Over 800,000 abortions occur annually in the United States, the majority of which are surgical abortion procedures. For pain during and after the procedure, current guidelines primarily recommend non-narcotic pain management options including nonsteroidal anti-inflammatory drugs and local anesthetic. Oral opioids are not typically recommended for post-procedural pain management, but real-world patterns of opioid dispensing after surgical abortion in the U.S. have not been well described.
Over three-quarters of patients report having unused opioid supply remaining after any surgical procedure, with fewer than one-third of patients reporting disposal of unused opioids. With limited evidence supporting effectiveness of opioids for pain management after surgical abortion, opioid prescription for surgical abortion post-procedural pain management may represent a source of overprescribing in the U.S.
In a recent publication in Contraception, we collaborated with co-authors from Brigham and Women’s Hospital and Planned Parenthood League of Massachusetts to describe prescription opioid dispensing after surgical abortion using real-world data.
Goal of the study
Our research team aimed to characterize prescription oral opioids dispensed after surgical abortion in the outpatient pharmacy setting, and to assess the association between opioids dispensed after abortion and subsequent chronic opioid use.
Process for the analysis
We used commercial health insurance data from IBM MarketScan’s de-identified medical and pharmacy claims database to identify a cohort of patients with a surgical abortion between 2014 and 2018 in the U.S. Using Aetion Evidence Platform®, we described the frequency of having a filled opioid prescription in the week following the procedure, frequency of refill, dose of dispensed opioids, and predictors of subsequent chronic use.
Key findings from the research
Among over 28,000 commercially insured patients with a surgical abortion, 8.3 percent filled an opioid prescription after the procedure. Patients with a dispensed opioid were more likely to reside outside of the Northeast, have had moderate sedation for the procedure, and have had a history of depression. The median dose of filled prescriptions was 75 morphine milligram equivalents (MME), which is equivalent to 10 tablets of 5mg oxycodone.
Among patients with a dispensed opioid and available follow-up data, 10.0 percent had a refill within six weeks. The median dose of refill prescriptions was 113 MME, which was higher than the median dose of first fill.
To assess chronic opioid use, we looked at the subset of patients with a surgical abortion who had data available for at least one year following the procedure. Patients with an initial opioid fill were more likely to have chronic use over the subsequent year compared to patients without an initial fill (2.1 percent versus 0.4 percent). After adjustment for patient and procedure characteristics, patients with an initial fill had over threefold higher odds of subsequent chronic use than patients without.
What is the impact?
Despite public health efforts to decrease opioid prescribing, these findings suggest opioid prescribing after surgical abortion as a potential source of overprescribing among commercially insured patients in the U.S. As surgical abortion is a minimally-invasive procedure, prescribing opioids for use in this setting may contribute to chronic use. RWE can be a tool to improve understanding of opioid prescribing and dispensing patterns in routine clinical practice—a key source of information in the evolving context of the opioid epidemic.