Opioid addiction is a nationwide problem. Prescription pain medication addiction and heroin addiction are one the rise. If affects millions of people in the US. Many of those same people are pregnant, or are considering pregnancy. One nationwide survey found that between 1998 and 2011, opioid abuse and addiction rose by 162% for pregnant women ages 20-34.
There are many risks associated with opioid abuse/addiction in pregnancy, including fetal growth restriction, stillbirths, and need for hospital based withdrawal of newborns (which can take weeks or months). Infection with Hepatitis C and HIV are also more common-both of which can infect the baby as well.
The good news is that there are effective treatments for people who suffer from opioid addiction/abuse, and they are approved for use in pregnancy. One treatment is methadone, a long-acting opioid, that requires daily, supervised visits to obtain. For many people, it is difficult to travel every day to a methadone clinic to receive a daily dose of methadone. It is certainly better than looking for a daily dose of heroin or black market pills to ease the pain of withdrawals, but for people with limited transportation, or that need to go to work every day, this can be a problem. Methadone is considered the “gold standard” treatment in pregnancy, but it can be a problem for pregnant moms to get their medication every day.
Even better news is that experience is growing rapidly with the use of buprenorphine (Subutex) in pregnancy. It is now considered a reasonable alternative to methadone. The main advantage is that this is a medication that can be obtained by prescription from a qualified and specially trained physician. After the initial “induction” phase of treatment, the patient can often be seen monthly for follow-up in the office. Not many OB-GYNs have been through the additional training required to obtain special licensing from the Drug Enforcement Agency (DEA). Also, not many doctors that have been through the training are comfortable treating pregnant women. This is especially true in Utah. That’s why I have gone through the training and obtained the “DATA2000” waiver from the DEA to prescribe buprenorphine to patients. I plan to focus on pregnant women, as there is such a need for this service in our area.
Some links to more information are here:
http://www.naabt.org/documents/naabt_brochure%20Version%202.pdf (general info on treatment)
http://buppractice.com/node/2641 (specific info on treatment in pregnancy)