611 W. Union Street
Benson, AZ 85602
(520) 586-0800

Health Choice Integrated Care crisis Line
1-877-756-4090

NurseWise 24-Hour Crisis Line
1-866-495-6735

NAZCARE Warm Line
1-888-404-5530



SEABHS
611 W. Union Street
Benson, AZ 85602
(520) 586-0800

NurseWise 24-Hr Crisis Line
1-866-495-6735

NAZCARE Warm Line
1-888-404-5530


powered by centersite dot net

Getting Started
Here are some forms to get started. These can be printed and brought with you so that you can pre-fill out some known info ahead of time. More...


Pain Management
Resources
Basic InformationLatest News
Kids Still Getting Risky Painkiller After TonsillectomyPatients Use ~Half of Opioids Prescribed After HysterectomyIn ER, Combination of Ibuprofen, Acetaminophen Relieves PainOpioids Not the Only Answer for Pain Relief in the ERASA: Opioid-Free Anesthesia Feasible for Surgical ProceduresSkip Opioid Treatment for Migraine in the ERAround the World, Too Little Relief for PainPost-Op Opioids: How Much Is Enough?ERs Prescribing Opioids at Lower Doses, Shorter DurationsBig Rise in Hospitalized Kids With Opioid Side EffectsMost Opioid Use Concentrated in Top 10 Percent of UsersCommon Painkillers May Boost Blood Pressure in Arthritis PatientsMany Migraine Sufferers Given Unecessary Opioids, Study FindsSleep, Caffeine Use May Play Role in Post-Op PainLonger Prescriptions Make Opioid Abuse More Likely: StudyMany Prescribed Opioids Even After OverdoseReview: Cannabis May Alleviate Neuropathic PainOpioid Prescription Rates Higher in Cancer SurvivorsDoctors May Be Over-Prescribing Seizure Drugs to Treat Pain2 of 3 U.S. Patients Keep Unused Painkillers After SurgeryDoctors Still Overprescribing Opioids in U.S.Reduction of Opioid Dose May Improve Pain, Quality of LifeEasing Opioid Dose May Improve Pain and Quality of LifeAt-Risk Pain Patients Can Cut Opioid Use With Psychology ToolsHalf of Opioid Prescriptions Go to People With Mental IllnessNerve Zap Unlikely to Ease Low Back PainReaching Beyond the Prescription Pad to Treat PainRx Changes, Counseling, Regular Visits Can Cut Opioid Deaths3 Simple Steps Might Reduce Opioid OD DeathsWhen Is an Opioid Safe to Take?Patient-Controlled Analgesia Reduces Pain at Higher CostYoga Soothes Back Pain in StudyAcupuncture May Be Effective Painkiller in the ERFDA Asks Maker of Opioid Painkiller Opana ER to Pull Drug From MarketOpioids Over-Prescribed After C-Sections: StudiesPersistent Pain May Lead to Memory Troubles1 in 5 Weight-Loss Surgery Patients Using Opioids Years LaterTaking Opioids Before Knee Surgery Could Raise Pain LaterERs May Need to Rethink Opioid Prescription PracticesCommon Painkillers Tied to Slight Rise in Heart Attack RiskOpioid Use by Iraq, Afghanistan War Vets Mirrors Rest of U.S.: Study'Mindfulness' Probably Won't Cure Your Back Pain: StudyExpectations, Concerns Vary With Age for Adults at Pain ClinicMusic May Soothe the 'Savage Beast' of Post-Op PainThis Fanged Fish Might Someday Help Ease Your PainSteroid Shots Offer No Long-Term Relief for Low-Back PainInitial Rx Can Affect Likelihood of Long-Term Opioid UseOpioid Dependence Can Start in Just a Few DaysOpioid Painkillers and Xanax or Valium a Deadly Mix: StudyDiazepam Not Beneficial for Acute Low Back Pain in ER
Questions and AnswersLinksBook Reviews
Related Topics

Depression: Depression & Related Conditions
Medical Disorders
Mental Disorders

Opioids Over-Prescribed After C-Sections: Studies

HealthDay News
by By Carole Tanzer Miller
HealthDay Reporter
Updated: Jun 9th 2017

new article illustration

THURSDAY, June 8, 2017 (HealthDay News) -- Women are routinely prescribed more opioid painkillers than they need after Cesarean sections, creating a high risk for misuse, a trio of new studies suggests.

C-sections are the most common inpatient surgery in the United States, with 1.3 million procedures performed a year, according to the researchers. But there is little data on how much medicine patients actually need to manage their pain. To that end, how many pills are prescribed varies from provider to provider, the researchers added.

More care is needed to limit the amount of leftover drugs that could wind up in the wrong hands, the studies concluded. Most people who use opioids for nonmedical reasons get them from friends and relatives who have unused medication. And patients may not lock their leftovers away, putting young children at risk.

"We are the source of these excess opioids, and we need to do more to restrain that, but we really need to tailor that so the individual gets what they need. Our take-home point is we don't want one-size-fits-all prescribing," said Dr. Sarah Osmundson, who led one of the three studies. She's an assistant professor of maternal-fetal medicine at Vanderbilt University in Nashville.

Addiction to prescription opioids such as oxycodone (Oxycontin, Percocet) and hydrocodone (Vicoprofen) is a growing epidemic in the United States. The number of opioid overdose deaths has quadrupled in the past 15 years, according to one of the studies.

Though women are unlikely to get hooked on opioids after a C-section, an addiction expert said non-opioid pain relief should always be the first treatment of choice.

"We need to be conscious of what the consequences of routine opioid prescribing are -- not just for the patient but for anyone who might encounter her medicine cabinet," said Dr. Mishka Terplan. He's a member of the American Congress of Obstetricians and Gynecologists' Opioid and Addiction Medicine Work Group.

The largest of the three new studies -- by researchers at Brigham and Women's Hospital and Harvard Medical School in Boston -- involved 720 C-section patients at six U.S. medical centers. About 85 percent filled an opioid prescription when they left the hospital.

The study found women were prescribed roughly twice as many pills as they used. On average, each had 15 left over. With 1.3 million C-sections a year in the United States, that's an estimated 20 million opioids that could be diverted and misused.

The researchers found no difference in pain scores when they compared women by number of pills prescribed. But women who were prescribed more pills wound up using more pills, according to the study.

"This was especially interesting to us, because it suggests that we are setting patient expectations based on the number of pills that we prescribed," corresponding author Dr. Brian Bateman said in a hospital news release. Bateman is chief of obstetric anesthesia at Brigham and Women's.

The studies suggest that the remedy isn't as simple as dispensing fewer pills.

In the second study, Osmundson's team urged providers to peg quantity to how much pain medicine women actually use in the hospital -- more pills for those who need more pain relief as hospital patients, fewer for others.

Of the 179 C-section patients they studied, 165 were prescribed an opioid. Doses ranged from eight to 84 pills, with nurse-midwives prescribing fewer than doctors.

More than three-quarters of the patients had pills left over, and only seven women threw them away. Most kept leftovers in an unlocked cabinet, according to the study.

The findings suggest counseling patients is key.

Osmundson said women should be reminded to use opioids only when they really need them, to taper off as soon as they can and to dispose of leftovers properly. Unused pills can be mixed with coffee grounds or kitty litter and tossed in the trash or taken to an approved drug disposal site, she said. Some medical practices also dispose of them.

Terplan, associate director of addiction medicine at Virginia Commonwealth University in Richmond, said patients have a responsibility to ask questions and be sure they understand their treatment.

Convenience may be one reason for the opioid over prescriptions, he said.

A patient who needs more opioid painkillers has to get a written prescription -- a trip to the doctor that may be burdensome for a new mom who is recovering from surgery and caring for a newborn. So providers try to make sure she has enough.

So, what's the prescription for over-prescription?

A third study investigated a novel approach that reduced opioid use after C-sections by 50 percent.

It centered on a 10-minute meeting where a clinician spoke about post-operative pain and opioids while patients viewed a presentation on a tablet computer. Women were told how much pain to expect, risks and benefits of opioid and non-opioid painkillers, how to get refills and how to safely dispose of leftovers.

Then, patients chose how many 5-milligram oxycodone tablets to receive at discharge, up to the hospital's typical 40. The median number of pills they chose was 20. The average number of pills left over was four.

Nine out of 10 participants said they were satisfied or very satisfied with their pain management, and nearly as many called the shared decision-making helpful, according to the study.

"This is the path forward, I think," Terplan said. "It's not saying everybody gets 90 Oxycontins or seven Oxycontins, it's actually involving the patient in her own decision-making."

The studies were published online June 8 in the journal Obstetrics & Gynecology.

More information

The American Medicine Chest Challenge lists places across the United States where you can safely dispose of unused prescription drugs.