Health Wanted: The Maternal Opioid Crisis
HEALTH WANTED, a weekly radio show and podcast produced in partnership with WABE, brings need-to-know public health headlines and breaks down the science behind trending topics.
The Episode
The topic: The opioid epidemic has affected the lives of millions of Americans, including pregnant people experiencing opioid use disorder and their newborns. This week on Health Wanted, host Laurel Bristow and guest Stephen Patrick, MD, speak about how the opioid epidemic impacts pregnant people and the importance of improving their access to life-saving treatment.
The takeaway: Over half a million people have died from opioid overdoses since the opioid epidemic began in 1999. Pregnant people with opioid use disorder often face challenges accessing care for their condition, which has negative health consequences for themselves and their newborns.
- Opioids are a type of drug that interacts with receptors in the nerves and brain to reduce the intensity of pain. Opioids can be found in nature, like certain poppy plants, or completely man-made and synthetic, like fentanyl. They can also be somewhere in between, like heroin and oxycodone, which are semisynthetic.
- The first wave of the opioid epidemic started in the late 90s when Purdue Pharma began making extended-release oxycodone and misinformed doctors that the drug had a low risk of dependency. Doctors began to prescribe more opiates, and more patients began to experience opioid use disorders.
- The third and current opioid epidemic wave has seen an increase in the use of fentanyl, which is cheap to produce and extremely strong. Fentanyl is a fully synthetic drug, easy to ship, and much easier for people to overdose on than other opiates.
- Pregnant people can experience opioid use disorder, but they often have less access to treatments that can improve health outcomes for both the birth parent and the baby. When birth parents can’t access treatment, their newborns are more likely to experience neonatal abstinence syndrome at birth, a form of drug withdrawal.
The Interview
The guest: Stephen Patrick, MD
The key takeaways:
- The opioid crisis has evolved from the use of prescription opioids to cheaper, illicit drugs like heroin and fentanyl. Multiple evidence-based treatments to help with the recovery process are available such as buprenorphine or methadone, but the majority of people with opioid use disorder, especially pregnant individuals, have a difficult time accessing them.
- Systemic racism plays a role in how treatment is allocated. Non-Hispanic Black people are more likely to face punitive measures, such as child welfare referrals and criminal charges, and have more trouble accessing treatment than white individuals. In some areas such as Tennessee, non-white parents are disproportionately arrested for substance use, but most babies with opioid withdrawal are born to white parents.
- Opioid overdose is the leading pregnancy-associated cause of death in multiple states, including Georgia. People will often cut down on substance use while they are pregnant, decreasing their opioid tolerance. They may then overdose from an amount of opioid that they could previously tolerate.
- Abruptly stopping opioids can lead to withdrawal for both pregnant people and their babies, which can result in fetal loss. Buprenorphine and methadone are safe to use during pregnancy and critical to avoid the higher risks of continuing opioid use during pregnancy.
The Listener Questions
Why are people getting cancer younger?
Early onset cancers, or cancers that happen in people under 50, still make up just a fraction of total cancer. Over 80% of cancers are still diagnosed in people over 55 years old.
Cancers in younger people have been slowly but steadily increasing, which is concerning given that rates of cancers have been decreasing in older groups. The risks are still lower the younger you are, but if there is an incremental increase with each generation, we need to figure out what’s causing it.
While we don’t yet have that answer we have a couple of ideas. It could be related to a more sedentary lifestyle, changes in diet and exercise, environmental exposures, changes in sleep habits, or a combination of everything. It’s not something to panic about, but it’s definitely something we want to investigate more so we can make better recommendations for both prevention and screening.
Is there a new medication for treating postpartum depression?
Zuranolone (brand name Zurzuvae) was approved just about a year ago to treat postpartum depression. It’s a twice daily pill that’s taken for 14 days and is the first oral medication to treat postpartum depression. It can kick in as quickly as within 3 days of starting and the effects can last as long as 4 weeks after the last dose.
Previously there was a different medication called brexanolone (brand name Zulresso) that could be used for postpartum depression, but it required a 60 hour IV and a hospital stay, which is not ideal when you have a new baby.
However, there are some limitations to the studies used to approve this new pill-based form of treatment. Mainly, they only followed people for 45 days, so long-term outcomes aren’t known yet. But considering that postpartum depression affects an estimated 1 in 7 new moms, and that suicide is one of the leading causes of maternal death, we desperately need more options on top of therapy and antidepressants to help people. Now that we are at just about a year of the pills being available, I am really hoping for some longer-term follow up data.
Catch all the listener questions and Laurel’s answers on the full episode of Health Wanted by:
- Streaming at wabe.org or the WABE app
- Subscribing on Apple or Spotify
- Watching on WABE's YouTube channel
