Introduction: The specter of opiate addiction in reproductive medicine.

The alarming trend in opiate misuse in developed countries is prompting an increasingly strident public call for action. Although many in our field have assumed that this building crisis does not really affect us or our patients, data show that the emerging demographic at highest risk for misusing opiates clearly includes patients who seek care in our practices. The goals of this Views and Reviews are to provide a clear understanding of emerging trends in opiate misuse, to review the impact of opiates on the reproductive axis, and to suggest practical recommendations aimed at both mitigating iatrogenic influences on promoting misuse and developing treatment frameworks when misuse is suspected or identified. Regrettably, there is little if any information on treatment of opiate misuse in the infertility population; we are perhaps best served by learning from successful approaches used in pregnant patients. It is hoped that this Views and Reviews will stimulate focused research and, ultimately, evidence-based guidelines and pathways that will address this widespread clinical problem.