Prescription Opioids in the Perinatal Period (POPP) Program

About POPP

The Prescription Opioids in the Perinatal Period (POPP) Program harnesses the power of ‘big data’ to generate real-world evidence regarding the use and safety of prescription opioids before, during and after pregnancy (also known as the perinatal period).

Opioids can be used for two main therapeutic purposes. Opioids such as codeine, oxycodone, tramadol, and morphine are used to manage pain. Conversely, opioids including methadone and buprenorphine, are used as part of a treatment known as opioid agonist therapy (OAT) for people with opioid dependence. The treatment for both these conditions requires careful monitoring and adherence to medical guidelines. 

Opioid use has increased worldwide over the last 20 years, including among pregnant women*, raising concerns about the health impacts during the perinatal period. Opioids can cause a condition known as neonatal withdrawn syndrome in newborn babies. Although the risk of this syndrome following opioid use during pregnancy is low (less than 1 case per 1000 babies delivered, in women with no risk factors), it increases with long-term use.¹ However, a few studies have found a connection between prescription opioid use for pain management during pregnancy and other harms such as specific birth defects or preterm birth. Still, it remains unclear whether opioid use directly causes these problems. For women with opioid dependence, current recommendations are to commence or continue OAT during pregnancy as it leads to better outcomes for the mother and infant compared to no treatment. However, questions remain about which OAT medicine is best to use during pregnancy.  

Our research addresses these lingering knowledge gaps by examining the extent to which prescription opioids are used among women of reproductive age and pregnant women and determining any short-term and long-term consequences of opioid use during pregnancy on both the child and the mother. Given that half of pregnancies are unplanned, women may receive treatment for pain or for opioid dependence before becoming aware of their pregnancy. Therefore, these questions about safety and risk are relevant for all women of reproductive age and should be considered when prescribing to women who may become pregnant. 

We are also interested in opioid use in the year after pregnancy. Women often take pain-relieving medicines during this period, which might lead to ongoing or persistent opioid use. Long-term opioid use can lead to dependence or an overdose. Understanding the patterns of medicine use during this time can help healthcare professionals identify risks of persistent use, provide appropriate support, and ensure the well-being of both the mother and her baby.

To answer these questions, our research group applies advanced epidemiological techniques to ‘big health data’, that is, large, routinely collected health-related datasets. Most of our planned work will be carried out in the ‘Early Life Course Data Platform', which contains data for all children born in New South Wales between 2001 and 2019, and their family health records. The Early Life Course Data Platform includes rich data from 20 data collections, including information on the antenatal period and birth, medicine dispensings and clinical outcomes for both mothers and babies.

*Please note that although we use terms which describe gender throughout the webpage content, including woman, mother, and maternal, our focus is on the biological sex. The information provided here should be considered inclusive of individuals who are pregnant or who have given birth but may not identify as women.

^{1. Desai RJ, Huybrechts KF, Hernandez-Diaz S, Mogun H, Patorno E, Kaltenbach K, et al. Exposure to prescription opioid analgesics in utero and risk of neonatal abstinence syndrome: population based cohort study. BMJ. 2015;350:h2102.}

Significance

Our findings will help clinicians and patients make informed decisions about whether to use prescription opioids to manage pain and determine the safest therapies for opioid dependence. 

National

• Ms Ximena Camacho, opens in a new window, Researcher, School of Population Health, University of New South Wales
• Dr Antonia Shand, opens in a new window, Obstetrician and Gynaecologist, Department of Maternal Fetal Medicine, Royal Hospital for Women
• Dr Erin Kelty, opens in a new window, Research Fellow, School of Population and Global Health, The University of Western Australia

International

• Prof Brian Bateman, opens in a new window, Professor of Anaesthesiology, Perioperative and Pain Medicine, Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University, United States
• Dr Kari Furu, opens in a new window, Senior Researcher, Norwegian Institute of Public Health, Norway
• Dr Jacqueline Mallory Cohen, opens in a new window, Researcher, Norwegian Institute of Public Health, Norway
• Dr Carolyn Cesta, opens in a new window, Assistant Professor, Centre for Pharmacoepidemiology, Karolinska Institutet, Sweden