid use during all trimesters of pregnancy has declined in Tennessee, but remains a common exposure. Our data identify 2010 to 2012 as the years where trends in opioid use changed. Investigation into state and national policies contributing to these changes in trends is warranted.