How the U.S. Opioid Crisis Affects Women and Infertility Medicine

The current opioid crisis in the United States is a frequent topic across headlines, in many conversations, and throughout the medical community. It is one of the major public health issues of today, and many Americans have suffered from its effects.

In her article in the August 2017 issue of the ASRM medical journal, Fertility and Sterility, Mishka Terplan, M.D., M.P.H. provides statistics to highlight the vast spread of the opioid crisis. Although the U.S. accounts for a mere 4.6% of the global population, it holds more than 80% of the world’s opioid supply. Current estimates say 4.7% of the American population misuses opioids. The majority of this misuse falls among women, especially women of reproductive age. This group receives more opioid prescriptions yearly than any other, often for pain management of endometriosis, dysmenorrhea, or other conditions and close to 40% of American women between the ages of 15 and 44 were prescribed an opioid last year. Consequently, women account for 57% of U.S. opioid misusers. Alongside the rise in misuse, opioid deaths have also risen—between 1999 and 2010, deaths in women from opioid abuse rose by 400%. Because of these scary statistics, ASRM recommends that all providers who care for female patients should be educated and able to assess all patients for their risks for opioid misuse and addiction.

Patients who need a reproductive surgery as part of their infertility treatment often experience pain, and may be prescribed opioids as part of recovery. In light of the current addiction crisis, many physicians and scientists are calling for alternative, less risky, approaches, especially for patients with a history of opioid use or an opioid use disorder. Malavika Prabhu et al. advocate for these alternative pain management strategies for women in their article within the same issue of Fertility and Sterility. They suggest replacing opioid prescriptions both pre-operatively and post-operatively with non-opioid analgesics, such as acetaminophen, or regional anesthetic blocks.

The authors note another new strategy that a hospital used effectively: shared decision-making between the physician and patient. In this case, physicians offered cesarean section patients the option to select the number of tablets of an opioid they would be prescribed after a procedure, up to the usual quantity given for the procedure. This followed a lengthy discussion of the prescription’s benefits and risks, normal use, and how to dispose of leftover tablets. In the case study mentioned here, shared decision-making led to a 50% decrease in the amount of pills prescribed after cesarean section surgeries.

These papers offer a hopeful outlook on curtailing the opioid crisis in the U.S. If physicians with female patients recognize the population of women of reproductive age as being particularly at-risk for misuse and addiction, and take tangible steps to address it such as those outlined above, many women can be effectively guided to avoid or overcome opioid addiction.

The physician team at IRMS is among the best in the nation, consisting of eight female physicians passionate about helping other women. All of our doctors specialize in providing holistic care to all of their patients and act as constant advocates for women’s health. If you have any concerns about your fertility relating to this subject or any other, contact us through our online contact form or by calling (973) 322-8286.

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