The steep increase in the number of opioid prescriptions dispensed in the United States has been associated with a parallel rise in their misuse, fatal overdoses, and heroin use. More recently, attention has been focused on the large increase in the number of infants born with neonatal abstinence syndrome (NAS). In the US, between 2000 and 2009, the incidence of NAS increased from 1.20 to 3.39 per 1000 live births, and between 2004 and 2013 the total percentage of days spent in intensive care because of NAS increased from 0.6% to 4.0%. The rise in NAS is also likely to be a consequence of increased opioid prescriptions—estimates indicate that 14-22% of pregnant women in the US receive an opioid prescription during their pregnancy—as well as an increase in the prevalence of opioid use disorders among pregnant women.
The lack of scientific information on the effects of opioids on fetal brain development, combined with their known association with NAS, indicates that opioids should be reserved for pregnant women with severe pain that cannot be controlled through more benign means, and ideally limited to a short term use. If long term use is unavoidable, such as for women in need of buprenorphine or methadone maintenance therapy for heroin addiction, then careful assessment and monitoring should be undertaken to minimise the risk of overdoses, NAS, and misuse.
Sources and more information
- Opioids in pregnancy: High prescribing rates have probably contributed to recent increases in neonatal abstinence syndrome, BMJ 2016;352:i19, 12 January 2016.
- Opioid use in pregnancy puts infants at risk, medicalnewstoday, 12 January 2016.
- Concerns over prescribed opioid use among pregnant women, eurekalert, 12 January 2016.