Opioid treatments are still warranted and safe at times during pregnancy and the postpartum period, according to the American College of Obstetricians and Gynecologists.
The statement comes in response to the CDC’s new guidelines for opioid prescriptions in primary care settings, which, among other recommendations, advised that nonopioid therapy is preferred for chronic pain, except in cases of active cancer, palliative and end-of-life care.
Mark S. DeFrancesco, MD, MBA, president of the American College of Obstetricians (ACOG), wrote the statement, arguing that while the organization agrees that opioid treatment should be reserved for cases with no safe or appropriate alternatives, it is nonetheless concerned the CDC’s guidelines could discourage women from receiving the appropriate care by “overstating the risk of rare complications associated with opioid use during pregnancy, and by understating the potential risk associated with opioid discontinuation.”
“ACOG agrees with the CDC that opioid should only be used for treatment of pain when alternatives are not appropriate or effective, but we also know that there are times, including during pregnancy and the postpartum period, when such use is both appropriate and safer than the alternative,” DeFrancesco wrote. “Opioids may be needed to treat acute pain such as from cesarean delivery, kidney stones, sickle cell crisis or trauma in pregnancy, or as part of an established plan to treat problems associated with substance use disorders.”
DeFrancesco said it is recommended that patients and providers continue opioid agonist treatment in pregnancy, adding that although their use can lead to neonatal abstinence syndrome, it is both expected and treatable, and does not pose any permanent risks. However, opioid withdrawal during pregnancy may be associated with complications including fetal death, he said.
“While some studies have suggested an association between birth defects and other adverse outcomes with opioid use in pregnancy, the absolute risk of these problems is low and data demonstrating a causal connection are lacking,” DeFrancesco wrote. “As a result, there are circumstances in which the balance of risk and benefits argues for judicious use of these medications in pregnancy, either for pain management or opioid agonist treatment.”
The ACOG also announced an Opioids and Addiction Medicine Expert Work Group, made up of ob-gyns working in opioid addiction, substance abuse and evidence-based medicine. The organization will also host a pair of opioid use courses on April 29, featuring educators from the American Society of Addition Medicine. One course, on buprenorphine, will “train ob-gyns to obtain a waiver to engage in office-based treatment of opioid use disorders using drugs approved by the FDA on Schedules III, IV and V,” with a special emphasis on women and pregnancy. The second course will cover opioid prescribing.
“ACOG hopes that CDC’s new information regarding opioid use helps to address and mitigate the ongoing opioid crisis in our country,” DeFrancesco wrote. “However, we continue to advocate for an evidence-based approach to opioid use during pregnancy that supports the ability of pregnant women to access appropriate care.” – by Jason Laday