566: Co-prescription of opioids and psychotropics among commercially insured US pregnant women and neonatal abstinence syndrome

Abstract

In the US the incidence of neonatal abstinence syndrome (NAS) is rising, and both maternal opioid and psychotropic use have been implicated as independent risk factors. Our objective was to determine the association between maternal co-prescription to opioid and psychotropic medications and NAS compared to either opioids or psychotropics alone. A retrospective observational study of the 2001-2015 MarketScan database, a nationwide de-identified population of commercial insurance beneficiaries. Our primary outcome was NAS identified by diagnosis codes (ICD-9 779.5x). Our exposure was outpatient opioid and psychotropic co-prescription compared to psychotropics only and opioids only. Among co-prescribed women, we conducted subgroup analyses among women prescribed >1 type of psychotropic, opioid prescription >30 days (i.e. chronic use), co-prescription during the same trimester, and prescription of gabapentin and benzodiazepine. Multivariable logistic regression models were used, adjusting for age, insurance type, dependent children, diagnosis codes for alcohol, tobacco, or illicit drug use, and US region to determine the association between maternal co-prescription and NAS. We identified 958,274 pregnant women with live births >21 weeks; 94,588 (9.9%) had only an opioid prescription, 55,285 (5.8%) had only a psychotropic prescription, and 19,884 (2.1%) had both. The frequency of NAS was significantly higher with co-prescription compared to either opioids or psychotropics (1.3% vs. 0.2%, 0.2%; p<0.0001); and increased further among subgroups of co-prescribed women. The adjusted odds of NAS for infants with mothers with co-prescription was 3.95 (95% CI: 3.22-4.85) compared to opioids only, and 6.10 (95% CI: 4.73-7.88) compared to psychotropics only (Table 1). Among co-prescribed women, opioid prescription >30 days (vs. ≤30 days), and co-prescription during the same trimester (vs. no trimester with co-prescription) further increased the adjusted odds of NAS (Table 2). Among commercially insured US pregnant women, compared to either prescription type alone, co-prescription of opioids and psychotropic medications is associated with significantly greater risk of NAS. These findings suggest that the evidence-based use of opioids and psychotropics for maternal pain and mental health disorders could decrease the rising rate of NAS.View Large Image Figure ViewerDownload Hi-res image Download (PPT)