Warning for women about opioid painkillers and birth defects

As more and more American women take prescription painkillers, health officials are raising the alarm about the risk of birth defects.

Powerful opioid drugs like hydrocodone, codeine and oxycodone are commonly prescribed for moderate to severe pain and they can be addictive. The drugs have also been linked to serious birth defects, including congenital heart defects; neural tube defects such as spina bifida; and gastroschisis, when a baby is born with the intestines erupting from their abdomen. Newborns can also suffer from withdrawal symptoms if their mothers took the drugs during pregnancy.

A new report from the U.S. Centers for Disease Control and Prevention looks how widely used these drugs are by women in their reproductive years, ages 15 to 44. It finds that more than a 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 between 2008 and 2012. The findings were published Thursday in the Morbidity and Mortality Weekly Report (MMWR).

"Taking opioid medications early in pregnancy can cause birth defects and serious problems for the infant and the mother," Dr. Tom Frieden, the CDC director, said in a statement.

The risk of birth defects from these drugs is greatest if they're taken during the first few weeks of pregnancy, a critical time for organ formation.

"Many women of reproductive age are taking these medicines and may not know they are pregnant and therefore may be unknowingly exposing their unborn child," Frieden said. "That's why it's critical for health care professionals to take a thorough health assessment before prescribing these medicines to women of reproductive age."

The researchers found that, on average, 39 percent of reproductive-aged women on Medicaid filled an opioid prescription from an outpatient pharmacy each year, as did 28 percent of those with private health insurance.

The CDC suggested a number of reasons why opioid prescription rates are higher among Medicaid enrollees, including differences in which drugs are covered under various insurance plans, greater use of health services or more prevalent underlying health conditions among patients with Medicaid.

The researchers also noted significant differences among racial groups and regions of the country. Non-Hispanic white women were nearly one and a half times more likely to get opioid prescriptions than black or Hispanic women, according to Medicaid data. Private insurance claims show opioid prescriptions rates were highest in the South and lowest in the Northeast.

"Many women need to take opioid-containing medications to appropriately manage their health conditions," the report acknowledged. "However, in some instances safer alternative treatments are available and use of opioids is unnecessary." It said doctors and patients need to be aware of the risk of birth defects to make informed decisions about use of these drugs.

Those decisions may also be swayed by a recent study in the Annals of Internal Medicine that found prescription painkillers are not necessarily effective for treating chronic pain from conditions like arthritis, headaches, backaches, shingles and fibromyalgia.

Overuse of painkillers is also behind a worrisome rise in hospital visits and overdose deaths. The number of U.S. hospital admissions for narcotics rose to 219 million in 2011, from 76 million in 1991. Death rates from prescription opioid pain reliever overdoses quadrupled from 1999 to 2010, the CDC reports.