Yep, it's Mom's Day! And in honor of all Moms everywhere we cite this new Vanderbilt University Medical Center study which "finds that new mothers who receive opioids after uncomplicated births face an increased risk of serious opioid-related events." That means abuse, addiction and even overdose. The dosage doesn't matter either. Low dose. High dose. In between. Any prescribed size could bring about serious harm. The findings could significantly impact the manner in which doctors handle the pain of childbirth.
The Tennessee Study
The PhD-wielding Andrew Wiese ran lead on the study. He was aided and abetted by Dr. Sarah Osmundson and other researchers in the departments of Biostatistics and Health Policy. EurekAlert! provided the news, which Wiese, assistant professor of Health Policy in Vanderbilt's Division of Pharmacoepidemiology, had published in Women's Health Issues.
The study was seriously extensive. In fact, it examined roughly 147,000 women over a seven year period (2007-2014). All of the women were enrolled in TennCare (Tennessee's Medicaid program). And all of the women gave birth and had received one or fewer opioid prescriptions prior to delivery. The median age was 23 years. Sixty-eight percent were white. And most were from Central and East Tennessee.
Like we said, the new Moms who received an outpatient opioid prescription within four days of childbirth had an increased risk of developing a serious opioid-related event. And again, those events included abuse, addiction and overdose. Or in the jargon of the release, "becoming a persistent opioid user, developing an opioid use disorder (OUD), or experiencing an opioid-related overdose or death."
No matter how you word the findings, they aren't good. Not for Moms. And not for Moms' families either, especially the kids, who risk losing their mothers even before they can say the word "Mom."
Any Dose Will Do -- and Undo
Again. Any dose was enough to produce adverse effects on the new Moms. Low dose. High dose. In between dose. "Even women prescribed less than 100 MME (morphine milligram equivalent) faced a 52% increase compared with those who did not fill a prescription," reads the release. That's "roughly the equivalent of 20 hydrocodone or 13 5mg oxycodone pills" in their first script. In other words, about an average-sized order.
"We generally assume that higher dosages of opioids are associated with a greater risk of negative outcomes," Wiese said. "But we wanted to answer the question of whether low-dose prescriptions were completely safe. And it turns out even low dose prescriptions harbor some increased risk of bad outcomes."
Very bad outcomes. The release does go on to say that "the absolute risk of these outcomes in the first year after birth is relatively rare, given the large number of annual births." But increased risk is increased risk. Proportionate or not. When the issue is opioids, it's probably not worth the increased risk. After all, they were the dominant contributor to last year's 87,000 drug overdose deaths.
One more thing. This research also shows that "many of these negative events occur after the traditional 42-day postpartum period." [emphasis added] So postpartum depression can't be blamed for the increase either.
Thankfully the good Doctor Wiese said these findings could very well affect how clinicians consider prescribing opioids in the future. They'll especially impact those in obstetrics and gynecology. And though Dr. Wiese also said they're still unclear about just what or how best practices can be established, the fact that he and his team are on the case bodes well for everyone.
"Our observation that no 'safe' opioid dose exists does raise some serious concern," he said, "and really should force researchers and clinical providers to take a hard look at what our routine opioid prescribing practices for uncomplicated births are, even at low doses, in Tennessee and beyond."
Saluting Those Who Consider Our Moms
Recovery Boot Camp salutes Dr. Andrew Wiese, Dr. Sarah Osmundson and the entire Vanderbilt University Medical Center team. That includes Ed Mitchel MS; Margaret Adgent, PhD, MSPH; Sharon Phillips, MSPH; Stephen Patrick, MD, MPH, MS; Arlyn Horn, PharmD, MPH; Lauren Samuels, PhD; Marie Griffin, MD, MPH; and Carlos Grijalva, MD, MPH. We also salute the good folks at both the National Institutes of Health (NIH) and the National Institute on Drug Abuse (NIDA) for supporting the research.
Again, the more good folks like these take long, hard looks into the manner in which opioids are prescribed, the less likely we'll see more people suffering the drug's wrath. It's especially important for us to be cognizant of opioids' often disastrous effects on new Moms. After all, they've just added a bright light into our world; it's only fair they're given a chance to further illuminate the future. Theirs and ours.