Concurrent Prescription Fills of Opioids and Benzodiazepines Among Postpartum Women During COVID-19.

Introduction: Concurrent prescribing of opioids and benzodiazepines is associated with increased risk of emergency department visits and overdose. Postpartum women commonly receive opioids for pain after delivery and are at risk for postpartum depression/anxiety. Although prior research finds increases in opioid prescribing and symptoms of depression/anxiety during COVID-19, concurrent prescribing among postpartum women has not been examined in the context of COVID-19. Methods: Using data from a large sample of privately insured postpartum women (N=514,120), the authors compared concurrent prescription fills of opioids and benzodiazepines before March 1, 2020, and after March 1, 2020. Primary outcome variables measured whether a patient ever filled concurrent opioid and benzodiazepine prescriptions and the number of concurrent prescription fills per patient in the 6 months after delivery. Results: Roughly 46.4% of postpartum women filled an opioid prescription, 2.4% filled a benzodiazepine prescription, and 1.2% of women filled a concurrent prescription. Among postpartum women filling a benzodiazepine prescription, 50.7% filled a concurrent opioid prescription. The number of concurrent fills among postpartum women significantly increased during the early period of COVID-19. On average, postpartum women filled 0.009 more concurrent prescriptions than expected on the basis of the preexisting trend, representing a 22.0% increase in the number of concurrent prescriptions relative to the sample mean. Conclusions: Concurrent prescribing of opioids and benzodiazepines places postpartum women at higher risk of emergency department visits and overdose. To reduce the harms associated with concurrent prescribing, clinicians should carefully consider whether opioids and/or benzodiazepines are clinically necessary for treatment and consult their state prescription drug monitoring program prior to prescribing these medications.

State Variation in U.S. Medical Cannabis Limits, Restrictions, and Therapeutic Cannabis Dosing.

Wide variation exists in the possession limits of cannabis products sold for medical use in the U.S. as well as the tetrahydrocannabinol (THC) content of cannabis products. Prior work has found that legal limits on recreational cannabis sold per transaction may promote moderate use and diversion. This paper finds similar results for monthly medical cannabis limits. In the present analyses, state limits on medical cannabis were aggregated and converted into 30-day limits and 5 milligram (mg) THC doses. Grams of pure THC were calculated using plant weight limits and medical cannabis median THC potency aggregated from Colorado and Washington state medical cannabis retail sales data. Weight in pure THC was then broken down into 5 mg doses. Weight-based possession limits of cannabis for medical use varied widely across states (range: 1.5-762.05 grams pure THC per 30 days), with three states lacking a quantifiable weight limit (in which limits are not by weight but by physician's recommendation). States generally do not impose limits on the potency of cannabis products, therefore small differences in weight limits can result in large differences in the amount of total THC allowed to be sold. Assuming a typical medical dose of 5 mg and the median THC potency of 21%, current laws allow for sales of 300 (Iowa) to 152,410 (Maine) doses per month. Current state statutes and methods of cannabis recommendation allow patients to increase therapeutic THC doses independently, and perhaps unknowingly. High THC content products combined with the higher purchase or possession limits allowed by medical cannabis laws may lead to an increased potential for overconsumption or diversion.

Comparison of Postpartum Opioid Prescriptions Before vs During the COVID-19 Pandemic.

Importance: The COVID-19 pandemic substantially disrupted routine health care and exacerbated existing barriers to health care access. Although postpartum women frequently experience pain that interferes with activities of daily living, which is often successfully treated with prescription opioid analgesics, they are also at high risk for opioid misuse. Objective: To compare postpartum opioid prescription fills after the onset of the COVID-19 pandemic in March 2020 with fills before the pandemic. Design, Setting, and Participants: In this cross-sectional study of 460 371 privately insured postpartum women who delivered a singleton live newborn between July 1, 2018, and December 31, 2020, postpartum opioid fills before March 1, 2020, were compared with fills after March 1, 2020. Statistical analysis was performed from December 1, 2021, to September 15, 2022. Exposure: COVID-19 pandemic onset in March 2020. Main Outcomes and Measures: The main outcome was postpartum opioid fills, defined as patient fills of opioid prescriptions during the 6 months after birth. Opioid prescriptions were explored in terms of 5 measures: mean number of fills per person, mean filled morphine milligram equivalents (MMEs) per day, mean days supplied, percentage of patients filling a prescription for a schedule II opioid, and percentage of patients filling a prescription for a schedule III or higher opioid. Results: Among 460 371 postpartum women (mean [SD] age at delivery, 29.0 [10.8] years), those who gave birth to a single, live newborn after March 2020 were 2.8 percentage points more likely to fill an opioid prescription than expected based on the preexisting trend (forecasted, 35.0% [95% CI, 34.0%-35.9%]; actual, 37.8% [95% CI, 36.8%-38.7%]). The COVID-19 period was also associated with an increase in MMEs per day (forecasted mean [SD], 34.1 [2.0] [95% CI, 33.6-34.7]; actual mean [SD], 35.8 [1.8] [95% CI, 35.3-36.3]), number of opioid fills per patient (forecasted, 0.49 [95% CI, 0.48-0.51]; actual, 0.54 [95% CI, 0.51-0.55]), and percentage of patients filling a schedule II opioid prescription (forecasted, 28.7% [95% CI, 27.9%-29.6%]; actual, 31.5% [95% CI, 30.6%-32.3%]). There was no significant association with days' suppy of opioids per prescription or percentage of patients filling a prescription for a schedule III or higher opioid. Results stratified by delivery modality showed that the observed increases were larger for patients who delivered by cesarean birth than those delivering vaginally. Conclusions and Relevance: This cross-sectional study suggests that the onset of the COVID-19 pandemic was associated with significant increases in postpartum opioid fills. Increases in opioid prescriptions may be associated with increased risk of opioid misuse, opioid use disorder, and opioid-related overdose among postpartum women.