Opioid Addiction During Pregnancy

The opioid crisis has been building in the U.S. for twenty years. Although federal, state, and local lawmakers are taking steps to combat the rising epidemic of opioid addiction and overdose deaths, it shows no sign of letting up. According to data provided by the National Institute on Drug Abuse (NIDA), more than 130 people die from opioid overdoses every single day.

The effect on children and families, including pregnant women, is staggering. This report from The Center for Disease Control (CDC) shows that the number of pregnant women addicted to opioid drugs has quadrupled between 1999 and 2014, resulting in a long list of devastating consequences.

The good news is that treatment can significantly reduce the risk opioid use disorders pose to mother and child. With high-quality treatment and compassionate care, many new mothers are able to deliver healthy babies. And they can stay clean after giving birth.

Exactly What are Opioid Drugs?

Prescription opioid drugs include strong painkillers that a doctor prescribes for chronic pain, or for pain after an injury or surgery. Commonly prescribed opioids include hydrocodone (Vicodin), oxycodone (OxyContin), tramadol, morphine or codeine.

Prescription painkillers are generally safe when used as prescribed. However, serious problems arise when people use their drugs in ways other than prescribed, or when they use the drugs to get high. People often purchased prescription painkillers illegally or steal them from friends or family members.

Heroin is an illegal opioid drug. It’s highly addictive and presents a significant risk of fatal overdose. Heroin is particularly dangerous when combined with alcohol or other drugs.

Fentanyl is an extremely powerful opioid medication prescribed by physicians to relieve severe pain, such as the pain experienced by people with advanced cancer. Fentanyl is 50 to 100 times more potent than morphine, and presents a very high risk of overdose.

Drugs made in clandestine, black-market labs cause most overdose deaths. Fentanyl is often laced with cocaine or heroin. This means buyers have no way of knowing the potency or exact contents of the drugs they’re ingesting.

Risks of Opioid Use During Pregnancy

Using drugs during pregnancy is akin to playing Russian roulette: it’s impossible to predict how the use of opioids during pregnancy will affect a developing baby. Problems may be relatively minor or extremely severe, depending on a number of factors. Genetics play a part, but the primary factors are how often, how much, and how long the pregnant mother has been using opioids.

The unborn child is affected when opioid drugs cross from the placenta to the baby. The risks to the child are the same whether the drug is legally prescribed or illegally purchased on the street. Risks to the developing baby may include the following:

  • Fetal convulsions
  • Birth defects
  • Malnutrition
  • Low birth weight
  • Stunted growth
  • Increased risk of Sudden Infant Death Syndrome (SIDS)
  • Respiratory problems
  • Withdrawal symptoms such as diarrhea, tremors, fever, difficulty feeding, irritability or seizures.

Pregnant women who use opioid drugs during pregnancy are at higher risk of miscarriage. Additionally, death from overdose may occur if the mother returns to use of drugs following the birth. This sometimes occurs if the mother is struggling with post-partum depression or the typical stress that goes along with being a new mother.

Why Many Women Don’t Seek Treatment: Stigma and Stereotypes

It’s essential that pregnant women with an opioid use disorder seek help as soon as possible to reduce the risk of serious complications to both mother and child.

The problem, however, is that many pregnant women who need help with substance use disorders receive poor treatment from medical professionals. All too often, pregnant women and new mothers are subject to discrimination and stigma.

As a result, many are reluctant to seek treatment when they need it the most. They shy away from treatment due to guilt, shame, and fear that their child will be taken away from them.

Eighteen states classify drug use by pregnant women as a form of child abuse. Three states consider it grounds for involuntary hospitalization. This de facto legal milieu makes it far less likely a pregnant woman will ask for help. Unfortunately, only four states have laws protecting pregnant women from this type of discrimination.

Specialized Treatment for Pregnant Women

Punishment isn’t an effective way to help pregnant women who have a chronic, relapsing disease. Most pregnant women understand the risks associated with the use of opioids during pregnancy. And most want to stop.

Research indicates that mothers who remain with their children are more likely to complete treatment successfully. Pregnant women need confidential treatment that is safe, supportive, compassionate, and nonjudgmental – but that treatment isn’t always easy to find.

Specialized treatment will also help women address underlying problems such as depression or anxiety, or PTSD due to emotional, physical, or sexual abuse during childhood or as an adult.

Help should be available for financial, legal, or relationship problems, and mothers should have an opportunity to learn healthier ways to cope with stress.

If pregnant women or new mothers are using opioids for chronic pain, they should receive advice on alternate ways to manage pain, such as exercise, physical therapy, or acupuncture.

Medicine-Assisted Therapy (MAT) During Pregnancy

Treatment of opioid use disorders often uses medication such as methadone and buprenorphine for pregnant women and new mothers. Methadone has been used for over 40 years, while buprenorphine is a newer drug. Both substantially improve the outcome for the infant, and can stabilize pregnant women while they receive appropriate counseling and healthcare.

Both drugs are safer than street drugs, which are sometimes cut with low-quality ingredients such as sugar or caffeine. MAT also eliminates the risk of HIV due to shared needles.

Research indicates that mothers in methadone programs – including those with severe addiction – remain in treatment longer. Evidence also shows that unborn babies exposed to buprenorphine display fewer withdrawal symptoms at birth than babies exposed to other opioids, such as heroin or Fentanyl.

No Cold Turkey for Pregnant Women: MAT is Gold Standard

It may seem like a good idea for pregnant women to stop using opioids cold turkey. But this is, without question, a bad idea. Completely stopping all at once may present serious problems for mother and child. Attempting a self-taper – i.e. gradually reducing the amount of drug without a doctor’s advice – may seem to make sense too, but unfortunately, it’s not: tapering is associated with high rates of relapse.

Research over the last few decades indicates that medication-assisted treatment is the safest and most effective treatment for pregnant women with an opioid use disorder. Therefore, pregnant women seeking help for an opioid use disorder should find a treatment center that specializes in issues unique to pregnant women and offers MAT programs: these programs may be more difficult to find, but they are exactly what these women need to stabilize their addiction, get on the road to health, and create a healthy environment for their children.