CDC Urges Caution on Opioid Prescribing in Young Women

Megan Brooks

January 22, 2015

Opioid pain medications are widely prescribed among women of childbearing age, which is a "significant public health concern," federal health officials with the Centers for Disease Control and Prevention said today.

A new report published in the January 23 issue of Morbidity and Mortality Weekly Report (MMWR) shows that roughly one fourth of privately insured women aged 15 to 44 years and about one third of their counterparts insured by Medicaid filled a prescription for an opioid each year during 2008 to 2012.

"Taking opioid medications early in pregnancy can cause birth defects and serious problems for the infant and the mother," CDC Director Tom Frieden, MD, MPH, said in a statement. These include neural tube defects, congenital heart defects, and gastroschisis. There is also a risk for neonatal abstinence syndrome from opioid exposure in pregnancy.

"Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child. That's why it's critical for health care professionals to take a thorough health assessment before prescribing these medicines to women of reproductive age," Dr Frieden said.

Risky Business

Using two large health insurance claims datasets, CDC researchers analyzed opioid prescription data from 2008 to 2012 for women aged 15 to 44 years with private insurance and Medicaid.

On average, 39.4% of Medicaid-enrolled women and 27.7% of privately insured women filled an opioid prescription from an outpatient pharmacy each year during the study period. The most commonly prescribed opioids were hydrocodone, codeine, and oxycodone.

Per year, an average of three opioids were prescribed for every four privately insured women, and nearly two opioids prescribed for every one Medicaid-enrolled woman, the CDC says.

Geographic data available for private insurance claims show the highest rates of opioid prescription among reproductive-aged women in the South and the lowest rates in the Northeast. Race/ethnicity data available for the Medicaid data show that opioid prescriptions were nearly 1.5 times higher among non-Hispanic white women compared with non-Hispanic black or Hispanic women.

"This new information underscores the importance of responsible prescribing, especially of opioids, for women of child bearing age," Coleen Boyle, PhD, director of CDC's National Center on Birth Defects and Developmental Disabilities, said in the statement.

Weigh Benefits, Risks

The CDC authors of the MMWR report note that opioid prescription claims were highest in 2009. "Although there appeared to be a decline in the frequency of opioids prescribed to both privately insured and Medicaid-enrolled women of reproductive age from 2009 to 2012, any conclusions about changes over time must be interpreted with caution," note first author Elizabeth Ailes, PhD, and colleagues.

At least one prior study did note a decrease in opioid prescriptions among pregnant women, from 14.9% in 2005 to 12.9% in 2011, they point out.

Still, they say more targeted interventions and communications strategies are needed to reduce "unnecessary prescribing and use of opioid-containing medications, particularly among women who might become pregnant."

In a safety communication issued earlier this month, the US Food and Drug Administration (FDA) urged clinicians to carefully weigh the benefits and risks of using prescription and over-the-counter (OTC) pain medicines during pregnancy.

Recent reports questioning the safety of prescription and OTC pain medicines when used during pregnancy prompted the FDA to evaluate relevant published studies. But the agency said they failed to find enough information to change current recommendations.

"As a result, our recommendations on how pain medicines are used during pregnancy will remain the same at this time," the FDA said.

The agency advises health care professionals to continue to follow the recommendations in the drug labels when prescribing pain medicines to pregnant patients. They advise pregnant women to consult with their health care professional before taking any prescription or OTC medicine.

MMWR Morb Mortal Wkly Rep. 2015;64:37-41. Full text

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