COMMENTARY

Opioid Medication Prescribing to Women of Reproductive Age

Jennifer N. Lind, PharmD, MPH

Disclosures

January 23, 2015

Editorial Collaboration

Medscape &

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I'm Dr Jennifer Lind, a pharmacist and epidemiologist with the CDC's National Center on Birth Defects and Developmental Disabilities. Thank you for watching this CDC Expert Video Commentary on Medscape, which highlights findings from a new study published in the Morbidity and Mortality Weekly Report.[1] This study examined outpatient opioid prescription claims from a sample of reproductive-aged women with public or private insurance in the United States.

Opioids are potent narcotic medications commonly prescribed by healthcare providers to treat a variety of different types of pain. We estimated that, in 2012, more than 1 in 3 Medicaid-insured reproductive-aged women and more than 1 in 4 commercially insured reproductive-aged women filled a prescription for an opioid-containing medication. Furthermore, from 2008 through 2012, the frequency of opioid prescription claims was consistently higher among Medicaid-insured women than commercially insured women. The most commonly prescribed opioids among women of reproductive age with either insurance type were hydrocodone, codeine, and oxycodone.

These findings are important because the estimates provide a sentinel for typical exposure among women in early pregnancy. More than half of all pregnancies in the United States are unplanned, and many women are not aware of their pregnancies until late in the first trimester, a critical period for organ development.

We do not fully understand the effects of opioid medications on a developing baby, but research suggests that taking these medications during pregnancy can increase the risk for adverse perinatal outcomes. Most providers are aware of the risk for neonatal abstinence syndrome that can result from maternal opioid use during pregnancy. Studies have also found that opioid use during pregnancy is associated with reductions in birth weight and increased risk for preterm birth, sudden infant death syndrome, and some major birth defects such as congenital heart defects, neural tube defects, and gastroschisis.

Given the fetal risks associated with prenatal opioid exposure, it is important that all healthcare providers, including physicians, physician assistants, nurse practitioners, dentists, and pharmacists, discuss the potential for adverse pregnancy outcomes when prescribing and dispensing opioid-containing medications to reproductive-aged women who could become pregnant.

In addition, here are some specific things that healthcare providers can do when treating pain in women of reproductive age:

First, avoid using opioids as first-line therapy. Explore all treatment options before considering opioids and only use opioids after other treatments have proven ineffective. Second, be careful about duration; prescribe and dispense opioid medications for the shortest duration possible. Third, prescribe the lowest effective dose, being sure to carefully monitor pain and treatment progress. And fourth, discuss effective contraception with women who are sexually active to reduce their risk of becoming pregnant while taking opioid medications.

If a woman becomes pregnant while taking an opioid, the pharmacist and patient should alert the provider immediately, and the potential risks vs benefits of continuing the opioid medication or considering other treatment options should be discussed.

Please suggest that your patients visit Treating for Two for more information. Thank you.

Web Resources for Patients

CDC: Treating for Two

CDC: Birth Defects

FDA: For Women

Jennifer N. Lind, PharmD, MPH, is a pharmacist and epidemiologist with the CDC's National Center on Birth Defects and Developmental Disabilities. Dr Lind received her Doctor of Pharmacy degree from Florida A&M University in 2007 and Master of Public Health from Georgia State University in 2012. After receiving her MPH, she completed a fellowship as an Epidemic Intelligence Service (EIS) officer in CDC's National Center for Chronic Disease Prevention and Health Promotion. Dr Lind is currently a Lieutenant in the United States Public Health Service, where her work focuses on safer medication use during pregnancy and researching the prevention and control of risk factors for birth defects. Her general interests include maternal and child health epidemiologic research and pharmacoepidemiology.

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