Prescription Opioid Drug Use during Pregnancy

  • Two roads lead to opioid chemical dependency. A person can become chemically dependent if opioids are used continuously to treat chronic pain. Another can become chemically dependent if opioids are being abused continuously. Both roads lead to a point when a person cannot live without the external source of opioid chemicals. At that point, a woman may find herself pregnant, too. Now what should she do?

     

    Don’t rock to boat too hard is what you should do if you are pregnant and chemically dependent. To do so, would mean that you are putting you and your baby at risk. Thus, doctors recommend opioid maintenance therapy in chemically-dependent, pregnant women. Typically, a pregnant woman would be advised to use methadone in order to maintain an even keel for both her and the baby. But lately, buprenorphine is emerging as the new preferred opioid to use during pregnancy. (1)

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    Buprenorphine offers some advantages over methadone. First, the birth weights of babies born to mothers using buprenorphine are higher than the methadone users. Next, babies are less likely to experience severe Neonatal Abstinence Syndrome with buprenorphine than with methadone. And finally, after the birth of the baby, mothers are able to breastfeed while using buprenorphine. These advantages make buprenorphine well worth considering for a pregnant woman that is chemically dependent to opioids, too. (2) (3)

     

    Doctors argue about which buprenorphine product is best in a pregnant woman. Some say that buprenorphine only without the naloxone is safest. Some say it does not matter. Others prefer to prescribe buprenorphine with naloxone to minimize risks of abuse and diverging. There is some evidence suggesting that buprenorphine with naloxone is safe during pregnancy; so it is really up to the clinician to make a choice with the client. (4)

     

    But, what if you really do not want to use opioids while being pregnant? Are there other options? Yes, you have two options. One is to do a medically-monitored detoxification program, preferably in the second trimester. This option should be avoided during the third trimester because of risk to you and your baby. Another option is to slowly wean off the opioid chemicals. This option requires a very motivated individual that is disciplined enough to go slowly enough to minimize withdrawal symptoms. Because both of these options require medical management, please do not try to do this on your own.

     

    If you are pregnant and opioid dependent, please know that you are not alone. Plenty of help is out there; so there is no need to hide or avoid the medical system. Start your prenatal care early. Look at all the options with your doctor, and then decide what is best for you and your baby.

     

     

    References:

    1. CNS Drugs. 2013 Aug;27(8):653-62
    2. Cochrane Database Syst Rev. 2013 Dec 23;12:CD006318
    3. J Perinat Neonatal Nurs. 2014 Jul-Sep;28(3):178-84
    4. Am J Addict. 2013 May-Jun;22(3):252-4
Published On: July 29, 2014