Prescription Opioid Use Among Populations of Reproductive Age: Effects on Fertility, Pregnancy Loss, and Pregnancy Complications

Abstract Prescription opioid use is common among men and women of reproductive age, including during assisted-reproduction procedures. Opioid use disorder and chronic use are associated with harms to fertility and pregnancy outcomes, but it is unclear whether these associations extend to common short-term patterns of prescription opioid use. We conducted a literature review using PubMed, Embase, Web of Science, and Scopus to identify studies of nonchronic, nondependent opioid use and reproductive endpoints including fertility, pregnancy loss, and pregnancy complications (i.e., preterm birth, birth weight, gestational diabetes, and hypertensive disorders of pregnancy). Seventeen studies were included. Although results of the studies suggest possible harms of short-term opioid use on fertility and pregnancy loss, methodologic limitations and the small number of studies make the literature inconclusive. This review highlights important data gaps that must be addressed to make conclusions about potential reproductive effects of short-term opioid use. These include the need for additional data on opioid use before clinically recognized pregnancy; accurate measurement of opioid exposure by multiple means with detailed information on the types and quantity of opioids used; assessment of important confounders, including opioid use indication, comorbidities, and use of other medications and substances; and studies of paternal opioid use, fertility, and pregnancy outcomes. A primary limitation of this review targeting studies of nonchronic opioid exposure is the possibility that selected studies included populations with unspecified chronic or dependent opioid use. Efforts to understand the impact of the prescription opioid epidemic should address potential reproductive harms of these medications among people of reproductive age.

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Prescription opioid use in Australian women of reproductive age: implications for unplanned pregnancies

British Journal of Clinical Pharmacology ◽

10.1111/bcp.15074 ◽

2021 ◽

Author(s):

Bianca Varney ◽

Helga Zoega ◽

Malcolm Bjørn Gillies ◽

Jonathan Brett ◽

Sallie‐Anne Pearson ◽

...

Keyword(s):

Reproductive Age ◽

Prescription Opioid ◽

Opioid Use ◽

Women Of Reproductive Age ◽

Unplanned Pregnancies ◽

Prescription Opioid Use

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Opioid tapering in patients with prescription opioid use disorder: A retrospective study

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2017.09.005 ◽

2017 ◽

Vol 17 (1) ◽

pp. 167-173 ◽

Cited By ~ 1

Author(s):

Kehua Zhou ◽

Peng Jia ◽

Swati Bhargava ◽

Yong Zhang ◽

Taslima Reza ◽

...

Keyword(s):

Trigger Point ◽

Retrospective Chart Review ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Office Visits ◽

Opioid Use ◽

Clinical Practices ◽

Medication Assisted Treatment ◽

Opioid Tapering ◽

Prescription Opioid Use

AbstractBackground and aimsOpioid use disorder (OUD) refers to a maladaptive pattern of opioid use leading to clinically significant impairment or distress. OUD causes, and vice versa, misuses and abuse of opioid medications. Clinicians face daily challenges to treat patients with prescription opioid use disorder. An evidence-based management for people who are already addicted to opioids has been identified as the national priority in the US; however, options are limited in clinical practices. In this study, we aimed to explore the success rate and important adjuvant medications in the medication assisted treatment with temporary use of methadone for opioid discontinuation in patients with prescription OUD.MethodsThis is a retrospective chart review performed at a private physician office for physical medicine and rehabilitation. We reviewed all medical records dated between December 1st, 2011 and August 30th, 2016. The initial evaluation of the included patients (N =140) was completed between December 1st, 2011 and December 31st, 2014. They all have concumittant prescription OUD and chronic non-cancer pain. The patients (87 female and 53 male) were 46.7 ± 12.7 years old, and had a history of opioid use of 7.7 ±6.1 years. All patients received the comprehensive opioid taper treatments (including interventional pain management techniques, psychotherapy, acupuncture, physical modalities and exercises, and adjuvant medications) on top of the medication assisted treatment using methadone (transient use). Opioid tapering was considered successful when no opioid medication was used in the last patient visit.ResultsThe 140 patients had pain of 9.6 ± 8.4 years with 8/10 intensity before treatment which decreased after treatment in all comparisons (p < 0.001 for all). Opioids were successfully tapered off in 39 (27.9%) patients after 6.6 ±6.7 visits over 8.8 ±7.2 months; these patients maintained opioid abstinence over 14.3 ± 13.0 months with regular office visits. Among the 101 patients with unsuccessful opioid tapering, 13 patients only visited the outpatient clinic once. Significant differences were found between patients with and without successful opioid tapering in treatment duration, number of clinic visits, the use of mirtazepine, bupropion, topiramate, and trigger point injections with the univariate analyses. The use of mirtazepine (OR, 3.75; 95% CI, 1.48–9.49), topiramate (OR, 5.61; 95% CI, 1.91–16.48), or bupropion (OR, 2.5; 95% CI, 1.08–5.81) was significantly associated with successful opioid tapering. The associations remain significant for mirtazepine and topiramate (not bupropion) in different adjusted models.ConclusionsWith comprehensive treatments, 27.9% of patients had successful opioid tapering with opioid abstinence for over a year. The use of mirtazepine, topiramate, or likely bupropion was associated with successful opioid tapering in the medication assisted treatment with temporary use of methadone. Opioid tapering may be a practical option and should be considered for managing prescription OUD.ImplicationsFor patients with OUD, indefinite opioid maintenance treatment may not be necessary. Considering the ethical values of autonomy, nonmaleficence, and beneficence, clinicians should provide patients with OUD the option of opioid tapering.

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Prefrontal Cortical Activation, but Not Behavioral Performance of Impulsivity and Risky Decision-Making Tasks, was Associated with Treatment Outcome in Residential Patients with Alcohol or Prescription Opioid Use Disorder.

Frontiers in Human Neuroscience ◽

10.3389/conf.fnhum.2018.227.00126 ◽

2018 ◽

Vol 12 ◽

Author(s):

Sarah Tilden ◽

Jonathan Harris ◽

Andrew Huhn ◽

Erin Deneke ◽

Jessica Parascando ◽

...

Keyword(s):

Decision Making ◽

Treatment Outcome ◽

Opioid Use Disorder ◽

Cortical Activation ◽

Prescription Opioid ◽

Behavioral Performance ◽

Opioid Use ◽

Risky Decision ◽

Prefrontal Cortical ◽

Prescription Opioid Use

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Social Stigma Toward Persons With Prescription Opioid Use Disorder: Associations With Public Support for Punitive and Public Health–Oriented Policies

Psychiatric Services ◽

10.1176/appi.ps.201600056 ◽

2017 ◽

Vol 68 (5) ◽

pp. 462-469 ◽

Cited By ~ 61

Author(s):

Alene Kennedy-Hendricks ◽

Colleen L. Barry ◽

Sarah E. Gollust ◽

Margaret E. Ensminger ◽

Margaret S. Chisolm ◽

...

Keyword(s):

Public Health ◽

Social Stigma ◽

Public Support ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Opioid Use ◽

Prescription Opioid Use

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Targeting the Orexin System for Prescription Opioid Use Disorder

Brain Sciences ◽

10.3390/brainsci10040226 ◽

2020 ◽

Vol 10 (4) ◽

pp. 226 ◽

Cited By ~ 2

Author(s):

Alessandra Matzeu ◽

Rémi Martin-Fardon

Keyword(s):

Opioid Use Disorder ◽

Prescription Opioid ◽

Prescription Opioids ◽

Opioid Use ◽

Effective Strategies ◽

System A ◽

Clinical Pain ◽

Promising Target ◽

Nonmedical Use ◽

Prescription Opioid Use

Prescription opioids are potent analgesics that are used for clinical pain management. However, the nonmedical use of these medications has emerged as a major concern because of dramatic increases in abuse and overdose. Therefore, effective strategies to prevent prescription opioid use disorder are urgently needed. The orexin system has been implicated in the regulation of motivation, arousal, and stress, making this system a promising target for the treatment of substance use disorder. This review discusses recent preclinical studies that suggest that orexin receptor blockade could be beneficial for the treatment of prescription opioid use disorder.

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