Safety and effectiveness of hormonal contraception for women who use opioids: A systematic review

Abstract

Objective: To systematically review the literature around the safety and effectiveness of hormonal contraception for women who use opioids. Our specific research questions are: 1) Among women who use opioids, do those who use hormonal contraception have increased adverse health events compared with those who do not use hormonal contraception? 2) Are there drug interactions between hormonal contraception and opioids that cause decreased effectiveness or increased toxicity from either drug?

Methods: We searched Medline, Embase, PsychInfo, CINAHL, the Cochrane Library, and clinicaltrials.gov through August 2018. We considered randomized controlled trials, cohort studies, and case-control studies, as well as pharmacokinetic and pharmacodynamic studies. We planned to use standard frameworks to assess risk of bias of included studies.

Results: The search identified 1852 articles. The full text of 66 articles was reviewed, and none met inclusion criteria.

Conclusions: Because we found no direct evidence on the safety and effectiveness of hormonal contraception for women who use opioids, we considered theoretical concerns. While women with OUD have a high prevalence of co-morbidities, such as viral hepatitis, generally women with medical conditions can safely use most contraceptive methods. When considering the pharmacokinetics and pharmacodynamics of hormonal contraception and opioids, there is little theoretical concern for interactions. Therefore, future research efforts could focus on improving access to the full range of contraceptive methods for women who use opioids, reducing unnecessary barriers to initiating and using contraception, while ensuring voluntary choice related to contraceptive use.

Keywords: Hormonal contraception; Opioid; Systematic review.