Postpartum Opioid Use Among Military Health System Beneficiaries: Lessons for the Nation [19R

Abstract

INTRODUCTION: The opioid epidemic in the US has been given much attention in recent years. The most common source of prescription opioids, among people who misuse them, is through family or friends, implicating that healthcare providers are likely overprescribing. METHODS: We evaluated postpartum opioid prescriptions at discharge among patients insured by TRICARE using the Military Health System Data Repository. The primary outcome compared the prevalence of opioid prescription at discharge for postpartum patients within civilian purchased care and direct military treatment facilities. Secondary outcomes investigated mode of delivery and demographics for those receiving opioid prescriptions. We included women age 15-49 years old insured by TRICARE between 2010-2015 with a pregnancy-related postpartum discharge diagnosis. We excluded abortive pregnancy outcomes and incomplete data sets. We extracted data using ICD-9 and CPT codes, and performed logistic regression using SAS 9.4. RESULTS: Postpartum patients receiving civilian purchased care were more likely to be discharged with an opioid prescription compared to direct care (OR 3.9, 95% CI 3.8-3.99). Asian race was least likely to receive an opioid prescription postpartum (OR 0.79, 95% CI 0.75-0.83). Age 15-19 had a lower odds of opioid prescription at discharge. CONCLUSION: Our data indicates that women who are cared for in civilian facilities were more likely to be prescribed an opioid at time of discharge when compared to military facilities. Factors such as race and age were also associated with opioid prescribing practices. OB/GYNs may be overprescribing opioids postpartum, and this study highlights areas for improvement.