Opiate abuse in pregnancy refers to the inappropriate use of prescription narcotics and the use of heroin during pregnancy. Problems of narcotic dependence in Kentucky are well known, and there has been a recent dramatic resurgence of heroin use and heroin-related deaths in Fayette County.
The pregnant woman addicted to drugs is in a no-win situation. Admitting to the disease and seeking help can be humiliating. Continued use is deadly. When a baby is involved, the emotions and stereotypes are magnified.
Healthcare professionals and others must adopt a non-judgmental approach to address the complex care of mothers and babies. Screening for opiate abuse should be a part of all routine prenatal care and be done in a uniform and confidential way. Some physicians have been reluctant to implement urine drug screens for all pregnant patients, but it is becoming more widely adopted to ensure plans are developed for the delivery and beyond to provide safe care for moms and babies.
Generally physicians do not recommend pregnant patients addicted to opiates discontinue opiates during pregnancy due to risk of withdrawal to the fetus as well as the high relapse rate. Standard of care for the treatment of heroin addiction, and more recently, the treatment of non-heroin opiate addiction, is maintenance therapy with methadone. The goals are to encourage and ensure safe prenatal care, prevent complications from illicit drug use, diminish the effects of withdrawal symptoms, provide access to comprehensive addiction treatment and reduce criminal activity.
New evidence supports the use of buprenorphine (Subutex) instead. Neonatal Abstinence Syndrome or withdrawal is an expected consequence of methadone or Subutex. Recent information suggests that these symptoms appear sooner, are milder and resolve more quickly with Subutex than methadone.
The medical and social consequences of opiate addiction during pregnancy make for a special challenge. However, it is also a time of great opportunity for the initiation of a long-term treatment program.
A list of local treatment programs for opiate addication can be found at http://1.usa.gov/Jn6560.
Dr. Blake Bradley is an OB/GYN with Baptist Health OB-GYN Associates of Lexington.