Pubdate: Sun, 08 Jan 2017
Source: Milwaukee Journal Sentinel (WI)
Copyright: 2017 Journal Sentinel Inc.
Author: John Fauber


Narcotic painkillers - which can cause birth defects - commonly were
prescribed for women of reproductive age, according to new data presented
Thursday by the U.S. Centers for Disease Control and Prevention.

The research, which looked at the years 2008-2012, found that 39% of women
ages 15 to 44 on Medicaid and 28% of those on private insurance received
an opioid prescription.

"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," CDC Director Tom Frieden said in a statement.

The most commonly prescribed drugs were hydrocodone, codeine and oxycodone.

Opioid use can double the risk of various birth defects such as spina
bifida, congenital heart defects and a condition known as gastroschisis in
which the intestines stick outside the abdominal wall and needs to be
corrected by surgery.

Spina bifida and gastroschisis occur in less than 2,000 births a year.
Congenital heart defects, which are structural defects in the heart, are
more common, occurring in about nine in 1,000 births. Most of those are

"These are risks these women are being exposed to even before they know
they are pregnant," said co-author Jennifer Lind, a CDC pharmacist. "The
critical window is usually the first trimester."

Investigations by the Milwaukee Journal Sentinel and MedPage Today have
documented how prescription opioid use boomed throughout the past 15
years, in part because a network of pain organizations pushed for more
liberalized use of the drugs in treating chronic pain.

The growth in prescriptions occurred despite a lack of evidence that
opioids are safe and effective for chronic, non-cancer pain.

The report highlights the need to counsel women about opioid risk much as
they are for smoking and using alcohol during pregnancy, said Cresta
Jones, an assistant professor of maternal and fetal medicine at the
Medical College of Wisconsin who was not a part of the study.

Only recently has research established a link between opioids and birth
defects, but there is not a lot of data quantifying that risk, said Jones,
who practices at Froedtert Hospital and works with pregnant women who are
dependent on opioids.

She said some women may need a short course of opioids, such as after
emergency surgery during pregnancy or for those who suffer from sickle
cell disease.

"We really have to say any amount is too much if it is not necessary for a
patient's health," Jones said.

The data is concerning because "it is hard to imagine that one-fourth or
one-third of young women annually suffer an injury requiring an opioid,"
said Lewis Nelson, professor emergency medicine and toxicology at New York
University School of Medicine.

"This suggests that opioids are being prescribed too freely for acute pain
or are being prescribed and dispensed for other, perhaps less legitimate,
reasons," said Nelson, who was not involved in the study.

While it is not known how many of the women are long-term opioid users, he
said, they would be at risk of delivering children who suffer the
devastating effects of neonatal abstinence syndrome, or opioid withdrawal.

Last year, a paper in the journal Obstetrics & Gynecology found that 22%
of pregnant women on Medicaid in 2007 had filled an opioid prescription
during their pregnancy.

To study more recent use of opioid use in women of reproductive age,
researchers looked at prescription claims data from private insurance
claims and Medicaid.

Up to 6.5 million prescriptions paid by private insurance and up to
800,000 Medicaid prescriptions were analyzed.

The higher rate of opioid prescriptions to Medicaid enrollees is
concerning because about half of U.S. births occur among them, the
researchers wrote.

Opioid prescriptions were the highest in 2009, when 29% of privately
insured women and 41% of Medicaid insured women ages 15 to 44 received at
least one prescription.

Of those on private insurance, the average was 2.6 prescriptions. For
Medicaid patients, it was 4.3.

Researchers said the higher prescribing rates for Medicaid might be due to
insurance coverage, differences in use of health care services and
possible differences in underlying health conditions.

Regional data was available only for privately covered women.

It showed the highest rate of opioid prescribing was in the South, at
31.5%, and the lowest was in the Northeast, 21.8%.

Lind, of the CDC, said women who may become pregnant need to talk to their
doctor about opioid use. If opioids are deemed necessary, they should use
the lowest effective dose for the shortest period.

She said doctors in all specialties, including dentistry, need to be aware
of the issue of opioids and pregnancy, Lind said.

"They might be treating for two," she said. "We are really trying to get
doctors to start thinking of that."
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