How Reliable Is a Statewide Prescription Monitoring Program for Identifying Post-Cesarean Opioid Use?

Objective  This study was aimed to estimate the percentage of women taking opioids post-cesarean who could be detected in a state prescription monitoring program (PMP) and characteristics of those not able to be detected. Study Design  This observational cohort study included all women with an Illinois address who delivered via cesarean section and used opioids within 24 hours prior to discharge at a tertiary care hospital between August 21, 2017 and March 1, 2018. The Illinois PMP was queried for presence of an opioid prescription filled within the first 3 months postpartum. Sociodemographic and clinical factors associated with an undetectable PMP record were evaluated in bivariable and multivariable logistic regression analyses. Results  A total of 517 women underwent a cesarean delivery during the study period, of whom 344 (66.5%) met inclusion criteria. Of these women, 169 (49%) did not have a detectable PMP record of filling any outpatient postpartum prescription opioid. On bivariable and multivariable logistic regression analysis, year of delivery (2018 vs. 2017) was significantly associated with a higher incidence of detectable postpartum prescription opioid record in the PMP with increasing relative risk of detectable records in the second year of analyses ( n  = 110/244 [45%] in 2017 vs. n  = 59/100 [59%] in 2018, adjusted risk ratio [aRR] = 1.32, 95% confidence interval [CI]: 1.06-1.64, p  = 0.013). No other sociodemographic or clinical characteristics was significantly associated. Conclusion  Nearly half of women who underwent a cesarean section and who were administered opioids 24 hours prior to discharge did not have a detectable postpartum opioid prescription in the PMP. While identification of prescription filling improved with time, many of women were not detectable in the PMP system. These data call into question the accuracy of PMPs in identifying prescription opioid filling patterns in the postpartum setting.