Feasibility and Acceptability of a Mobile Application to Monitor Opioid Use Post-Cesarean Section

Introduction

Opioid misuse and its consequences, including opioid use disorder and overdose, represent a significant public health crisis. In the U.S., over 9.7 million adults misused prescription opioids in 2020, with drug overdose deaths rising to an estimated 93,331, including 69,710 involving opioids. The economic impact is profound, with costs related to opioid overdose, abuse, and dependence estimated at $78.5 billion annually.

Prescription Opioids and Cesarean Section

Postoperative opioid prescription patterns are variable, often leading to excess opioids being dispensed. A notable risk factor for opioid misuse is prescription following surgical procedures, including cesarean sections. Studies have shown that a significant percentage of patients develop new persistent opioid use post-surgery, with cesarean deliveries associated with a 28% increased risk of chronic opioid use.

Technology-Based Health Interventions

With the widespread ownership of smartphones, technology-based health interventions are increasingly common. Smart applications have been utilized for various health-related purposes, including the management of substance use disorders and chronic conditions. A pilot study demonstrated the feasibility of using a mobile application to track pain, with patients finding the app easy to use and willing to continue its use post-study.

The Present Study

This study introduces a smart application, CPMRx, designed to monitor opioid consumption and pain scores post-cesarean section accurately. The application aims to promote behavior modification through psychoeducation and gamification. The study's objectives include assessing the feasibility and acceptability of the mobile application among patients and clinicians and evaluating postoperative opioid use and misuse patterns.

Methods

Participants were recruited from an inner-city academic hospital, focusing on women undergoing scheduled repeat cesarean sections. The study utilized a smart pill pack and the CPMRx app to monitor medication consumption and pain scores. Data on acceptability and feasibility were collected through patient assessments and the mobile application.

Results

The study found the CPMRx mobile application feasible and acceptable, with participants reporting ease of use and minimal time investment. However, it also highlighted significant variability in opioid use post-cesarean section, with a majority of patients not using the entire opioid prescription. The study identified instances of opioid misuse, underscoring the need for more precise prescribing practices and patient education.

Discussion

The findings suggest that the CPMRx application could be scaled up for broader use, offering a tool for better-informed clinical decisions regarding postoperative pain management. The study also points to the necessity of addressing excess opioid prescriptions and misuse, advocating for a reevaluation of postoperative pain management strategies to prevent opioid diversion and misuse.

Conclusion

The CPMRx mobile application represents a promising approach to monitoring and managing opioid use post-cesarean section. Future research should focus on larger randomized controlled trials to further evaluate the application's effectiveness in modifying behavior and improving medication adherence, aiming for precision medicine in prescribing practices to mitigate the risks associated with opioid use.