Prescription Opioids And Their Effects on Infants

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the Clinical Pain Advisor take:

"Vanderbilt University Medical Center reports a well know link between opioid use during pregnancy and Neonatal Abstinence Syndrome (NAS) in a recently-published study that is quickly gaining traction online.

It is sparking a great deal of controversy — in part because there is an already murky atmosphere surrounding opioids.The article reports infants born to mothers on opioids have a greater risk of low birth weights and premature births.

Yet, many clinicians and researchers alike are quick to point out that there are some serious leaps and discrepancies in the way the study is portrayed by the media, and unfortunately for many in the chronic pain community, such discourse can be painfully detrimental to their well-being.

It has been reported that the study implies that opioids are responsible for low birth weight and premature birth among infants. Perhaps this is true, but even the study's researchers point out that the risk to the infant may be less if the mother is on opioids.

As every introductory science and statistics course engrains in its students: correlation is not causation. In fact, the researchers tell us that the mothers with premature births and low infant weights were more likely to be smokers, and smoking has long been associated with greater risk of miscarriage, low birth weight, premature birth, Sudden Infant Death Syndrome (SIDS) and birth defects. Therefore, it’s more logical to conclude that tobacco use alone could explain the premature births and low birth weights.

To be sure, investigations like this one by researchers are important – the more we know about what things cause harm, the more able we are to prevent harm. However, we must be cautious in our interpretations of the results.

Ultimately, the conclusion of the media portrayal is inaccurate, misleading, and potentially harmful to the millions of Americans suffering from chronic pain, a community that sometimes relies on opioids to cope with their conditions.

Opioids are not, nor should they be the first line of defense against pain. They are not a long-term solution for many. Sadly, because public policy and insurance companies have not caught up to the complex needs of chronic pain patients, research remains underfunded and patient needs under-serviced. And for those patients, opioids are a last resort; truthfully, one most would gladly give up for a pain-free existence.

Media stories often wrongfully undermine and stigmatize an already undermined and stigmatized population.

They act as a deterrent from the real issue, ignore the needs of chronic pain sufferers and promote a tainted view of the benefits of opioids, without having concrete facts to support their claims.

Chronic pain patients need support. The interpretation of the Vanderbilt study by the media is one more setback against the progression of finding a suitable course of treatment for chronic pain sufferers across the United States."

Lynn Webster, MD, is the immediate past president of the American Academy of Pain Medicine and Vice President of Scientific Affairs at PRA Health Sciences. He is the author of a forthcoming book, “The Painful Truth.” Visit his blog, follow him on Twitter and Facebook.

Editor's Note: Many thanks from Clinical Pain Advisor to Lynn Webster, MD, immediate past president of the American Academy of Pain Medicine and Vice President of Scientific Affairs at PRA Health Sciences, who agreed to write this editorial response on this study (see below), and other related media reports on the study.

Among babies with NAS, 65% had mothers that filled opioid prescriptions.
Among babies with NAS, 65% had mothers that filled opioid prescriptions.

A new study from Vanderbilt University Medical Center shows that pregnant women are commonly being prescribed opioid pain relievers, which may increase the likelihood of neonatal abstinence syndrome (NAS) in infants following birth. Study findings were published in Pediatrics.

While not all babies exposed to opioids have withdrawal after birth, certain factors may increase an infant's risk, including the type of opioid and duration of exposure, tobacco use, or selective serotonin reuptake inhibitor use.

Researchers examined three years of data from Tennessee's Medicaid program and assessed records for 112,029 pregnant mothers. About 28% of women (n=31,354) were prescribed and had filled at least one opioid pain reliever. Among babies with NAS, 65% had mothers that filled prescriptions for opioid pain relievers. 

Ninety-six percent of women prescribed opioids received short-acting medications, while 2% received maintenance doses and <1% received long-acting opioids. Also, pregnant women who took opioid pain relievers were more likely to be white, have anxiety or depression, or suffer from headache or migraine and have musculoskeletal disease. Financially, every $1 spent on short-acting opioid pain relievers was linked to $50 spent caring for infants with drug withdrawal. 

Researchers wrote that they hope that findings from the study will help bring attention to the impact the prescription opioid epidemic can have on both mothers and infants.  - written by Da Hee Han, PharmD

Reference

1. Patrick SW, et al. Pediatrics. 2015; doi:10.1542/peds.2014-3299

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