The Opioid Epidemic Hits Obstetrics

Summary and Comment |
August 8, 2016

The Opioid Epidemic Hits Obstetrics

  1. Allison Bryant, MD, MPH

What is the role of health policy in combating the effects of opioid abuse on pregnancy outcomes?

  1. Allison Bryant, MD, MPH

The epidemic of opioid use in the U.S. has not spared women of childbearing age: In the past decade, 30% to 40% of these women and 20% of pregnant Medicaid recipients have filled narcotic prescriptions, and this trend has been associated with a concomitant rise in opiate abuse (both prescription medications and the more readily available heroin). In part because of a shift in the demographic pattern of opiate abusers toward white, middle-class, suburban patients, renewed focus has been brought to the crisis, and some of this attention has come from policymakers. Authors of a special report explore the role of health policy in this epidemic. Key points are as follows:

  • The criminalization of substance use during pregnancy is counterproductive; providers should be free to screen all pregnant women for substance use disorders without concern for the consequences.

  • The chronic nature of addiction should not be underestimated; although women may be abstinent during pregnancy, postpartum relapse rates are significant.

  • While the standard of care during pregnancy remains medication-assisted treatment (MAT), this strategy's efficacy is bolstered by counseling, behavioral therapy, or both.

  • Access to MAT during pregnancy (whether with methadone or buprenorphine) must increase to meet current and future needs.

  • Care of neonates prenatally exposed to opioids requires standardization using evidence-based protocols.

Comment

The roots and consequences of the opioid epidemic extend far beyond the edges of the health care system. Women's health clinicians can be important allies and advocates for their patients who have opioid use disorders, with spheres of influence ranging from their clinics to Capitol Hill. Our professional societies should strive to keep providers up to date regarding evidence-based strategies to care for women and families touched by these disorders, while also leveraging clinicians' considerable influence as agents of policy change.

Editor Disclosures at Time of Publication

  • Disclosures for Allison Bryant, MD, MPH at time of publication Nothing to disclose

Citation(s):

Reader Comments (1)

Edward Hall M.D. Physician, Obstetrics/Gynecology, St Elizabeth Healthcare, Edgewood, KY

The findings expressed above are painfull clear and seen on a daily basis in our urban/suburban practice. We need to get beyond the old dictum that careful tapering of opiate dose during pregnancy is forbidden. With an educated and motivated patient, this is possible.

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