COMMENTARY

Opioid Prescribing Practices of Ob/Gyns

Room for Improvement

Andrew M. Kaunitz, MD

Disclosures

January 11, 2018

Hello. I am Andrew Kaunitz, professor and associate chair in the Department of Obstetrics and Gynecology at the University of Florida College of Medicine in Jacksonville.

More than two million Americans have a prescription opioid use disorder, and more than half of these individuals report obtaining pain medicines through diversion of prescribed medications.

In 2016, researchers used a survey to query American College of Obstetricians and Gynecologists (ACOG) fellows about four approaches suggested by the College when prescribing pain medications to ambulatory patients, including those being discharged from the hospital:

  • Screening all patients for opioid dependence;

  • Prescribing the fewest number of pills appropriate for the patient's condition;

  • Tailoring opioid prescriptions to the individual patient’s needs; and

  • Counseling patients regarding proper use, storage, and disposal of opioids.

Fewer than 1 in 5 respondents indicated that they adhered to at least three of these recommendations.

Almost all respondents indicated that following laparotomy performed for hysterectomy or cesarean birth, they normally prescribed opioids for outpatient postoperative pain management. In contrast, only 1 in 5 reported typically prescribing such medications after vaginal delivery.

Respondents reported prescribing a median of 30 opioid tablets after laparotomies and 25 after minimally invasive hysterectomy. Finally, fewer than one quarter of respondents were aware that most individuals who misuse pain medications obtain them from family or friends.[1]

Although we often prescribe a standard number of pills to ensure adequate pain control, a recent study noted that only half of opioids prescribed after cesarean birth were consumed, allowing the possibility of abuse and diversion.[2]

I learned a lot from reading this survey, which underscores the need for more education among resident and practicing obstetrician/gynecologists about the prescription of opioids.

Thank you for the honor of your time, and wishing you a healthy and productive new year. I am Andrew Kaunitz.

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