Opioid Use During Pregnancy Has Increased Among Women Enrolled in Medicaid

The portion of pregnant Medicaid beneficiaries who received a prescription for an opioid painkiller increased from 18.5% in 2000 to 22.8% in 2007, according to the results of a new study.

As multiple studies have found increasing opioid painkiller use among various populations, new research indicates that pregnant women enrolled in Medicaid are also receiving more prescriptions for the painkillers.

Following a study published earlier this year that found increased use of opioids among pregnant women with private insurance, the new study assessed the prevalence and trends of prescription opioid use among a large cohort of pregnant women covered by Medicaid. Data on more than 1.1 million women from 46 states and Washington, DC, who gave birth from 2000 through 2007 were drawn from the Medicaid Analytical eXtract and included in the analysis. Using claims from filled prescriptions, the researchers evaluated the total amount of opioids dispensed during each trimester of pregnancy and the breakdown by class and individual drug types. Patterns of use were also analyzed by demographic characteristics and geographic location and over time. The results were published in the May 2014 issue of Obstetrics and Gynecology.

Overall, 21.6% of pregnant women included in the study filled at least 1 prescription for an opioid at some point during their pregnancy. This proportion increased over the study period from 18.5% in 2000 to 22.8% in 2007. When analyzed by trimester, 10.5% of women received the painkillers during their first trimester, 9.6% during their second trimester, and 9.8% in the third trimester.

Opioids containing codeine and hydrocodone were most commonly prescribed and were given to 11.1% and 10.0% of pregnant women, respectively. The painkillers were most frequently prescribed for abdominal pain (48.4%), followed by lower back pain (33.0%), headache (13.3%), joint pain (11.2%), and migraine (7.9%).

The results also indicated that opioid use varied substantially by demographics and by region. When analyzed by ethnicity, 29.0% of white women were prescribed opioids during pregnancy, compared with 19.1% of black and 13.4% of Hispanic women. In addition, rates of opioid use during pregnancy ranged from 9.5% to 41.6% across the states. Use of the painkillers during pregnancy was highest in Utah (41.6%), followed by Idaho (35.6%), New Hampshire (34.3%), Wyoming (34.1%), and Tennessee (33.6%).

Although the effects of opioid use during pregnancy are largely unknown, the authors note that new evidence suggests that the painkillers may be harmful to the fetus, making the study’s results particularly concerning.

“[O]ur findings of high and increasing number of filled prescriptions for opioids during pregnancy among Medicaid-enrolled women call for further safety evaluations of these drugs and their effects on the developing fetus to inform clinical practice,” the study authors conclude.