Procedural abortion in individuals with opioid dependence: Patient characteristics and pain experience

To describe the prevalence and characteristics of individuals with opioid-dependence who have procedural abortions, and to compare their experience of procedural pain to individuals without opioid-dependence.

Cross-sectional study of procedural abortion patients at a high-volume ambulatory abortion practice. We offered an anonymous survey to all procedural abortion patients which included medical and demographic information, assessment of opioid dependence with the Rapid Opioid Dependence Screen (RODS), measurement of procedural pain, and satisfaction with pain control.

We approached 1888 individuals, 1553 (82%) completed the survey and 1525 were included in analysis. Eighty-eight participants screened positive for opioid-dependence (5.9%). Opioid-dependent participants were older, more likely to use other drugs, pay for abortion with insurance, report chronic pain, disability, anxiety, depression, prior abortion, and more frequently presented at 15+ weeks. Opioid-dependent patients reported higher mean pain scores (35 vs. 22.5, p = 0.002), with a mean difference of 7.73 in logistic regression analysis accounting for relevant demographic and medical characteristics (p = 0.041). No interaction was seen between opioid-dependence and effect of intravenous (IV) moderate sedation, with reduction in mean pain scores of 13.76 points in opioid-dependent patients versus 14.54 among those without (p = 0.937). The odds unacceptable pain control did not differ between opioid-dependent and non-dependent individuals (OR 1.73, p = 0.18).

Procedural abortion patients with opioid-dependence differ from those without along several reproductive and demographic factors. They have higher mean pain scores but similar improvement in pain with IV moderate sedation. Satisfaction with pain control is similar for patients with and without opioid dependence.

Intravenous moderate sedation is effective in reducing pain in patients with opioid-dependence, despite their overall higher pain scores. It should not be restricted in these patients due to concerns for ineffectiveness as it may be an important factor in improving the abortion experience for these marginalized patients.