How to develop drug formularies for pain treatment in women of reproductive age

More than one-third of reproductive-aged women enrolled in Medicaid, and more than a quarter of those with private insurance, filled a prescription for an opioid pain medication each year during 2008 to 2012, according to a recent report in Morbidity and Mortality Weekly Report (MMWR).

The most commonly prescribed opioids among both groups of women were hydrocodone, codeine and oxycodone.

Dr Lind

Study co-author Jennifer Lind PharmD, MPH, Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, CDC, and researchers analyzed 2008 to 2012 data from 2 large health insurance claims datasets: One of women aged 15 to 44 years with private insurance and another of women in the same age group enrolled in Medicaid.

They found that, on average, 39% of Medicaid-enrolled women filled an opioid prescription from an outpatient pharmacy each year compared to 28% of women with private health insurance. 

Related: Opioid use among pregnant women: Surprising rate

The higher opioid prescribing rates among Medicaid enrollees might be due to differences in the prescription medications covered under their health insurance plan, differences in use of healthcare services, or differences in the prevalence of underlying health conditions among Medicaid enrollees compared with persons covered by private health insurance.

Geographic region data available in the private insurance claims indicated that opioid prescription rates were highest among reproductive-aged women in the South and lowest in the Northeast.  Race/ethnicity information was available for the Medicaid data and indicated opioid prescriptions were nearly one and a half times higher among non-Hispanic white women of reproductive age compared to non-Hispanic black or Hispanic women.

Study: Many opioid users are taking Rx drugs in potentially harmful combinations; education needed

Previous studies of opioid use in pregnancy suggest these medications might increase the risk of neural tube defects, congenital heart defects and gastroschisis (a defect of the baby’s abdominal wall). There is also a risk of neonatal abstinence syndrome (NAS) from exposure to medications such as opioids in pregnancy. NAS is when a newborn experiences symptoms of withdrawal from medications or drugs taken by a mother during pregnancy.

According to Dr Lind, when developing drug formularies for pain treatment in women of reproductive age, formulary managers should ensure that:

1/ Opioids are avoided as first-line therapy. All treatment options should be explored before considering opioid medications and opioids should only be used after other treatments have proven ineffective.

2/ Opioid medications are prescribed and dispensed for the shortest duration possible.

3/ The lowest effective dose is prescribed and that pain and treatment progress is carefully monitored.

4/ Effective contraception is discussed with women who are sexually active to reduce their risk of becoming pregnant while taking opioid medications.

Related: Once-daily opioid formulated with abuse-deterrent properties now available

“This important study is a part of CDC’s Treating for Two initiative, which aims to expand research and develop guidance for safe medication use during pregnancy,” Dr Lind said. “This information will allow women and their doctors to make informed decisions about treating health conditions, like pain, during pregnancy.”