overdose, which includes patients taking more than 50 MME per day, patients with a history of overdose or substance use disorders, and those concurrently taking benzodiazepines. The patient’s history of controlled substance prescriptions should be evaluated periodically using prescription drug monitoring program (PDMP) data. Depending on the patient, data evaluation can range from every prescription to every three months. Urine drug testing can also be used as a tool to prevent the diversion of opioids; testing before Opioid Side Effects Many patients treated with an opioid will experience side effects. Unfortunately, these side effects are challenging to manage, and tolerance to these problems frequently does not develop. Some patients can benefit from changing the opioid or the route of administration used. Proper screening, education, and pre-emptive treatment will minimize bad outcomes and enhance efficacy in many cases. 111 Respiratory depression is the most serious adverse effect of opioids; it can be immediately life- threatening. The risk of respiratory depression or respiratory arrest is higher in patients with an upper respiratory infection, asthma, or other respiratory problems. 160 Constipation is the most common side effect but can often be managed with laxatives or stool softeners. 161 Other common side effects include sedation, dizziness, vomiting, physical dependence, tolerance, and respiratory depression. Less frequently observed side effects of opioid use are delayed gastric emptying, hyperalgesia (increased sensitivity to pain), immunologic or hormonal dysfunction, muscle rigidity, and myoclonus (spasmodic jerky contractions of groups of muscles). 160 Opioids that have agonist effects have various immediate and long-term effects on the body. Other short-term side effects of opioids include the
and periodically during long-term opioid therapy is recommended by CDC. 118 Patients should be required to submit to urine drug screens before initiating opioid therapy and at least annually to confirm adherence to the treatment plan. Drug testing must be consensual as a part of the treatment plan, with the understanding that it is key to patient safety. 118 opioids ingested by the mother. Maternal opioid use is associated with obstetric complications including premature membrane rupture, preeclampsia, spontaneous abortion, abruption placentae, and fetal death. Fetal opioid exposure is associated with preterm birth, low birth weight, small head circumference, and sudden infant death. Neonatal abstinence syndrome is reported frequently in newborns that were exposed to opioids in utero, which has been shown to cause behavioral, cognitive, and psychomotor impairments as the child gets older. 162 The Nebraska Pain Management Guidance Document points out several special considerations regarding opioids and pregnancy, including: 163 ● Pregnant women are generally younger patients, who have different treatment needs and risk factors for abuse than other populations. ● A number of potentially serious adverse consequences can result from opioid withdrawal, including premature labor, membrane rupture, and fetal death ● Pregnant women may experience significant shame and guilt with their opioid use during pregnancy, resulting in a situation where the patient doesn’t acknowledge the seriousness of their opioid use and leading to provider misconceptions on the severity of their addiction. ● Pregnancy causes several maternal metabolic changes, which can reduce the opioid dose needed to prevent withdrawal. ● Prolonged opioid use during pregnancy can lead to the development of neonatal abstinence syndrome, which is best treated when providers are aware of the situation before delivery. ● When treating pregnant patients for opioid-use disorder, buprenorphine is the first-line agent for treatment. Methadone has also been used for years in this population, but it is associated with a higher frequency of neonatal abstinence syndrome and opioid-related adverse effects. Obstetricians should collaborate with pain management specialists to ensure that special dosing considerations for this population are implemented. A systematic review was conducted in 2017 to establish a better understanding of what is known about opioid use during pregnancy and birth defects. It found maternal opioid use may be linked to several congenital defects in neonates. These malformations include oral clefts, septal defects in the heart, and clubfoot. In addition, prenatal opioid exposure was
following: 118,144 ● Analgesia. ● Reduction of consciousness. ● Euphoria. ● Reduction in blood pressure. ● Nausea and vomiting. ● Constipation. ● Urinary retention. ● Pruritus.
Many long-term side effects of opioid agonists can be explained by hormonal dysregulation, including the following: 111 ● Depression. ● Sexual dysfunction.
● Gastroparesis. ● Hyperalgesia. ● Fractures. Opioids and Pregnancy
Maternal opioid treatment during pregnancy is associated with a variety of birth defects that are important contributors to infant morbidity and mortality. Opioids can cross both the placenta and the blood-brain barrier, allowing for fetal exposure to
Book Code: CA23CME
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