RT Journal Article SR Electronic T1 Opt-in versus universal codeine provision for medical abortion up to 10 weeks of gestation at British Pregnancy Advisory Service: a cross-sectional evaluation JF BMJ Sexual & Reproductive Health JO BMJ Sex Reprod Health FD British Medical Journal Publishing Group SP 114 OP 121 DO 10.1136/bmjsrh-2023-201893 VO 50 IS 2 A1 Taghinejadi, Neda A1 McCulloch, Hannah A1 Krassowski, Michał A1 McInnes-Dean, Amelia A1 Whitehouse, Katherine C A1 Lohr, Patricia A YR 2024 UL http://jfprhc.bmj.com/content/50/2/114.abstract AB Objective To assess patient experiences of pain management during medical abortion up to 10 weeks’ gestation with opt-in versus universal codeine provision.Methods We invited patients who underwent medical abortion up to 10 weeks of gestation to participate in an online, anonymous, English-language survey from November 2021 to March 2022. We performed ordinal regression analyses to compare satisfaction with pain management (5-point Likert scale) and maximum abortion pain score (11-point numerical rating scale) in the opt-in versus universal codeine provision groups.Results Of 11 906 patients invited to participate, 1625 (13.6%) completed the survey. Participants reported a mean maximum pain score of 6.8±2.2. A total of 1149 participants (70.7%) reported using codeine for pain management during their abortion. Participants in the opt-in codeine provision group were significantly more likely to be satisfied with their pain management than those in the universal group (aOR 1.48, 95% CI 1.12 to 1.96, p<0.01). Maximum abortion pain scores were lower on average among the opt-in codeine provision group (OR 0.80, 95% CI 0.66 to 0.96, p=0.02); however, this association was not statistically significant in the model adjusted for covariates (aOR 0.85, 95% CI 0.70 to 1.03, p=0.09).Conclusion Our findings suggest that patients have a better experience with pain management during medical abortion when able to opt-in to codeine provision following counselling versus receiving this medication routinely.Data are available upon reasonable request. Data are available upon reasonable request. Requests should be submitted to research@bpas.org for consideration.