clOUDi 3.0 updates newsletter

October 25, 2023

In the Literature...

Prescription of oxycodone versus codeine after childbirth and risk of persistent opioid use: a population-based cohort study

Background: Oxycodone is increasingly prescribed for postpartum analgesia in lieu of codeine owing to concerns regarding the neonatal safety of codeine during lactation. We examined whether initiation of oxycodone after delivery was associated with an increased risk of persistent opioid use relative to initiation of codeine.

Results: Compared with people who filled a prescription for codeine, receipt of oxycodone was not associated with persistent opioid use. We found an association between a prescription for oxycodone and persistent use after vaginal delivery, but not after cesarean delivery

Patient and Community Factors Affecting Treatment Access for Opioid Use Disorder

OBJECTIVE: To examine whether access to treatment for women with opioid use disorder (OUD) varied by race

and ethnicity, community characteristics, and pregnancy status.

RESULTS: Buprenorphine-waivered prescribers were more likely to be in communities that were more than 50% White, and opioid treatment programs were more likely to be in communities that were less than 50% White. Callers were more likely to be granted appointments in majority Black, Hispanic, Asian, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander communities and at opioid treatment programs and if they were not pregnant.

CONCLUSION: Clinic distribution and likelihood of acceptance for treatment varied by community race and ethnicity distribution. Access to treatment for OUD remains challenging for pregnant people and in many

historically marginalized U.S. communities.

Postpartum Opioid-Related Mortality in Patients With Public Insurance

OBJECTIVE: To assess the incidence and risk factors for postpartum opioid overdose death and describe other causes of postpartum death in individuals with opioid use disorder (OUD).

RESULTS: Individuals with OUD had a sixfold higher incidence of all-cause postpartum death than all individuals. Common causes of death in individuals with OUD were other drug- and alcohol-related deaths (47/100,000), suicide (26/100,000), and other injuries, including accidents and falls (33/100,000). Risk factors strongly associated with postpartum opioid overdose death included mental health and other substance use disorders. Among patients with OUD, postpartum use of medication to treat OUD was associated with 60% lower odds of opioid overdose death.

CONCLUSION: Postpartum individuals with OUD have a high incidence of postpartum opioid overdose death and other preventable deaths, including nonopioid substance-related injuries, accidents, and suicide. Use of medications for OUD is strongly associated with lower opioid-related mortality.

Data Reminders

1. The final Monthly Leadership Report for this initiative is due November 15th
2. clOUDi data collection continues through December - you should be current through September now, if not, please prioritize getting caught up!

Sepsis in Obstetric Care now enrolling teams...

After months of work and multiple virtual meetings by our Sepsis in Obstetric Care Expert Team, we are proud to announce that work is complete (AIM/Mission statement, action plan, key driver diagram, metrics and prework) and we are prepared for launch of our Sepsis in Obstetric Care Initiative in January at our January Kickoff.

What is needed now is you and your hospital and a commitment to address the challenge that is infection in obstetric care.

Maternal death due to sepsis is fortunately relatively low, but it is reported as 11.7% of maternal mortality cases in North Carolina, and it should be lower.

This is our chance!

Please consider and discuss with your perinatal and hospital leaders the opportunity you have to reduce maternal deaths and morbidity from sepsis in your hospital. Join us on this path as we continue the mission to make North Carolina the best place to give birth and be born!

Care of the Late Preterm Infant Initiative now enrolling teams....

In January 2024, PQCNC will be kicking off an initiative to improve the care and outcomes for the late preterm infant population. In 2022, North Carolina saw over 7,500 infants born between 35-36 weeks gestation. This initiative will provide an opportunity to ensure you have an evidence based care pathway for this population as we collectively work to reduce readmissions of these infants.

Over the last few months, the expert team has worked to develop the charter, action plan/driver diagram and data collection elements for this initiative. Please take a moment to review these items as you discuss the opportunity to improve care for these infants.

This is all hands on deck! Every delivery hospital in North Carolina cares for late preterm infants and now is the chance to improve the care that is provided.

Please consider joining us on our journey…..