Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 30

Opioids have been part of human culture and healing for millennia. Initially cultivated and distributed throughout the ancient world, opioids are described in Sumerian, Egyptian, Greek, Islamic, and Chinese medical treatises. Whereas opioid use is ancient, problematic use and, specifically, addiction are more modern phenomena. The first opioid crisis, which dates to the latter half of the 18th century, was iatrogenic in origin. This was an epidemic overwhelmingly of women, who had initially been exposed to opioids through a prescription for the treatment of “female ailments.”

The current opioid crisis in the US is arguably the most severe in history and, like the first, features a large proportion of women. Overdose deaths have become one of the leading causes of mortality and, along with hepatitis C and suicide, have contributed to a decrease in life expectancy especially among white, middle‐aged Americans. The current crisis consists of three related phases. The first began with a marked increase in opioid prescribing starting in the mid‐1990s and peaked in 2010. The second was driven by illicit heroin distribution while the third phase began in 2016 powered by fentanyl and other illicitly manufactured synthetic opioids. Opioid‐related drug deaths may have plateaued nationally in 2019, but a fourth wave of stimulant‐related mortality (both amphetamine and cocaine) is now emerging.

The current crisis has changed the demographics of substance use and addiction. Whereas less than 20% of people who used heroin in the 1970s were women, today roughly 50% are women. Although more men have addiction than women, for opioid use disorder at least half of people presenting for treatment are female.

Opioid use, misuse, and addiction have increased in pregnancy and postpartum, in parallel with the overall crisis. Rates of opioid use disorder assessed at the time of delivery more than quadrupled between 1999 and 2014, as have rates of neonatal abstinence syndrome (NAS), and, in many states, overdose is the leading cause of maternal death.