Buprenorphine and methadone are just two ways those addicted to opioids find relief from withdrawal symptoms. These treatments were created for adults, but they are being made available to opioid addicted infants. How can buprenorphine help opioid addicted newborns?
Opioid Use in Pregnancy
Between 2007 and 2012, an estimated 21,000 pregnant women between 15 and 44 years old abused opioids in the past month. The younger the woman in this group, the more likely they are to misuse opioids while pregnant. While opioids are often prescribed for acute and chronic pain, use by pregnant women is becoming more common. Pain is commonly reported during pregnancy: back pain, abdominal pain, leg and foot pain – all may drive a woman to ask her doctor for prescription pain assistance. But opioid exposure by a fetus during pregnancy isn’t exactly well understood. For obvious ethical reasons, subjecting a woman and her baby to opioids during pregnancy isn’t possible. So, scientists and doctors must rely on observational evidence to guide them on opioid use during pregnancy Opioids are currently considered a category C controlled substance for pregnancy. This means evidence indicates potential harm to the fetus. Observational and animal studies support this classification. So…
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Why Are Women Using Opioids During Pregnancy?
Reports from the United States and Europe are showing evidence that prescription opioid misuse among pregnant women is becoming more common. “Medicaid-enrolled pregnant women from 47 states in the United States reported that 21.6 percent of the women filled at least one opioid prescription during their pregnancy.” For pregnant women enrolled in commercial healthcare plans in the United States, that number is 14.4 percent between 2005 and 2011. There are many reasons a woman would choose to use and misuse opioids while pregnant. The biggest reasons: pain and a previous addiction.
Commonly Used Opioid Drugs During Pregnancy
The most commonly filled prescription opioids by pregnant women include:
- Codeine
- Hydrocodone
- Oxycodone
- Propoxyphene
There are observed risks to fetuses while mothers use these prescriptions painkillers. The same is true for mothers who choose to use illicit opioids such as heroin during pregnancy.
What Happens to Babies Addicted to Opioids
Due to the lack of large studies, most of the data we have is from regional hospital groups. Data on altered growth, birth defects and preterm birth offers no definitive correlation. The only truly certain outcome is neonatal withdrawal. Officially called Neonatal Abstinence Syndrome, it describes any child struggling with symptoms due to exposure to addictive drugs while in the womb.
Symptoms of Neonatal Abstinence Syndrome
- Fever
- Sweating
- Mottled skin
- Projectile vomiting
- Weight loss
- Loose stools
- Difficulty feeding
- Tremors (shaking)
- Difficulty sleeping
- Seizures
- Excessive crying
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Buprenorphine Treatment for Drug Addicted Mothers
In 2012, the National Institute on Drug Abuse (NIDA), supported a clinical trial to test the treatment of opioid addiction during pregnancy. “Methadone is currently the most commonly prescribed treatment for opioid addiction during pregnancy, although the evidence suggests that buprenorphine may be associated with less severe neonatal withdrawal than methadone.” -Karen McQueen, R.N., Ph.D., and Jodie Murphy-Oikonen, M.S.W., Ph.D., Lakehead University of Nursing, Ontario, Canada The study found buprenorphine to be a safe alternative to methadone use to treat opioid dependence during pregnancy. There was evidence that when the children were born, they had milder symptoms of Neonatal Abstinence Syndrome. According to NIDA, “Methadone has been the standard of care for the past 40 years for opioid-dependent pregnant women.” Buprenorphine is changing the way we treat pregnant women, and in turn, it’s changing how we treat babies.
Buprenorphine Treatment for Drug Addicted Babies
The success of buprenorphine treatment on opioid addicted pregnant women led NIDA to fund another clinical trial. This 2017 clinical trial from the Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College in Philadelphia, Pennsylvania assigned 63 term infants to receive either sublingual buprenorphine or oral morphine. The result? “Among infants with the neonatal abstinence syndrome, treatment with sublingual buprenorphine resulted in a shorter duration of treatment and shorter length of hospital stay than treatment with oral morphine, with similar rates of adverse events.” Babies who took buprenorphine saw significantly shorter treatment (15 days vs. 28 days). The median length of their hospital stay was improved, as well (21 days vs. 33 days). This is a huge step forward in the treatment of drug addicted newborns. Finding help for mothers with addiction issues is extremely important to the recovery of the baby.
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Getting Drug Addicted Mothers the Help They Need
In a 2012 National Survey of Substance Abuse Treatment Services, it was estimated that only 13 percent of outpatient-only drug treatment centers had programs for pregnant or postpartum women. For those treatment centers with inpatient programs, only seven percent offered programs for these women. At Northpoint Washington, we understand that finding a treatment program that addresses pregnant mothers specifically is crucial. Talk to one of our addiction and treatment specialists to learn more about the options available to pregnant women and mothers.
Sources
Buprenorphine During Pregnancy Reduces Neonate Distress. (2017). Drugabuse.gov. Retrieved 4 July 2017, from https://www.drugabuse.gov/news-events/nida-notes/2012/07/buprenorphine-during-pregnancy-reduces-neonate-distress Desai, R., Brogly, S., & Yazdy, M. (2015). Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature. Journal Of Pediatric Genetics, 04(02), 056-070. https://dx.doi.org/10.1055/s-0035-1556740 Kraft, W., Adeniyi-Jones, S., Chervoneva, I., Greenspan, J., Abatemarco, D., Kaltenbach, K., & Ehrlich, M. (2017). Buprenorphine for the Treatment of the Neonatal Abstinence Syndrome. New England Journal Of Medicine, 376(24), 2341-2348. https://dx.doi.org/10.1056/nejmoa1614835 McQueen, K., & Murphy-Oikonen, J. (2016). Neonatal Abstinence Syndrome. New England Journal Of Medicine, 375(25), 2468-2479. https://dx.doi.org/10.1056/nejmra1600879 Women of Childbearing Age and Opioids. (2017). Samhsa.gov. Retrieved 4 July 2017, from https://www.samhsa.gov/data/sites/default/files/report_2724/ShortReport-2724.html