Facing an opioid addiction
when you're pregnant means that you have to monitor so much more than just your health. Your growing baby's health must also be taken into consideration, and you have to plan for aftercare once your child is born. This may seem overwhelming, especially when you're going through the pangs of pregnancy simultaneously, but there are ways to get clean while maintaining the health and safety of both you and your baby.
What are opioids?
Opioids fall into two categories: legal and illicit. Both, however, are derived from poppy seeds, which contain morphine and codeine, both narcotic alkaloids. The seeds themselves or synthetic laboratory creations can be used to create a number of prescription painkillers
, such as:
Illicit drugs made from the same chemicals include:
All of these are classified as opioids, regardless of their legal status.
What counts as abuse, dependence, and addiction?
According to the National Institute on Drug Abuse, abuse
occurs when you use illegal drugs. Using legal drugs to get high, in a way that doesn't comply with how they are prescribed, or without a prescription, also counts as abuse. Dependence
happens when your body gets used to regular exposure to a drug. If you stop using it, withdrawal symptoms can set in. Dependence can lead to addiction, but dependence itself does not mean that you are addicted. You can be considered someone with a substance use disorder when you experience loss of control, a decrease in or lack of social contact, continuing to use even when it endangers you or others, and experiencing cravings, tolerance (needing to increase your usage to feel the same high), and withdrawal. Substance use disorder is a chronic disease, unlike abuse and dependence. An addict's substance use is usually involuntary, and relapse is likely.
How common is opioid use and abuse during pregnancy?
As reported in a 2010 study,
1% of pregnant women said they had abused prescription opioids in the past thirty days, and 0.1% said they had used heroin in the same timeframe. However, 2.6% of these women tested positive for opiates after urinalysis, making it hard to rely on self-reported statistics. A seven-year study of 1.1 million pregnant women on Medicaid showed that 21.6% filled at least one prescription for opioids during their pregnancy. The percentage of women who received opioid prescriptions increased 4.3% over the span of the study.
What are the signs of opioid abuse in pregnant women?
Some things to watch for when you suspect a pregnant woman may be abusing opiates include:
- Not keeping their medical appointments.
- Not gaining enough weight.
- Seeming sedated or intoxicated.
- Erratic behavior.
- Showing signs of drug use, like track marks, lesions, abscesses, or skin infections.
If you suspect that a woman is abusing opioids during her pregnancy, urine drug testing should be suggested to her doctor. However, it can only be done with her consent.
How does opioid abuse affect the pregnant mother?
If you use heroin while pregnant, you increase your risk for:
- Placental abruption, or a condition where the placenta detaches from the wall of the uterus before delivery. This can cause blood loss of 20% or more, the inability of the blood to clot, a ruptured uterus, kidney failure, and a lack of blood flow to the organs, resulting in the death of bodily tissues.
- Preterm labor.
- Preeclampsia, or a pregnancy complication mainly defined by high blood pressure and kidney damage. However, it can also cause lack of blood flow to the placenta, placental abruption, destruction of red blood cells, low platelet count, and seizures.
- Premature rupture of membranes (AKA your "water breaking" early), which can lead to infection or preterm labor.
How does opioid misuse affect the fetus?
Misusing opioids during pregnancy harms a growing fetus in many ways: Opioid misuse from one month before conception to three months after conception resulted in significant risk of:
- Spina bifida.
- Hydrocephalus- a build-up of fluid in the brain that can lead to problems walking, urinary incontinence, and progressive mental decline, among others.
- Gastroschisis- a birth defect that causes an infant's intestines to come outside of the body through a hole in the abdomen.
- Hypoplastic left heart syndrome- a birth defect that inhibits the left side of the heart from pumping oxygen-rich blood to the infant's body.
Heroin use during pregnancy can cause:
- Inhibited fetal growth.
- Placental abruption, which can cause oxygen deficiency, anemia, slowed growth, central nervous system anomalies, or even fetal death.
- Premature birth caused by preterm labor.
Using any sort of opioid during pregnancy increases the risk of:
- Spontaneous abortion.
- Low birthweight.
- Preeclampsia, which can result in less oxygen and fewer nutrients for the fetus and fetal distress.
- Premature rupture of membranes can result in premature birth.
What is Neonatal Abstinence Syndrome?
When a pregnant woman takes opioids, her fetus becomes reliant on the substances and, after the baby is born, they may suffer from Neonatal Abstinence Syndrome (NAS). Symptoms of this condition include:
- Blotchy skin.
- Crying often or in a high pitch.
- Trouble feeding, sleeping and gaining weight.
- Breathing rapidly.
In 2013, 27,000 cases of NAS were diagnosed.
What are treatment options for the mother?
There are three medication
options for pregnant women who abuse opioids— methadone, buprenorphine, and Suboxone. Each has their pros and cons.
Methadone is and has been the 'standard of care' for opioid addicted pregnant women, though it works better for those addicted to heroin than those addicted to opioid painkillers. If you're on methadone while pregnant, you should remain on it, since the withdrawal symptoms can cause stillbirth, fetal distress, and premature delivery. Most women can use methadone through an outpatient program that communicates with their OB/GYN. However, methadone treatment usually means a longer course of treatment for NAS.
Buprenorphine, or Subutex, is a relatively new medication for the treatment of opioid withdrawal and has been found to be a safe and effective alternative to methadone; with the exception of less intense symptoms of NAS, all other symptoms of mother and baby were comparable. Despite these advantages, buprenorphine has also been associated with troubles with liver functionality, a lack of long-term effects on mothers and children, an increased risk of sharing or selling the drug, and a higher drop-out rate from the drug program. It can also be highly addictive
, requiring a detox program of its own.
Suboxone is a combination of buprenorphine and naloxone and is generally seen as a last resort. Data show that exposure to naloxone may initialize withdrawal in both the mother and the fetus, which can cause distress in both. Either buprenorphine or methadone therapy is recommended instead.
What are the treatment options for infants?
Children born with NAS are often difficult to soothe, so extra calming measures are often needed, such as gently rocking him/her, reducing his/her exposure to noise and light, and swaddling. Since their growth may be restricted by exposure to opioids, they may also need high-calorie feedings, or smaller feedings more often. Treatment with medication can help. Methadone or morphine can be used in a hospital setting to treat the symptoms of withdrawal. The goal is to use medication as similar as possible to what the mother was using during pregnancy, then slowly taper the infant off. If the condition is severe, a doctor may prescribe phenobarbital to control seizures or clonidine to reduce heart rate, blood pressure, and hyperactivity. If the mother is in a methadone or buprenorphine program and isn't using any other drugs, breastfeeding can also be helpful. While dealing with substance use disorder and pregnancy at the same time can be a challenge, it is certainly possible. There are a number of reasons to stop misusing opioids—both for your sake and for your child's—, and now that you know what to expect, you can prepare for your future as a mother in recovery. Sources
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