Reproductive health and opioids: How real-world evidence reveals patients’ stories
Senior Scientific Analyst, Aetion
Research conducted using real-world data (RWD) in recent years has increased our understanding of the opioid epidemic and potential sources of overprescribing. One subpopulation of timely interest: women of reproductive age.
With deaths from prescription painkiller overdose rising more sharply in women than in men in the last ten years, understanding the greater context surrounding opioid prescribing patterns in this subpopulation gives us more tools with which to tackle this epidemic. Recent research conducted using commercial health insurance claims data has been able to characterize the frequency and dose of opioid dispensing in women following vaginal delivery, following egg retrieval, and in women with endometriosis.
Opioids dispensed following vaginal deliveries
Through the use of a claims dataset, researchers were able to characterize opioid dispensing following 1.3 million vaginal births in the U.S. between 2003 and 2015 with respect to region, patient medical history, and pain-associated characteristics of delivery such as tubal ligation. This study found that, of women without recent opioid use undergoing vaginal delivery, nearly 30 percent were dispensed an opioid in the week following hospital discharge, often in high quantities. Additional pain-associated procedures at the delivery accounted for less than 20 percent of these dispensings, and the median dose dispensed was the same for deliveries with and without pain-associated procedures.
In other words, deliveries involving additional painful procedures were not associated with higher prescribed doses. Given the approximately three million vaginal deliveries occurring each year in the U.S., limiting unnecessary opioid prescription following deliveries could offer substantial public health benefit.
Opioids prescribed for egg retrieval and endometriosis
A related study using claims data reported that among the 12 percent of women who were dispensed opioids following egg retrieval, there was substantial variation in the dose dispensed following this minimally-invasive procedure, indicating a need for better prescribing recommendations. In another subpopulation, recent findings demonstrate an increased risk of chronic opioid use experienced by women with endometriosis, highlighting the need for alternative forms of pain management for this condition.
Studies such as these conducted using RWD give tangible insight into actual opioid dispensing patterns across a wide range of subpopulations, including patient experiences which may be underrepresented in clinical trials. A key step toward untangling the many factors which influence opioid use in women is understanding the diverse range of women’s experiences which may lead to increased risk, and evidence generated from real healthcare encounters is a great place to start.
A key step toward untangling the many factors which influence opioid use in women is understanding the diverse range of women’s experiences which may lead to increased risk.
The use of RWD to characterize patient journeys is applicable across patient populations, and is already laying the groundwork for tangible impact in some sectors. With data generated from their own members, Horizon Healthcare Services has been able to characterize subpopulations of high-risk type 2 diabetes patients to implement interventions and improve treatment pathway effectiveness.
“Our Horizon-specific population may be younger or have a different comorbidity. With real-world data, we can look at our own population to identify high-risk members who would benefit from a specific intervention,” said Saira Jan, director of pharmacy strategy and clinical integration at Horizon.
Understanding every patient’s experience extends lifesaving insight to all patients, not just those for whom clinical trials happen to be appropriate. Women and other groups—racial and ethnic minorities, the LGBTQ community, those with multiple comorbidities, children, and the elderly, to name a few—have historically been left out of the equation when it comes to medical research. Real-world evidence has the potential to help level the playing field when it comes to characterizing the diversity of patient experiences playing out in the “real world” each day.
As highlighted by these claims-based studies, there is opportunity to improve prescribing practices related to procedures uniquely affecting women, which in turn has the potential to mitigate the risk of opioid use disorder specific to this population. In the face of complex problems such as the opioid crisis, research carried out based on actual patient experiences offers substantial potential to tell stories and better understand the many factors influencing our health.