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In the United States, it's standard practice to prescribe powerful opioid painkillers such as oxycodone (OxyContin and generic) and hydrocodone (Vicodin and generic) to manage discomfort during recovery from a Caesarean section.
According to Marvin M. Lipman, Consumer Reports' chief medical adviser, opioids can be effective for such acute post-surgical pain but must be used with great care.
Three studies recently published in the journal Obstetrics & Gynecology suggest that after a C-section, women may go home from the hospital with far more opioid pills than needed. That's concerning, researchers say.
"These are addictive medications," says Brian Bateman, chief of obstetric anesthesia at Brigham and Women's Hospital in Boston and lead author of two of the three studies. "For some patients, being exposed, even in the setting of appropriate treatment for pain, may precipitate an affinity for the drug that leads to subsequent chronic use and even abuse." In 2015, about 11,000 Americans died of overdoses of prescription opioids, according to the Centers for Disease Control and Prevention.
When Bateman's team surveyed 615 women who had filled opioid prescriptions after a C-section, they found that about 84 percent of the new mothers had leftovers.
Most used only about half of the painkillers they were prescribed. But those who received more pills tended to use more pills. For example, women who were prescribed fewer than 30 pills took only about 15, and women prescribed 40 pills took about 32. (Most prescriptions were for five-milligram painkillers.) This potentially heightens their risk of addiction.
What's also worrisome is that 95 percent of the survey subjects who had leftover pills kept them instead of disposing of them. A second study in Obstetrics & Gynecology, this one from Vanderbilt University, detected a similar pattern. When those researchers looked at opioid use in 179 women who had had C-sections, they found that three-fourths of those who filled prescriptions had leftover pills. The vast majority kept their leftovers, and 63 percent stored them in an unlocked location.
Having opioids in the house increases the likelihood they might be ingested by someone else. "This is leading to excess pills in the community, which are subject to misuse," says Chad Brummett, director of pain research at the University of Michigan Medical School.
A short patient-doctor conversation may be helpful, according to a third study published in Obstetrics & Gynecology. Here, Bateman's team looked at what happened when 50 women who had had a C-section at Massachusetts General Hospital talked with their doctors before discharge about expected pain levels during at-home recovery, how much opioid medication they might need, the drugs' benefits and risks, and more. These women asked for about 50 percent fewer pills than the 40 usually prescribed to C-section patients at that hospital.
If you are considering an opioid during C-section recovery, take these steps:
● Go home with fewer pills. Create a pain-management strategy with your doctor before you have a planned C-section. If it's unplanned, "have a conversation with your doctor before you leave the hospital about managing your pain at home," says Orly Avitzur, Consumer Reports' medical director.
● Take opioids short-term only. According to the CDC, most people can transition to non-opioid painkillers just three days after surgery. Few need to take opioids for more than a week.
● Dispose of extra pills properly. During the time you're using opioids, store them safely, preferably locked away. Afterward, take leftovers to an authorized drug-take-back site. These are often in pharmacies, hospitals and police departments. The Drug Enforcement Administration runs take-back programs twice per year.
● Get the most benefit from over-the-counter drugs. For example, Lipman says, acetaminophen (Tylenol and generic) may be used in tandem with nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB and generic) or naproxen (Aleve and generic) under a doctor's supervision.
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