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Spokane, Washington  Est. May 19, 1883

Study tracks opioid use among women age 15 to 44

More prescriptions issued despite risks

John Fauber Tribune News Service

MILWAUKEE – 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 percent of women age 15 to 44 on Medicaid and 28 percent 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. Gastroschisis needs to be corrected by surgery.

Spina bifida and gastroschisis occur in fewer than 2,000 births a year. Congenital heart defects, which are structural defects in the heart, are more common, occurring in about 9 in 1,000 births. Most of those are mild.

“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, noncancer pain.

The report highlights the need to counsel women about opioid risk much like 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.

Last year, a paper in the journal Obstetrics & Gynecology found that 22 percent 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 percent of privately insured women and 41 percent of Medicaid insured women age 15 to 44 received at least one prescription.

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

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.