# Postpartum Opioid Use in the United States and the Implications to Maternal and Public Health: A Scoping Review

## TL;DR

This review explores high postpartum opioid use in the U.S., its health risks, and interventions to reduce it, including a proposed pain task force protocol.

## Contribution

The paper introduces the postpartum pain task force protocol (PPTFP) as a novel approach to reduce opioid use after childbirth.

## Key findings

- Postpartum opioid prescription rates remain high despite successful reduction efforts.
- Interventions like PPTFP may reduce opioid use while managing pain expectations effectively.
- Opioid use postpartum increases risks of misuse, addiction, and community diversion.

## Abstract

Postpartum opioid prescription rates remain high, leading to increased morbidity and mortality and increased licit opioid medications diverted into communities. This scoping analysis examined the current processes of postpartum opioid prescribing patterns in America and the implications to maternal and public health.

From the databases PubMed, Medline, and Web of Science, a scoping review was performed utilizing the PRISMA-ScR checklist (Tricco et al. in Ann Intern Med 169(7):467–473, 2018, 10.7326/M18-0850). The primary objective of the search strategy was to identify studies that focused on the postpartum timeframe (obstetric delivery to one year postpartum) and prescribed opioids.

A total of 26 articles met inclusion criteria. Articles were broken down into four themes: trends or current state of postpartum opioid prescribing practices (n = 7); postpartum opioid related risk factors (n = 6); rates of new persistent opioid use and opioid use disorder (OUD; n = 5); protocols or research into reducing postpartum opioid use (n = 8).

A variety of interventions and protocols have been found to be advantageous in reducing postpartum opioid use. Despite many of these successful efforts, postpartum opioid prescription rates remain high. Implementation of any number of interventions and protocols may be beneficial to reducing postpartum opioid use. Initiating a postpartum pain task force protocol (PPTFP) before obstetric delivery is recommended.

Postpartum is characterized by substantial opioid use. Despite successful efforts to reduce postpartum opioid use, rates remain high, increasing likelihood of breakthrough pain, new persistent opioid use & OUD, harms related to opioid use, and opioid diversion. Escalation contributes to higher levels of prescribed opioids used nonmedically in communities.

To our knowledge, no study has utilized PPTFP and examined effects on opioid prescribing, and use, postpartum. This review found utilization of multiple interventions, including PPTFP, may significantly reduce postpartum opioid use while keeping patient pain expectation levels appropriate using functionality scales (e.g., ability to lift baby, ease of gentle movement).