Analysis Health Systems

The CDC’s Newest Report on Opioids Prioritizes Hypothetical Fetuses Above Living Women

Kristen Gwynne

The CDC suggested in a press release that women “of reproductive age”—pregnant or not—should face additional scrutiny when it comes to receiving prescription painkillers, simply because they are biologically capable of hosting a fetus.

On Thursday, the Centers for Disease Control and Prevention (CDC) released a report on opioid prescription claims among women 15-to-44 years old. The report found that between 2008 and 2012, about one-third of women on Medicaid and private health insurance filled opioid prescriptions in the past year. Rather than explore the data’s implications for women’s health, however, CDC representatives have concentrated their manufactured alarm on the report’s potential implications for patients’ hypothetical fetuses, potentially welcoming medical discrimination against people with wombs.

Because of the (overstated) risk of birth defects and withdrawal symptoms in newborns, the CDC suggested in a press release that women “of reproductive age”—pregnant or not—should face additional scrutiny when it comes to receiving prescription painkillers, simply because they are biologically capable of hosting a fetus. CDC officials did not make an explicit judgment call on doctors’ decisions; still, it is not inconceivable that providers could take their recommendation as a justification for withholding prescriptions.

“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. 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,” CDC Director Tom Frieden said in the press release, as if all women should be treated by physicians as potentially pregnant—with a fetus whose welfare takes priority over the woman’s own.

Indeed, though Frieden touched on the possibility of opioids’ harm to grown women by saying, “Taking opioid medications early in pregnancy can cause birth defects and serious problems for the infant and the mother,” neither he nor the CDC report provided any additional insight into the effects of opioid use on women themselves. The report did not even acknowledge that fatal opioid overdose among women is rising at the alarming rate of 400 percent since 1999; nor did its authors wonder what diagnoses may be causing the pain behind the prescriptions. Any concern CDC representatives had for women themselves was not documented in their report or press release.

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Instead, the agency dwelled on the possibility of birth defects in the fetuses of pregnant women using opioids. “Previous studies of opioid use in pregnancy suggest these medications might increase the risk of neural tube defects (major defects of the baby’s brain and spine), congenital heart defects and gastroschisis (a defect of the baby’s abdominal wall),” its press release noted. “There is also a risk of neonatal abstinence syndrome (NAS) [characterized by symptoms of withdrawal] from exposure to medications such as opioids in pregnancy.”

To suggest that women be held to a different medical standard simply because they are presumed biologically capable of pregnancy is not only sexist; it also presents the possibility of inadequate treatment for women. Prioritizing wombs over people could have serious implications for women’s health, particularly when it comes to access to opioid painkillers for the treatment of chronic or severe pain. Whether a woman suffers from rheumatoid arthritis, has slipped a disc in her back, or has undergone dental surgery, she deserves access to medication that will make her pain more tolerable. No one should endure unnecessary suffering when there is a remedy available, and suggesting that a woman’s reproductive ability should urge doctors to take special care when prescribing her opioids puts the potential for a fetus above a living woman and her needs.

What’s additionally alarming is that CDC officials also overlooked the benefits of treatment for opioid-dependent women, while sensationalizing the broader potential health risks of fetuses exposed to opioids in utero.

The report, for example, included in its data women who were prescribed opioid-replacement therapy medications like buprenorphine and methadone, but did not note that these substances have become standard in care for opioid-dependent pregnant women.

“Methadone maintenance therapy (MMT) enhances an opioid-dependent woman’s chances for a trouble-free pregnancy and a healthy baby,” a National Institute Drug Abuse staffer wrote of a 2012 report, “Compared with continued opioid abuse, MMT lowers her risk of developing infectious diseases, including hepatitis and HIV; of experiencing pregnancy complications, including spontaneous abortion and miscarriages; and of having a child with challenges including low birth weight and neurobehavioral problems.”

Similarly, a 2010 report from the National Institute of Health advised, “Methadone is currently the recommended treatment for opioid-addicted pregnant women, and when properly used is considered relatively safe for the fetus.” A 2012 report funded by the National Institute of Drug Abuse concluded “buprenorphine treatment during pregnancy has some advantages for infants compared with methadone and is equally safe.” The articles do mention the possibility of neonatal abstinence syndrome; however, medical advances are available to treat such withdrawal, and these replacements are still believed to be safer for a developing fetus than other opioids.

Opioid-replacement therapy drugs are also considered a healthier alternative for fetuses to quitting cold turkey. According to the American Congress of Obstetricians and Gynecologists, “Abrupt discontinuation of opioids in an opioid-dependent pregnant woman can result in preterm labor, fetal distress, or fetal demise.”

Yet, in a report full of worry regarding the wellness of fetuses, the CDC waived an opportunity for education and lumped opioid replacement medication in with the other opioids it recommended doctors be leery of prescribing to women. Regardless of whether women are pregnant, denying them replacement therapy is an inhumane action: According to a 2013 UN Human Rights Council Report on torture and other cruel or degrading treatment or punishment, “A particular form of ill-treatment and possibly torture of drug users is the denial of opiate substitution treatment.” And again, if women are pregnant, neglecting to prescribe them opioid replacements could, in fact, put their fetuses in more danger.

Meanwhile, the authors of the CDC report also overstated the risks of birth defects in fetuses, relying on a 2011 study by Cheryl S. Broussard et. al. that does not, in fact, support the wide-sweeping claims the agency makes in its report.

“The development of birth defects often results from exposures during the first few weeks of pregnancy, which is a critical period for organ formation,” the CDC researchers said. “Given that many pregnancies are not recognized until well after the first few weeks and half of all U.S. pregnancies are unplanned, all women who might become pregnant are at risk”—though, again, these risks are to the hypothetical fetus rather than the woman herself.

A much more modest summary than the CDC report’s characterization of the research, Broussard et. al.’s study actually concluded, “It is important to emphasize that an increased relative risk for any rare birth defect with an exposure [to substances] usually translates into only a modest absolute increase in risk above the baseline birth defects risk.”

In other words, the study cited by the CDC researchers found that although opioid use during pregnancy raised the risk of some birth defects, they still remained exceedingly rare even among opioid-exposed newborns. Broussard et. al.’s study found, for example, that the chances of a baby being born with a congenital heart defect to a mother who used opioids more than doubled, but only brought the rate up to “5.8 in 10,000”—less than 1 percent.

Regarding the “neural tube defects” mentioned in the CDC’s press release, too, Broussard et. al. wrote that these defects “have not been associated with maternal opioid treatment in human pregnancy,” but only in pregnant hamsters. Broussard’s study did find a previously unobserved link between opioid use and babies born with glaucoma, hydrocephaly, and gastroschisis—the third birth defect referenced in the release—but said that “Given the probability that some findings may be due to chance, our results should be treated with caution and deserve further investigation.”

Broussard et. al.’s study also acknowledged as a limitation that “opioids were most commonly reported within the surgical procedures” part of the questionnaire, and the potential effects of anesthesia or the medical conditions that prompted the surgery were not differentiated from opioid use. Unlike the CDC scientists, the authors of this study noted that previous research has been inconsistent and limited, so that “the effects of opioid use on the developing fetus during pregnancy are poorly understood.”

Meanwhile, the 2011 study by Ann Kellogg, et. al. that CDC researchers used to point to withdrawal symptoms in opioid-exposed newborns is also an inappropriate resource to parrot. This study actually found withdrawal symptoms among infants exposed to opioids in-utero was uncommon: Only 5.6 percent of babies exposed in-utero were diagnosed with neonatal withdrawal syndrome. But the study did not evaluate the effects of “co-morbid conditions” like cigarette-smoking and alcohol use, which could have also played a factor in the results. And like the Broussard study, its reliance on surveys conducted after-the-fact made confirming at what doses prescriptions were consumed—or whether they were taken at all, and not just filled—impossible.

Why some opioid-exposed fetuses are born experiencing withdrawal, but most are not, is unknown. “What we do know is that if we abruptly discontinue their mother from opioid treatment, a greater percentage will experience problems. And we know how to treat withdrawal. It’s simple,” Dr. Carl Hart, an associate professor of psychology and psychiatry at Columbia University who has studied drug-use in pregnant women, told Rewire. “And so when we think about risk-benefit ratio, it is more favorable in terms of keeping mothers on opioids and then dealing with withdrawal, if the infant even has it. That’s a no-brainer.”

All in all, although medical providers and patients should be aware of the potential risks of opioid use on themselves and their fetuses, it is offensive and discriminatory to use these inconclusive studies to suggest that gender should be a factor in decisions regarding the prescription of medications that can help mitigate debilitating pain.

And yet, despite the damaging implications of the CDC’s study and instructive press release, dozens of media outlets took the bait. NBC went so far as to run the absurd headline, “Pill-Popping Mommas: ‘Many’ Pregnant Women Take Opioids, CDC Finds.” The New York Times claimed, “In Scioto County in southeast Ohio, for example, about one in 10 babies are born addicted,” despite the fact that babies cannot possibly exhibit addictive behavior—the seeking-out of drugs despite interference with their lives—required by DSM guidelines. “Ladies!!! The CDC Says to Dial Back the Opioids!!!” the feminist website Jezebel declared in a headline, quoting the press release before adding, “This is particularly important because opioid addiction rates are climbing in the United States, with overdoses among women becoming disproportionately common.” The site’s endorsement of the report came despite the fact that, again, the CDC made no mention of said increase in overdose.

Do feminists really think that women should be suscepted to a system of scrutiny when it comes to opioid prescriptions, simply because of their biology? Should pregnant women who have undergone surgery be denied these medications because the fetuses they may or may not be carrying just might show symptoms of withdrawal?

It’s time everyone—feminists in particular—understands the implications of drug and health policy that uses stigma to put women’s wombs over their person. Beyond the possibility of bias in the health-care system, the demonization of opioid use during pregnancy can lead to unnecessary, invasive medical procedures like drug-testing at birth, the results of which can strip loving parents, especially people of color, from guardianship over their children. In Ohio, for example, a pregnant woman addicted to opioids began buprenorphine treatment at the recommendation of her doctor, only to be charged by Child Protective Services after her son tested positive for the drug.

The CDC’s latest report, which relies on the perception of women as vessels for human reproduction, is the most recent in a long line of panic over “drug-addicted babies” who grew up to be just fine. Elevating inconclusive research to pit the interests of a fetus against those of a woman is degrading and dangerous, and the CDC—and much of the mainstream media—owes us an apology.

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