High prescription rates for opioid medications among reproductive-age women are raising concerns about the risks associated with their use and the development of adverse pregnancy outcomes.
Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, called on healthcare professionals to assess the prescribing of opioid painkillers to women who could get pregnant, since the use of such drugs during early pregnancy has been associated with a higher risk for unborn children to develop birth defects and other health conditions.
More than a third of women enrolled in Medicaid, and more than a quarter of women with private insurance between the ages of 15 and 44 filled a prescription for opioid pain medication annually between 2008 and 2012, according to the findings of a new CDC report released Thursday.
Researchers found that 39% of women covered under Medicaid filled an opioid prescription at an outpatient pharmacy each year, compared with 28% of reproductive-age women with private health insurance.
A 2011 CDC study published in the American Journal of Obstetrics & Gynecology found that women who took opioid medications between one month before pregnancy and the end of their first trimester had higher associated risks of their children developing conditions such as congenital heart defects, spina bifida or gastroschisis, a birth defect in which a baby's intestines stick outside of its body.
“Taking opioid medications early in pregnancy can cause birth defects and serious problems for the infant and the mother,” Freidan said in a released statement. “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.”
The findings were based on an analysis of insurance and Medicaid data from 2008 to 2012 that examined outpatient pharmacy prescription-drug claims.
The reasons for higher opioid prescription rates among Medicaid beneficiaries compared to women with private insurance were unclear. Researchers speculated that possible factors might be underlying differences in health conditions between the two groups, differences in the health services they seek, or the medications that are covered.
Prescription rates were higher among older women, regardless of whether they were covered under Medicaid or private insurance, according to the study. Among the privately insured, women between the ages of 30 and 34 had the highest prescription rates, while women between the ages of 40 and 44 had the highest prescription rates among Medicaid beneficiaries. Among women with either type of healthcare coverage, the lowest prescription rates were found among those between the ages of 15 and 19.
The most commonly prescribed opioids, among both Medicaid and privately insured women studied, were hydrocodone, codeine and oxycodone. Geographic region data available within private-insurance claims showed opioid prescription rates were highest among reproductive-age women in the South and lowest in the Northeast. A racial breakdown of Medicaid data found opioid prescriptions among white women were nearly one-and-a-half times higher compared to black or Hispanic women.
More than 15,000 female deaths in the U.S. in 2010 were attributed to drug overdose, according to a 2013 CDC report. The number of overdose deaths among women from opioid painkillers increased fivefold between 1999 and 2010, with the number of emergency department visits attributed to female opioid drug abuse doubling between 2004 and 2010.
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