The Morbidity and Mortality Weekly Report issued by the Centers for Disease Control and Prevention on August 10, 2018, indicates a growing prevalence of opioid use disorder (OUD) in women delivering babies at hospitals across 28 US states and the District of Columbia (DC) between 1999 and 2014, with quadrupling at the national level during this period.
The authors of the report emphasize the significant public health burden associated with this phenomenon because of related health issues in mothers and newborns, which include neonatal abstinence syndrome. “State-level actions are critical to curbing the opioid epidemic through programs and policies to reduce use of prescription opioids and illegal opioids including heroin and illicitly manufactured fentanyl, both of which contribute to the epidemic,” noted the authors.
Hospital discharge data from the State Inpatient Databases (for 28 states and DC) and the National Inpatient Sample of the Healthcare Cost and Utilization Project for the period of 1999 to 2014 were examined. In-hospital deliveries and opioid use disorders were identified by codes for obstetric deliveries and opioid dependence/nondependent opioid abuse, respectively, using the International Classification of Diseases, Ninth Revision.
During the period examined, the prevalence of OUD rose from 1.5 to 6.5 cases per 1000 deliveries nationally (average annual increase, 0.4 case per 1000 deliveries; P <.05), corresponding to a 333% increase. Prevalence of OUD varied widely by state, with some states affected to a greater extent (eg, in 1999: 0.1 vs 8.2 cases per 1000 deliveries in Iowa and Maryland, respectively; in 2014: 0.7 vs 48.6 cases per 1000 deliveries in DC and Vermont, respectively). Across all 28 states for which data were available, the prevalence of OUD in women delivering at hospitals increased in a linear manner during the period examined (P <.05 for all states). Vermont, Maine, West Virginia, and New Mexico had the greatest annual rate increases in OUD between 1999 and 2014 of the 28 states examined (5.37, 4.13, 2.83, and 2.47 cases per 1000 deliveries, respectively), and California had the lowest, with 0.01 case of OUD per 1000 deliveries.
“If a patient has opioid use disorder, clinicians should prescribe medication-assisted therapy when possible and appropriate,” noted the report authors. “Pregnant women with [OUD] involving heroin might require referral to harm reduction services (eg, comprehensive syringe services). Arranging for pregnant patients with [OUD] to deliver at facilities prepared to monitor and care for infants with neonatal abstinence syndrome can facilitate access to appropriate care. After delivery, women might need referrals to postpartum psychosocial support services, substance-use treatment, and relapse-prevention programs,” they added.
Haight SC, Ko JY, Tong VT, Bohm MK, Callaghan WM. Opioid use disorder documented at delivery hospitals – United States, 1999-2014. MMWR Morb Mortal Wkly Rep. 2018;67:845-849.