What We Can Do About Opioid Use Disorder in Pregnancy

I'm Dr Jean Ko, an epidemiologist in the Centers for Disease Control and Prevention's (CDC's) Division of Reproductive Health. In today's CDC Expert Commentary series on Medscape, I'm sharing some vital health news: Opioid use disorder during pregnancy is on the rise. Opioid use disorder during pregnancy has been associated with a range of negative health outcomes for both mothers and their babies, including maternal death, preterm birth, stillbirth, and neonatal abstinence syndrome.

A recent CDC analysis of national data^[1] showed that the number of pregnant women with opioid use disorder (documented at the time of delivery) more than quadrupled from 1999 through 2014. Additionally, this report revealed significant increases in opioid use disorder among pregnant women in every one of the 28 states with publicly available data.

These findings show the devastating impact of the opioid crisis for mothers and babies. However, working together, clinicians and public health practitioners can advance prevention and treatment efforts to reverse these trends. Recommended strategies for addressing opioid use disorder among pregnant women include:

Ensuring appropriate opioid prescribing for pregnant and reproductive-age women, in line with the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain^[2]
Reviewing the patient's history of controlled substance prescriptions using state prescription drug monitoring programs (PDMP) data before prescribing opioids
Implementing universal substance use screening at the first prenatal visit, with use of verbal validated screening tools, as recommended by the American College of Obstetricians and Gynecologists^[3]
Ensuring that pregnant women with opioid use disorder have access to medication-assisted therapy and related addiction services
Ensuring that mothers with opioid use disorder receive adequate patient-centered postpartum care, including mental health and substance use treatment, relapse-prevention programs, and family planning services

To address the ongoing epidemic of opioid use disorder, it will take coordinated efforts by communities, healthcare providers, public health, law enforcement, and other sectors. Providers have an important role in combatting the opioid crisis. To provide safer, more effective pain management, talk to your patients about the risks and benefits of opioids and work together toward treatment goals. Below, you'll find resources to help you carry out the complex task of balancing pain management with the potential risks posed by prescription opioids.