U of M study: opioid epidemic poses specific dangers for reproductive-age women

Significant numbers of reproductive-age women — including pregnant women — are using prescription opioids for non-medical uses, according to a new study from University of Minnesota researchers.

The study also found that most reproductive-age women are getting the opioids  — prescription pain relievers such as OxyContin, Percocet and Vicodin — from a friend or relative, although half of the pregnant women cite doctors as their source for the drugs.

These troubling findings underscore the complexity of the public health challenge posed by the U.S. opioid epidemic — and the need to develop policies that target the different populations affected by it, say the study’s authors.

“Often the face of the opioid epidemic in the U.S. is white, rural, middle-aged men, or younger men, but the truth of the matter is that the epidemic is affecting broad swaths of the population, including a face we don’t often see, which is reproductive-age and pregnant women,” said Katy Kozhimannil, the study’s lead author and an associate professor of health policy and management at the U of M, in an interview with MinnPost.

The study was published Friday in the journal Drug and Alcohol Dependence.

A disturbing trend

Previous research has shown that overdose deaths from opioid pain relievers increased five-fold among women in the United States between 1999 and 2010. Although men are still more likely than women to die from such overdoses, the percentage increase in deaths over the past decade has been greater among women — and the gender difference in overdose deaths is rapidly disappearing.

“It’s sort of following some of what we saw with smoking, where we saw death rates higher among men earlier,” said Kozhimannil. “Then, as the substance seeps into the fabric of society, more and more women are affected.”

Younger women have not escaped that trend. In fact, the Centers for Disease Control and Prevention (CDC) reported last year that women between the ages of 15 and 44 are more likely than older women to require emergency medical care related to the misuse or abuse of opioids.

Opioid dependency is dangerous for everyone, of course, but it poses specific risks for younger women. “There is the chance for the woman to become pregnant, and during pregnancy opioid use has a lot of effect on the mom in terms of pregnancy-related complications,” said Kozhimannil.

The consequences for babies born to women who use opioids during pregnancy can be devastating. Research suggests opioid exposure raises the risk that an infant will be born with major defects of the brain and spine (known as neural tube defects), as well as congenital heart defects and a defect of the child’s abdominal wall (a condition known as gastroschisis). 

There is also the risk that the baby will be born prematurely and/or experience neonatal abstinence syndrome — a group of health problems that can develop when the baby is withdrawing from exposure to the opioids. 

When younger women use opioids, they often don’t anticipate that they might become pregnant. But about half of all pregnancies in the U.S. are unintended, and unintended pregnancies are particularly high among women with substance abuse disorders, said Kozhimannil. 

Study details

Because of these trends and issues, Kozhimannil and her U of M colleagues decided to investigate the extent of non-medical use of prescription opioids by reproductive-age women. They also wanted to look at where the women are getting the medications.

Associate Professor

Katy Kozhimannil

“If we have a growing, catastrophic opioid epidemic in this country, and we know that the epidemic is affecting men and women differently, then we need very specific information about which women are being affected and where they are getting their opioids to effectively target prevention strategies,” said Kozhimannil.

For their study, she and her colleagues analyzed data collected from more than 150,000 women aged 18 to 44 who participated in the National Survey of Drug Use and Health between the years 2005 and 2014. About 8,000 of the women were pregnant when they took the survey.

One of the questions on the survey was “Have you ever, even once, used any type of prescription pain reliever that was not prescribed for you or that you only took for the experience or feeling it caused?” Another question was whether the women had used a prescription pain reliever within the past 30 days.  

The results revealed that 2.3 percent of non-pregnant and 0.8 percent of pregnant women reported using opioids for non-medical reasons within the previous month.

Those percentages, however, don’t really relay the magnitude of the findings, said Kozhimannil.

“There are a lot of reproductive-age women in this country,” she explained. “So 2.3 percent of them is 1.4 million women. And with reproductive pregnant women, it’s about 50,000 at any given time.”

Three main sources

Most of the women who were using opioids for non-medical reasons  — 53.8 percent of the pregnant women and 75 percent of the non-pregnant women — cited a friend or relative as the source of the drugs.

“Part of that is because of the sheer volume of these medications that are out there in the community,” said Kozhimannil. “It’s also born out of the empathy that people have for the pain of others who they love and care about.”

“They’re just unaware of the dangers,” she added.

But, strikingly, the study also found that almost half (46 percent) of the pregnant women and more than a quarter (27.6 percent) of the non-pregnant women who were using opioids for non-medical reasons got them from a doctor.

This finding surprised Kozhimannil, although she noted that pregnancy is a time when women see doctors quite frequently, and it’s also a time when women tend to experience a lot of pain. 

Still, the finding clearly suggests that doctors need to take a more tailored approach to helping women with pain during pregnancy, she said.

Criminalizing use would lead to harm

Dealers of illicit drugs were the third source of the opioids for the women surveyed: 14.6 percent of the pregnant women and 10.6 of the non-pregnant women who said they used such drugs for non-medical purposes reported getting the drugs through a dealer.

Although the illegal sale of prescription opioids needs to be reduced, said Kozhimannil, solutions that focus on criminal justice — particularly ones that criminalize pregnant women for using opioids — need to be balanced with public health approaches.

“Criminalizing opioids use during pregnancy means women will not seek prenatal care,” she said. “That could have really horrible effects on the woman and her infant, but it could also have also devastating financial consequences for our state” through higher Medicaid costs.

Medicaid currently pays for about half of all births in the United States. It also pays for about 70 percent of the costs related to neonatal abstinence syndrome — those medical problems that develop when a child is born dependent on opioids.

FMI: An abstract of the study is available on the Drug and Alcohol Dependence website, but the full study is behind a paywall.