Increase in Prescription Opioid Use During Pregnancy Among Medicaid-Enrolled Women Reply

ArticleinObstetrics and Gynecology 123(5):997-1002 · May 2014with53 Reads
DOI: 10.1097/AOG.0000000000000208 · Source: PubMed
To report the prevalence of prescription opioid use and evaluate the trends in a large cohort of Medicaid-enrolled pregnant women. A cohort of pregnancies was identified using data from the Medicaid Analytical eXtract for the period of 2000-2007. Dispensing of opioids, as a class and separately for individual agents, was evaluated using claims from filled prescriptions. Variations in patterns of prescription opioid fills were examined by demographic characteristics, by geographic region, and over time. Median number of opioid prescriptions dispensed and cumulative days of availability for prescription opioids during pregnancy were reported. The study population consisted of more than 1.1 million women with completed pregnancies from 46 U.S. states and Washington, DC. One of five women from our cohort (21.6%) filled a prescription for an opioid during pregnancy; this proportion increased from 18.5% in 2000 to 22.8% in 2007. Substantial regional variation was seen with the proportion of women who filled a prescription during pregnancy, ranging between 9.5% and 41.6% across the states. Codeine and hydrocodone were the most commonly prescribed opioids. Among women filling at least one opioid prescription, the median (interquartile range) number of prescriptions filled was 1 (1-2) and the median (interquartile range) cumulative days of opioid availability during pregnancy were 5 (3-13) days. We observed high and increasing number of filled prescriptions for opioids during pregnancy among Medicaid-enrolled women. These findings call for further safety evaluations of these drugs and their effects on the developing fetus to inform clinical practice. LEVEL OF EVIDENCE:: II.
    • "A recent study, with a cohort of more than 500,000 pregnant women in the United States, found that 14% of women filled a prescription for an opioid at least once during the antepartum period and 6% of women received opioids throughout all trimesters [1]. Additionally, another study reporting on more than one million pregnant women found that prescription opioids were dispensed to approximately one out of five women during pregnancy [2]. While these results reflect the high incidence of pain syndromes during pregnancy, they also highlight the increasing use of narcotics for pain management through the antepartum period. "
    [Show abstract] [Hide abstract] ABSTRACT: Nonobstetrical causes of pain during pregnancy are very common and can be incapacitating if not treated appropriately. Recent reports in the literature show that a significant percentage of pregnant women are treated with opioids during pregnancy. To address common pain conditions that present during pregnancy and the available pharmacological and nonpharmacological treatment options, for each of the pain conditions identified, a search using MEDLINE, PubMed, Embase, and Cochrane databases was performed. The quality of the evidence was evaluated in the context of study design. This paper is a narrative summary of the results obtained from individual reviews. There were significant disparities in the studies in terms of design, research and methodology, and outcomes analyzed. There is reasonable evidence available for pharmacological approaches; however, these are also associated with adverse events. Evidence for nonpharmacological approaches is limited and hence their efficacy is unclear, although they do appear to be primarily safe. A multimodal approach using a combination of nonpharmacological and pharmacological options to treat these pain conditions is likely to have the most benefit while limiting risk. Research trials with sound methodology and analysis of outcome data are needed.
    Full-text · Article · Oct 2015
    • "In the past decade, there has been a significant increase in both prescribed and illicit opioid use during pregnancy. Up to 1 in 5 women in the US are taking an opioid medication at some point while pregnant, leading to increasing rates of neonatal abstinence syndrome (NAS) (Desai et al., 2014; Patrick et al., 2012; USDHHS, 2013). NAS represents a constellation of signs and symptoms due to infant withdrawal from in utero opioids and often requires prolonged hospitalization lasting from weeks to over a month, and E-mail addresses: "
    [Show abstract] [Hide abstract] ABSTRACT: There is significant variability in the severity of neonatal abstinence syndrome (NAS) due to in-utero opioid exposure. We wanted to determine if single nucleotide polymorphisms (SNPs) in key candidate genes contribute to this variability. Full-term opioid-exposed newborns and their mothers (n=86 pairs) were studied. DNA was genotyped for 80 SNPs from 14 genes utilizing a custom designed microarray. The association of each SNP with NAS outcomes was evaluated. SNPs in two opioid receptor genes in the infants were associated with worse NAS severity: (1) The PNOC rs732636 A allele (OR=3.8, p=0.004) for treatment with 2 medications and a longer hospital stay (LOS) of 5.8 days (p=0.01), and (2) The OPRK1 rs702764 C allele (OR=4.1, p=0.003) for treatment with 2 medications. The OPRM1 rs1799971 G allele (β=-6.9 days, p=0.02) and COMT rs740603 A allele (β=-5.3 days, p=0.01) were associated with shorter LOS. The OPRD1 rs204076 A allele in the mothers was associated with a longer LOS by 6.6 days (p=0.008). Results were significant point-wise but did not meet the experiment-wide significance level. These findings suggest that SNPs in opioid receptor and the PNOC genes are associated with NAS severity. However, further testing in a large sample is warranted. This has important implications for prenatal prediction and personalized treatment regimens for infants at highest risk for severe NAS. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Jul 2015
    • "Substance use disorders are prevalent among Medicaid beneficiaries , affecting about 12% of adults (Substance Abuse & Mental Health Services Administration [SAMHSA], 2013b). Studies show increasing rates of drug misuse nationwide (Centers for Disease Control & Prevention, 2014), and there has been an increase in opioid prescribing, including Medicaid populations (Desai, Hernandez-Diaz, Bateman, & Huybrechts, 2014; Epstein et al., 2013). Some reports reveal overdose death rates that are much higher among Medicaid enrollees compared with individuals covered by other payers (Kuehn, 2014), yet only 4.4% of Medicaid beneficiaries receive substance use disorder treatment in any given year (SAMHSA, 2013b). "
    [Show abstract] [Hide abstract] ABSTRACT: Substance use disorders affect 12% of Medicaid beneficiaries. The prescription drug epidemic and growing need for treatment of alcohol and opioid dependence have refocused states' attention on their provision of substance use disorder treatment services, including medications. This study characterized how Medicaid programs cover these treatment medications. Data were from 2013 Medicaid pharmacy documents, 2011 and 2012 Medicaid state drug utilization records, and a 2013 American Society of Addiction Medicine survey. Results showed that only 13 state Medicaid programs included all medications approved for alcohol and opioid dependence on their preferred drug lists. The most commonly excluded were extended-release naltrexone (19 programs), acamprosate (19 programs), and methadone (20 programs). For combined buprenorphine-naloxone, 48 Medicaid programs required prior authorization, and 11 programs used 1- to 3-year lifetime treatment limits. Given the chronic nature of substance use disorders and the overwhelming evidence supporting ongoing coverage for many of these medications, states may want to reexamine substance use disorder benefits. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Apr 2015
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