Standard vs Customized Post-Cesarean Opioid Prescription: A Randomized Controlled Trial to Reduce Unused Opioids [39H]

INTRODUCTION: Most women have unused opioids after cesarean, a source of opioid misuse and diversion. This study examined whether customized prescribing can reduce unused opioids after cesarean. METHODS: Between 6/14/2017 and 8/25/2017, all English- and Spanish-speaking women >18 years undergoing a cesarean were considered for eligibility. Women with complicated cesarean or chronic opioid use were excluded. Eligible women were approached postoperative day 1 and informed consent was obtained. Enrolled women were randomized to standard post-discharge opioid prescription (30 tablets of 5mg oxycodone) or customized prescription (formula derived from a prior study, and based on inpatient opioid use). Subjects were contacted on postoperative day 14 to assess opioid tablets used and pain. The Tennessee Controlled Substance Monitoring Database was accessed to confirm dispensed opioids. The primary outcome was unused opioid tablets. RESULTS: Of 323 cesarean deliveries, 34 declined participation and 99 were excluded, leaving 190 (84%) for randomization. Of 172 in final analysis (18, 9.5% lost to follow-up), the proportions reporting unused opioids were 65/87 (74.7%) in customized group, 60/85 (70.6%) in standard group (p=0.74). The customized prescription group received half the opioid tablets (14 [IQR 12-16]) compared to standard group (30), used less opioids (8 [IQR 4-14] vs 15 [IQR 6-30], p<0.001), and had less unused (5 [IQR 1-8] vs 10 [IQR 0-22], p<0.001) tablets. Reported pain outcomes and analgesic satisfaction with analgesia were not statistically significant. CONCLUSION: Customized opioid prescribing was associated with reduced opioid use and fewer unused opioids after cesarean, without affecting pain management.