Opioid Use and Pregnancy

July 9, 2018 - Opioid Addiction - 1 Comments

Opioids, which include a range of painkillers as well as street drugs like heroin, are among the most commonly abused drugs in the world. With estimates showing that between 26 and 34 million people abuse opioids worldwide, a significant portion of the population is at risk for both abuse and addiction. In women, who account for nearly half of all opioid abusers, health risks are exacerbated by increased exposure to sex work, promiscuity, lack of protection during sex, and eventual pregnancy. Opioid use during pregnancy contributes to further health challenges to both the mother and fetus, often putting both at risk and resulting in an 85% increase in women’s opioid related deaths between 1998 and 2015, or about double that of men.

Understanding the factors playing into opioid abuse, the risks to both the mother and the child, and the efficacy of treatment or preventive measures can help you to determine the right choices for you or your loved one’s health during pregnancy.

Are Opioids Harmful During Pregnancy?

While the vast majority of women using opioids do so with a prescription, following the directions of their doctor, 39.4% of Medicaid insured and 27.7% of privately insured women of reproductive age receive prescription opioids, with 21.5% of pregnant women receiving opioids, and 2.5% receiving chronic opioid prescriptions for 30+ days. While these opioids are still prescribed to women who are pregnant, many also come with contraindications, warning of possible side effects and harm to the infant. At the same time, studies show that even normal use can cause development issues with the fetus, resulting in birth defects, leading to a consistent reduction in doctors offering prescription painkillers to women who are pregnant, even under normal use. In larger doses, opioids cause direct respiratory and physical distress, which can directly harm the baby.

Opioid Addiction During Pregnancy

With millions of people addicted to opioids across the United States, opioid use is a major risk factor to pregnant women. Studies also show that the proportion of women admitted to substance abuse facilities while pregnant increased from 2% to 28% between 1992 to 2012. At the same time, heroin and opioid-related deaths have more than tripled in the United States, as the cost of heroin drops and women are more exposed to intravenous heroin use, which causes an overdose and harmful side-effects more easily than prescription pills.

This has, in turn, led to an increase in harmful side effects to the baby, known as neonatal outcomes, with death, neonatal abstinence syndrome (NAS) or the infant suffering withdrawal, respiratory complications, feeding difficulty, low birth weight, and seizures on the rise. In 2012, nearly 50% of all intensive care unit hospital admissions relate to NAS.

The increasing prevalence of opioid use disorder in pregnant women has led the American College of Obstetricians and Gynecologists (ACOG) to recommend that doctors screen pregnant women for signs of opioid use or abuse. However, the direct recommendations for taking action to prevent harm to the mother or child can vary significantly, as abruptly ceasing opioid use during pregnancy can be as harmful as continued abuse.

Quitting Opioids While Pregnant

While a light or prescription user can likely quit normal painkiller use with minimal or no harmful side-effects, anyone experiencing withdrawal can cause suffer severe side-effects from doing so while pregnant. Women who are physically dependent on opioids (even most prescription users are) put themselves at risk of pre-term labor, and fetal distress or death depending on their level of dependence and the body.

As a result, most obstetricians recommend using prescription medication such as methadone to reduce withdrawal effects and prevent pre-term labor or potential fetal death. These drugs come with many of the same risks as other opioids, including the risk of NAS after birth, but often at a reduced scale. As a result, methadone is not formally sanctioned by the FDA to treat opioid dependence during pregnancy.

Using Methadone and Buprenorphine to Treat Opioid Addiction During Pregnancy

Methadone is the most commonly recognized drug for managing and treating opioid addiction in pregnant women. While methadone still has risks over no substance use at all, it reduces risks over heroin or uncontrolled opioid abuse, prevents cravings, and prevents potentially deadly withdrawal symptoms which could harm or kill the infant. Most women are recommended to 10mg-30mg doses, which are stabilized over the course of about a week and then maintained for the duration of pregnancy, typically in an inpatient setting. Women who are very early on in pregnancy may receive different recommendations.

Buprenorphine, a similar drug and the active opioid in Suboxone, is also popular for treating withdrawal symptoms in opioid dependent pregnant women, but methadone is often preferred because it requires women to go to the clinic daily, reduces exposure to the drug, and ensures that daily monitoring is possible.

However, the effects of pregnancy on the action of methadone inside the body are not well studied. Women seeking methadone treatment during pregnancy should seek out inpatient care to ensure constant monitoring to protect their and their baby’s health during the process.

Getting Help for Opioid Addiction While Pregnant

If you or a loved one is addicted to an opioid, it is crucial that you seek out help as quickly as possible. Prolonged opioid use can damage a developing baby, causing health problems which will last for the rest of their life. With immediate problems from opioid abuse resulting in reduced fetal growth, premature labor, placental abruption, and potential fetal death, seeking out treatment, and as quickly as possible, is crucial to minimizing or preventing those side effects.

While it is true that withdrawing from opioids can cause problems, the risks are lower than continuing to abuse a substance. Methadone and buprenorphine use can both stabilize the pregnancy to reduce NAS side-effects after birth by reducing withdrawal symptoms and stabilizing opioid levels in the blood, ensures the mother receives better prenatal care, and decreases the risks of other harmful side-effects.

This often means seeking out inpatient care with medical support either in a hospital or a licensed drug detox facility. Many rehab centers offer specific care for pregnant women, who need additional support, more care, and prenatal care to ensure the health and continued health of the baby. Here, the detox phase is the most critical, and should be very carefully monitored to ensure that both mother and baby remain safe while detoxing or switching over to buprenorphine or methadone. Seeking out additional treatment including cognitive behavioral therapy, group treatment such as AA, counseling, and learning ways to manage stress and behavior to reduce the risks of relapse are also crucial to preventing continued abuse during pregnancy. Continued access to relapse prevention and care programs after going through detox is also crucial, and many pregnant women are recommended to stay in inpatient care for 90 days or longer or to move into a sober house after treatment to increase their chances of continued recovery.

Opioid addiction is increasingly common, but if you or a loved one is pregnant and using, getting help is crucial. Most rehab facilities offer some support for pregnant women and some will offer specific facilities catering to the special needs of women at any stage of pregnancy. Most importantly, seeking out help and getting medical care can save both the mother and baby’s life.

If you or someone you love is struggling with Opioid addiction, or you just have some questions, please contact Lighthouse Treatment Center today. We are happy to provide a no-cost, no-obligation consultation with one of our experienced treatment advisors. Help is available today.