Opiate use among reproductive-age women is disturbingly high, especially given the documented risks that these drugs pose to a developing fetus. As many women don’t learn of a pregnancy until well into the first trimester, it is questionable whether those in their childbearing years should even be prescribed opiate painkillers. Recent studies have revealed the growing problem of opiate use among reproductive-age women and the groups that are at the highest risk. The data makes it clear that physicians must take a new approach to prescribing opiates to this at-risk population of women.
Opioid Prescription Rates for Women Ages 15-44
A January 2015 study published in Morbidity and Mortality Weekly Report analyzed prescription data for patients on Medicaid versus private insurers. The research limited the data to women between the ages of 15 and 44. The results revealed that over a third (39 percent) of women on Medicaid in their reproductive years filled an opioid prescription each year between 2008 and 2012. Over a quarter (28 percent) of reproductive-age women using private insurance filled an opioid prescription each year. The most common opiate prescriptions filled by women in both of the groups were hydrocodone, codeine and oxycodone. Additionally, opiate use was much higher for women living in the south and was one and a half times higher for Caucasian women than for African American or Hispanic women.
Theories for the higher opiate use rate among Medicaid patients include the difference in underlying health conditions between the two populations, access to different health care facilities and different drug coverage under each insurance plan.
Opioid Risks to a Developing Fetus and Mother
Taking opiates during early pregnancy has been shown to cause a high risk of birth defects and serious complications for both the mother and the developing fetus. Documented studies have shown a clear correlation between opiate use and neural tube defects of a fetus’ brain and spine, congenital heart defects and gastroschisis. There is also a risk of neonatal abstinence syndrome causing newborns to go through opiate withdrawal immediately following birth.
Of particular concern, is that the study only evaluated prescriptions that were filled and paid for by insurance. It did not include prescriptions that were paid for with cash, prescriptions that went unfilled or illegal opiate use. The likely conclusion is that the number of reproductive-age women using opiates is far higher than the study results indicate.
Changes in Opioid Prescription Methods
Preventing the pregnancy risks associated with opiates requires that medical providers take a comprehensive approach to treating patients rather than an illness-specific approach. Instead of automatically prescribing opiate-based painkillers to relieve pain, physicians must talk with patients about their contraceptive use and family planning methods. Women in their reproductive years should be advised of the high risk of pregnancy complications associated with opiate use. In addition, opiate prescriptions should not be the first course of treatment for patients exhibiting pain symptoms. Responsible prescribing practices for physicians include assessing a patient’s risk for pregnancy before considering prescribing opiates.
Given that approximately a third of all pregnancies in the U.S. are unplanned, the continued prescribing of opiates to reproductive-age women poses a threat not only to the women and fetuses but to society as a whole.
Opioid painkillers widely prescribed among reproductive-age women. Centers for Disease Control and Prevention. Retrieved March 27, 2015.
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