Why younger women should skip taking narcotic painkillers

Enough prescriptions are written every year for drugs such as OxyContin, Percocet, and Vicodin to provide every U.S. adult with a bottle of pills. Shockingly, opioid prescribing has become routine even for women of childbearing age, a group particularly vulnerable to opioid dangers, according to a recent analysis from the Centers for Disease Control and Prevention (CDC). Among women aged 15 to 44, more than one fourth of those with private insurance and more than one third of those enrolled in Medicaid were prescribed an opioid each year. 

"That was certainly one of the most surprising things we found; how widespread the use of these drugs was in this group of women," says Jennifer Lind, Pharm.D., M.P.H., a pharmacist and epidemiologist with the CDC's National Center on Birth Defects and Developmental Disabilities. 

These drugs carry risks for adults as well, including a risk of addiction and other serious side effects and even death—especially when used at high doses or for long periods of time. About 16,000 Americans die each year due to opioid overdose, and the rate of fatal overdoses is rising much more quickly in women than men.

Surprising and worrisome

While opioids—found mostly in narcotic pain killers but also in some prescription cough and cold drugs—are among the most commonly used prescription drugs in the U.S., they can be especially dangerous for developing infants.

"We want to get the word out that women in this age group should avoid opioids as first-line therapy," says Lind.

The CDC analysis found that women of childbearing age most commonly used the opioids listed below, which are found in more than 150 different prescription medications. (We provide a few brand-name examples, but in many cases the drugs are also available as generics.) 

• Codeine. Found in prescription pain drugs such as Tylenol 3 (acetaminophen and codeine) and Empirin with codeine (aspirin and codeine) as well as a long list of prescription cough and cold drugs, including Cotabflu (acetaminophen, chlorpheniramine, codeine), Mar-cof BP (brompheniramine, codeine), Nasotuss (chlorcyclizine, codeine, and phenylephrine), and Robitussin-AC (codeine and guaifenesin).
• Hydrocodone. Found in prescription pain drugs such as Vicodin (acetaminophen and hydrocodone) and Zohydro ER (extended-release hydrocodone) as well as some prescription cold and cold drugs, including EndaCof-Plus (dexchlorpheniramine, hydrocodone, and phenylephrine) and Tussionex (chlorpheniramine and hydrocodone).  
• Oxycodone. Found in many prescription pain drugs such as Percocet (acetaminophen and oxycodone) and Oxycontin (extended-release oxycodone).  

With half of pregnancies in the U.S. unplanned "many women may wind up taking opioids during the early weeks, before they even realize they are pregnant" says Lind. Early pregnancy is a critical window of development, when the baby's organs are forming. Research suggests that using opioids during that time may slightly increase the risk of defects in the baby's brain, spine, heart, and abdominal wall. 

See our list of 10 over-the-counter drugs you should avoid taking while pregnant.

Opioid medications may pose risks to developing infants at other points as well. Taken throughout pregnancy, the drugs increase the chances that babies will be born underweight or too early, which increases the risk of complications such as low blood sugar, jaundice, and problems with breathing and feeding. If a woman takes opioids towards the end of her pregnancy, the baby may be born addicted to the drugs and undergo withdrawal in the first days to weeks of life.

Other research confirms that women wind up taking opioids while they are pregnant. Nearly a quarter of the 1.1 million pregnant women enrolled in Medicaid filled a prescription for an opioid medication in 2007 according to a study published in the journal Obstetrics & Gynecology in 2014. Another recent study of one-half million pregnant women with private insurance found that doctors had prescribed opioids for 14 percent of them.

Read more about the dangers of opioids in our special report, "The Dangers of Painkillers."

Bottom line: If you are pregnant or could possibly become pregnant, avoid opioid medications if at all possible. Even if a baby is not in your immediate plans, it's still prudent to talk to your doctor about the safer options. That means, for example, opting out of prescription cough and cold drugs that contain codeine or hydrocodone and treating mild-to-moderate pain with over-the-counter pain relievers such as acetaminophen (Tylenol and generic) rather than prescription narcotics.

Keep in mind that not all OTC drugs are safe to take when you're expecting. (See our list of top 10 OTC drugs to avoid during pregnancy.)

If you wind up needing an opioid drug to ease more severe pain, talk to your doctor about taking the lowest possible dose for the shortest time Lind advises. And, if you are not pregnant and there's a chance you could become pregnant, always use a reliable form of contraception while taking the medication.

—Teresa Carr