• Jonathan S Zipursky, Karl Everett, Tara Gomes, J Michael Paterson, Ping Li, Peter C Austin, Muhammad Mamdani, Joel G Ray, and David N Juurlink.
• Department of Medicine (Zipursky), Sunnybrook Health Sciences Centre; Institute of Health Policy, Management, and Evaluation (Zipursky, Gomes, Paterson, Austin, Mamdani, Ray), University of Toronto; ICES Central (Everett, Gomes, Paterson, Li, Austin, Mamdani, Ray, Zipursky); Keenan Research Centre of the Li Ka Shing Knowledge Institute (Gomes, Mamdani), St. Michael's Hospital; Leslie Dan Faculty of Pharmacy (Gomes, Mamdani), University of Toronto; Sunnybrook Research Institute (Austin, Juurlink, Zipursky); Department of Medicine (Ray), St. Michael's Hospital, Toronto, Ont. Jonathan.Zipursky@sunnybrook.ca.
• CMAJ. 2023 Jul 31; 195 (29): E973E983E973-E983.

BackgroundOxycodone 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.MethodsWe conducted a population-based cohort study of people who filled a prescription for either codeine or oxycodone within 7 days of discharge from hospital after delivery between Sept. 1, 2012, and June 30, 2020. The primary outcome was persistent opioid use, defined as 1 or more additional prescriptions for an opioid within 90 days of the first postpartum prescription and 1 or more additional prescriptions in the 91 to 365 days thereafter. We used inverse probability of treatment weighting to assess the risk of persistent postpartum opioid use, comparing people who initiated oxycodone with those who initiated codeine.ResultsOver the 8-year study period, we identified 70 607 people who filled an opioid prescription within 7 days of discharge from hospital: 21 308 (30.2%) received codeine and 49 299 (69.8%) oxycodone. Compared with people who filled a prescription for codeine, receipt of oxycodone was not associated with persistent opioid use (relative risk [RR] 1.04, 95% confidence interval [CI] 0.91-1.20). We found an association between a prescription for oxycodone and persistent use after vaginal delivery (RR 1.63, 95% CI 1.31-2.03), but not after cesarean delivery (RR 0.85, 95% CI 0.73-1.00).InterpretationInitiation of oxycodone (v. codeine) was not associated with an increased risk of persistent opioid use, except after vaginal delivery.© 2023 CMA Impact Inc. or its licensors.

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