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    Study: Prescription habits show ob/gyns not well informed about opioids

    Using a cross-sectional survey of American obstetricians and gynecologists, a group of researchers examined the opioid prescribing habits of the specialty and found that ob/gyns need to become better informed about prescribing the drugs, more aware of misuse, and educate their patients about proper disposal. The study was published in Obstetrics and Gynecology.

    The researchers reached out to 300 American College of Obstetricians and Gynecologists (ACOG) Fellows and Junior Fellows who are part of the Collaborative Ambulatory Research Network. Of the 300 solicited members, 179 (60%) members responded. The respondents reported prescribing a median of 26 (5-80) pills per patient across all indications. The most common indication was for surgery, of which 98% of the respondents reported prescribing opioids. More specifically, 97% prescribed opioids after abdominal hysterectomy, 94% after cesarean delivery, 89% after laparoscopic hysterectomy, and 86% after vaginal hysterectomy. In regard to nonsurgical indications, 30% of respondents reported prescribing opioids for ovarian cysts, 24% for endometriosis, 22% for pain after vaginal birth, and 18% prescribed for chronic pelvic pain of unknown cause. Overall, physicians were more comfortable prescribing opioids for acute pain than for chronic pain.   

    In regard to the type of opioids that respondents were prescribing, 34% prescribed acetaminophen with hydrocodone, 29% prescribed acetaminophen with oxycodone, 13% prescribed acetaminophen with codeine, 8% prescribed oxycodone, 3% prescribed hydrocodone, and 1% prescribed hydromorphone. The largest number of pills prescribed varied by indication, but the most pills were prescribed after laparotomies for cesarean delivery and abdominal hysterectomy (median, 30; range 8-80). The largest variation in pills prescribed was for chronic endometriosis and pelvic pain of unknown cause (range 9-60 pills).

    Beyond prescribing habits, the researchers also looked at adherence to four practices recommended by state and federal agencies as well as by ACOG. These included: screening for dependence; prescribing the smallest effective dose; tailoring prescriptions; and counseling patients on the risks and benefits of proper use, storage, and disposal of the medication. Of the respondents, 57 (19%) reported adherence to at least three of the recommended practices. Only 22% of respondents said they typically performed an opioid dependence screen and just 17% regularly told patients about proper disposal of unused opioids. The majority of respondents (67%) reported that they usually review inpatient pain medication use and 47% prescribe outpatient opioids based on the level of pain medication a patient required during hospitalization.

    The researchers also said that, according to the responses from the survey, relatively few doctors were well-informed about opioids. They noted that 81% of the respondents did not know that the predominant sources of misused opioids are friends or relatives. Almost half (44%) of the respondents also didn’t know how to properly dispose of unused prescription opioids.

    The authors identified a few limitations to their study. These include recall bias, using a small sample of ACOG members, and the issue of self-reporting. However, the study showed a wide variance in prescribing habits, which highlights the need for continued development and promotion of educational efforts to emphasize the role of the physician in fighting the opioid epidemic.

    NEXT: Does ADHD medication use during pregnancy increase risk of congenital malformations?

     

    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.
    Ben Schwartz
    Ben Schwartz is Associate Editor, Contemporary OB/GYN.

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