Opioid abuse by pregnant and delivering women has been the focus of a state level task force this year hosted by the Department of Behavioral Health and Development Services’ Office of Substance Abuse Services. At an early informational meeting of all stakeholders, two important pieces of information were shared. One is that pregnancy is a time during which addicts will make every effort to abstain from abusing drugs. The other is that mothers will continue to remain drug free after delivering their child if they are given support. One suggestion emanating from a brainstorming session about how to best support these new mothers: don’t prescribe them opioids for 30 days after discharge. That suggestion promoted questions about how often opioids are prescribed and how many days’ supply is “normal” for these prescriptions.
Using the 2013 data from Virginia’s All-Payer Claims Database (APCD), VHHA has mined and mapped the number of opioid prescription claims for obstetric-related services to the county in which they were prescribed. VHHA pulled records on patients in diagnosis-related groups (DRG) for cesarean and vaginal deliveries with or without complications. Paid claims in the database cover those patients with commercial or Medicaid coverage for their delivery. The data do not include self-pay or uninsured patients. The chart labeled Figure 1 illustrates the distribution of total opioid prescription claims related to obstetric services per total days’ supply of the prescription. The chart labeled Figure 2 illustrates a heat map of obstetric-related opioid claims across Virginia. The chart labeled Figure 3 illustrates all 30-day supply prescriptions for opioid claims related to obstetric services. A few trends are evident when the three charts are compared. It appears that opioid prescriptions are given to obstetric patients post-delivery, but that it is not a common occurrence. In Virginia, approximately 30 percent of all births are by cesarean section. This is roughly 27,000 births yearly. According to Figure 1, there were less than 1,900 prescriptions for opioids. Prescribing an opioid upon discharge is not routine even for those with a surgical delivery. It also appears that there is wide variation in pill supply but often pill prescriptions tend to be five days or less. Given the concerns about addiction in rural areas, we then looked at the location of opioid prescriptions filled. Figure 2 shows that the prescriptions occur in all cities and counties. They are more prevalent in urban areas where there are more women of childbearing age. There is no indication in the data that the majority of prescriptions are distributed to patients in Southwest Virginia. Next, we looked at the outliers or pills prescribed for 30 days (Figure 3). Again, we found no pattern except more prescriptions where more deliveries occur. Giving an opioid prescription, based on the data, is not commonplace, though it does happen. On the infrequent occasion when a prescription is written, it is usually for fewer than five days. Why more of the drug is prescribed cannot be determined from this data, but is an issue hospitals with maternity services could investigate. (2/5)