Opioid use epidemic among reproductive-age women

 

The opioid epidemic in the United States strikes the population at large and, of specific interest to family planning providers, reproductive-age women. Overdoses have led to a death rate that has been rising faster than the death rate from other causes of death, affecting nearly every county in the nation.[1] In addition to the risk of overdose, opioids lead to an array of birth defects when taken by pregnant women.

In 2015, the Centers for Disease Control and Prevention reported that medications containing opioids are widely prescribed among reproductive-aged women. Each year between 2008–2012, more than one-fourth of women (27.7%) with private insurance and more than one-third of women (39.4%) on Medicaid filled a prescription for an opioid.[2] Among privately insured women, opioid prescription claims were highest among those residing in the South. Among Medicaid-enrolled women, opioid prescription claims were highest among non-Hispanic whites.

Just this year, the CDC published another report, this one looking more closely at the fertility status of women who filled opioid prescriptions from 2008 through 2013.[3] Among all women of reproductive age residing in New York state, one-fifth (20.0%) were prescribed an opioid-containing drug. Most likely to receive a prescription were women who were either using contraceptives or were infertile; more than one in four (27.3%) of these women had been prescribed an opioid. However, prescriptions given to just under one in four women (17.3%) who did not appear to be using a contraceptive posed an additional hazard.

As the CDC warns, “This is a significant public health concern given evidence of adverse pregnancy outcomes with opioid exposure, the likelihood of exposures occurring among unrecognized or unintended pregnancies, and health care provider concerns about using other pain medications during early pregnancy… Given the high rate (approximately 50%) of unintended pregnancies in the United States, opioid use among reproductive-aged women can result in many early pregnancy exposures.”² In the New York study, about one in ten (9.5%) of women who had had a live birth had been prescribed an opioid-containing drug.

Despite the high rate of opioid prescriptions reported in the study, the rate in New York was low compared with other states.³Since 1972, New York has monitored prescriptions of Schedule II controlled substances. In 2012, the state began also to electronically monitor Schedule II, III and IV controlled substances. It is likely that these programs led to fewer prescriptions of opioid-containing drugs in New York state as compared to the rest of the United States. The most commonly reported opioid prescriptions during the study period were hydrocodone, codeine, and oxycodone.

Why would women take, or be prescribed opioid-containing drugs? Most of the time, it is for treatment to manage pain associated with surgical procedures, infections, chronic diseases, and injuries, according to the CDC.[4] Compared to men, women are more likely to be prescribed opioid-containing drugs and use them for longer lengths of time. These more quickly become dependent upon the drugs than do men. And when they are taken during pregnancy, opioid use can be associated with a number of birth defects: spina bifida, glaucoma, gastroschisis, and heart defects including septal defects in the ventricles and atria, tretralogy of Fallot, hypoplastic left heart syndrome, and pulmonary valve stenosis.