Opioids and Opioid Use Disorder (OUD) in Pregnancy

Abstract

Opioid use in pregnancy has seen a similar rise, as seen in the general population in recent years. In a recent national survey, 6.6% of respondents reported prescription opioid use during pregnancy (Ko et al., MMWR Morb Mortal Wkly Rep 69:897–903, 2020). A surprising statistic presented in another recent survey reported that opioid prescription doses were often higher in women during pregnancy who were also co-prescribed anxiolytics. Compared with those prescribed opioids only, women with co-prescriptions of anxiolytics were more likely to exceed morphine milliequivalents (MME) of 90 or greater per day (Venkatesh et al., Ann Intern Med 173:S19–S28, 2020). This survey possibly highlights the role that poorly managed anxiety plays in worsening pain. Although the judicious use of opioids during pregnancy may be necessary and useful, the same concerns exist as with the use of opioids in the general population. This chapter will discuss the safe use of opioids during pregnancy, the importance of early identification and management of opioid use disorder (OUD), and appropriate follow-up and considerations following delivery.