Opioids after a cesarean section: Prescribing, patient use, storage, and disposal practices

Cesarean sections (C-sections) are commonly performed procedures, accounting for approximately one-third of births in the United States. This is often one of the first medical encounters for women which require prescription medications to manage post-operative pain. Our observational study looked at opioids prescribed and consumed for post-surgical C-section pain. We interviewed patients to examine handling practices of those who had excess opioids, including storage and disposal. Patients underwent a C-section at Duke University Health System from January 2017 through July 2018 and were pre-scribed opioids post-operatively. In this study, we observed 154 women who met inclusion criteria. Sixty women declined participation, and 15 could not recall the details of their opioid use. Of the 77 women who participated, most (97 percent) received oxycodone 5 mg tablets. About one-third of the women did not use any opioids, about one-third used all of their opioids, and the remainder used only a fraction of the pills prescribed. After sharing preliminary results with providers, they began prescribing fewer pills. Even then, only a fraction or none of the pills were used, and patients rarely required a renewal of pain prescriptions. We found only 1 percent of women stored their opioids in a secure location. These findings suggest an individualized approach to opioid prescribing along with nonopioid analgesics use may mitigate the consequences of excess opioid prescribing, which include lack of proper disposal and excess opioids in the community.