People all across the U.S. struggle with addiction to opioids and this includes many pregnant women. Quitting opioid use before getting pregnant is ideal, but many women don’t have this choice.
Medical oversight is needed so a pregnant woman can slowly get off opioids. In some cases, medication-assisted treatment (MAT) will be used throughout pregnancy.
Medical supervision ensures that the woman and her baby can be safe. Without medical care, it is likely that the infant will suffer from neonatal withdrawal syndrome after birth.
Opioid drugs are synthetic versions of opium, which comes from the opium poppy.
While opium itself has been used both as a medicine and a recreational substance for thousands of years, synthetic opiates have only been available since morphine was first synthesized in the 19th century. Morphine became a significant problem for many people, leading to high rates of opioid addiction, nearly as soon as it hit the market.
Since then, epidemics of abuse have swept through the United States. Per the U.S. Centers for Disease Control and Prevention (CDC), opioid abuse kills an average of 130 people in the U.S. every day from an overdose.
These drugs, whether prescription or illicit, produce an intense, relaxing euphoria that is highly reinforcing, meaning it stimulates the brain’s reward system, so the person quickly learns that taking opioids leads to feeling much better.
At the same time, opioid drugs lead to physical dependence. The brain quickly begins to need the presence of opioids to manage all pain reactions, along with mood-managing neurotransmitters like serotonin and dopamine. Without enough of these neurotransmitters, the person may feel anxious or panicked, suffer from insomnia, and feel sick.
Although withdrawal from opioids is not life-threatening for adults, it is very uncomfortable. If a person does not have medical help, the brain’s dependence on the drug can cause the individual to relapse very soon after they attempt to stop using it.
Pregnant women are a particular risk group. They need specialized help to detox from opioids to prevent harm to the fetus.
The National Institute on Drug Abuse (NIDA) reports that a baby in withdrawal from opioids, with neonatal abstinence syndrome (NAS), is born every 15 minutes in the U.S.
A 2014 survey found that, in that one year, there were 32,000 babies born with NAS, which was a fivefold increase from 2004.
Treating NAS means that the infant remains in the hospital longer, so withdrawal symptoms can be monitored. Unlike adults, infants do not have the option of medication-assisted treatment (MAT).
NAS symptoms appear between 48 and 72 hours after the child is born.
A 2016 study found that up to 22 percent of pregnant women are prescribed opioid drugs during their pregnancies. Hence, some cases of NAS occur in infants from women with chronic pain problems who took opioids to manage their condition.
That being said, most instances involve mothers who struggle with opioid use disorder (OUD). Treating women before they become pregnant or while they are pregnant helps to reduce the burden of NAS. This makes the long-term situation easier for the whole family.
The first step in ending addiction to any drug, including opioids, is to be assessed by a medical professional. For pregnant women, this should be their obstetrician or general practitioner.
These professionals often know the woman well and can help her understand opioid addiction and options for treatment. They can clinically assess her health and diagnose how severe the addiction may be. Then refer her to treatment.
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Many adults who are not pregnant are still referred to programs that do not use medication-assisted treatment (MAT) to manage opioid addiction. For pregnant women, this can be very risky because it increases the risk of relapse, which can cause further harm to the fetus, and it may even cause a miscarriage.
The CDC notes that in surveys of pregnant women in different treatment programs, those who underwent supervised tapering from opioid drugs in a detox program experienced higher rates of relapse compared to those who were on methadone maintenance. Both the Substance Abuse and Mental Health Services Administration (SAMHSA) and the American College of Obstetricians and Gynecologists (ACOG) state that MAT, using either methadone or buprenorphine, is the best approach to helping pregnant women who are struggling with opioid addiction.
Pregnant women who struggle with opioid abuse have a 70 percent chance that their infant will be born addicted to opioid drugs. As the mother gets help from a medically supervised program, the risk drops:
Adding strong social support to the mix helps to reduce the relapse rate regardless of whether the woman is using MAT or not.
MAT appears to be the leading predictor of whether a woman will be able to stop taking opioids safely and have a healthy child.
Methadone is currently the standard for pregnant women who struggle with opioid addiction, but increasingly, buprenorphine is also used. Combination products like buprenorphine/naloxone, which was first introduced as Suboxone, is not considered the best approach for pregnant women working to end opioid abuse, although it is an effective treatment for adults who are not pregnant.
More evidence-based treatment programs are offering MAT to adults, including pregnant women.
If you are pregnant and need help overcoming an addiction to opioids, talk to your gynecologist or obstetrician, primary care doctor, a counselor, or a social worker to get started.
The important part is that you get help quickly. Immediate and comprehensive care in the prenatal period can reduce the potential for harm to your baby.
(November 2018) Opioid Use Disorder. American Psychiatric Association (APA). Retrieved April 2019 from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder
(December 19, 2018) Opioid Overdose: Understanding the Epidemic. U.S. Centers for Disease Control and Prevention (CDC). Retrieved April 2019 from https://www.cdc.gov/drugoverdose/epidemic/index.html
(January 2019) Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome. National Institute on Drug Abuse (NIDA). Retrieved April 2019 from https://www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome
(February 7, 2018) Medication-Assisted Treatment (MAT). Substance Abuse and Mental Health Services Administration (SAMHSA). Retrieved April 2019 from https://www.samhsa.gov/medication-assisted-treatment
(March 10, 2017) CDC Grand Rounds: Public Health Strategies to Prevent Neonatal Abstinence Syndrome. U.S. Centers for Disease Control and Prevention (CDC). Retrieved April 2019 from https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm
(May 9, 2018) Pregnant Women on Opioids Shouldn’t Go “Cold Turkey” to Protect Their Baby. Healthline.com. Retrieved April 2019 from https://www.healthline.com/health-news/pregnant-women-on-opioids-should-not-go-cold-turkey#2
(September 2016) Opioid Detoxification During Pregnancy: The Door Continues to Open. American Journal of Obstetrics and Gynecology (AJOG). Retrieved April 2019 from https://www.ajog.org/article/S0002-9378(16)30206-X/fulltext
(June 1, 2015) The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. American Society of Addiction Medicine (ASAM). Retrieved April 2019 from https://www.asam.org/docs/default-source/practice-support/guidelines-and-consensus-docs/asam-national-practice-guideline-supplement.pdf