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Opioid Addiction in Pregnancy

Opioids-PregnantMedications to treat pregnant women struggling with opioid dependence are available. But a tragically low number of women are accessing this life-saving treatment.

“Current evidence suggests opioid agonist therapy (OAT) is safe and effective for pregnant women with opioid use disorder, yet barriers to accessing care and socioeconomic disparities prevent too many women from receiving OAT,” according to the American Society of Addiction Medicine (ASAM), which is currently hosting its 48th Annual Conference in New Orleans. One of the topics of discussion at this year’s consortium of addiction experts: “Substance Withdrawal in Pregnancy: From Research to Practice to Public Health.”

We don’t allow pregnant women with chronic medical illnesses such as high blood pressure, poorly-controlled diabetes or lupus go untreated. They receive medications such as labetalol, insulin or prednisone. So why don’t we provide the same degree of care and compassion to those with the chronic medical disease of opioid addiction?Opioids-Pregnant2

The sad reality is that – in spite decades of research in support of medications such as methadone and buprenorphine (“Suboxone”) – far too many pregnant women live in locations where they cannot access this life-saving treatment. According to a study by Dr. Mishka Terplan and colleagues, in 2012, only 37% of pregnant women reporting any prescription opioid misuse at admission to a substance use treatment facility received medication for maintenance therapy.

Abruptly stopping opioids – which often occurs when a pregnant woman is arrested – can cause opioid withdrawal, which can be extremely uncomfortable. Symptoms range from nausea, vomiting and diarrhea to bodyaches, sweats and anxiety; and can last anywhere from one week to a month. The best way to reduce these symptoms? Detoxification with medications for addiction treatment (formerly known as ‘medication-assisted treatment,’ or MAT) — methadone or buprenorphine.*

NICU TourUntreated opioid use in pregnant women can also adversely impact the fetus. According to the National Institute of Drug Abuse (NIDA), every 25 minutes, a baby is born suffering from opioid withdrawal. Neonatal outcomes include prematurity, microcephaly, neurobehavioral deficits, sudden infant death syndrome (SIDS) and neonatal abstinence syndrome (NAS). Neonates with NAS experience fever, vomiting, diarrhea, tremors, slow weight gain, excessive crying, irritability, seizures and even death. Babies with NAS need to be hospitalized and treated with medication – usually morphine – to relieve symptoms. Over time, the medication is tapered off until the baby adjusts to being opioid-free.

All subsets of society – government, education, health care, law enforcement, criminal justice, etc. – need to recognize that substance use disorders (including alcohol, cocaine, opioids) are chronic medical diseases, and need to be treated as such. Gaps in knowledge combined with colossal stigma towards individuals experiencing addiction need to be addressed “stat.” Mother-Baby--image

“We have to use this moment — with all the public attention on opioids — to build lasting and accessible systems of care,” said Dr. Mishka. “It is unconscionable that women can be punished for using drugs while pregnant yet not have access to treatment.”

Most people, including pregnant women, with addiction – once connected to the appropriate treatment and recovery services – GET BETTER. Let’s make a safe and healthy environment for women and their babies.

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*Neonates born to pregnant, opioid-dependent women on methadone maintenance treatment will need to be treated for NAS. Buprenorphine has been a safe and effective alternative to methadone, with less risk of NAS in the neonate.

 

References
NIDA
CDC
SAMHSA
Surgeon General’s 2016 Report

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