Opioid Abuse Among Pregnant Women
By: Dr. Lawrence Tucker
Over the past 3 years, there has been a dramatic increase in substance abuse rates among women of childbearing age. Between 2013 and 2014, the number of women between ages 15 and 44 who reported past-month nonmedical use of OxyContin (oxycodone) increased to 98,000, up 5.4% from 2011–2012.1 In the same timeframe, the number of women in this age group who reported past-month heroin use increased by 31% to 109,000.1
The prevalence of opioid use disorder during pregnancy more than doubled between 1998 and 2011, to about 4 per 1,000 deliveries.2 This steep increase is concerning, given that women who are dealing with addiction during pregnancy are at high risk for negative peripartum developments such as preeclampsia, placental abruption, premature rupture of membranes, preterm delivery, miscarriage and other adverse outcomes such as stillbirth, low birthweight, birth deformities, and neonatal abstinence syndrome (NAS).3,4 The severity of NAS symptoms may be influenced by a number of factors, including the health of the mother, the specific opioid drug(s) the mother used, and whether the mother used other substances in addition to opioids during pregnancy.3
Abruptly quitting opioids during pregnancy can have a number of harmful consequences including miscarriage, premature labor, and fetal distress.
Because of this, I recommend that women who are using opioids during pregnancy and wish to stop do so under the medical care of a team that specializes in treating perinatal addiction.
There are several unique risks that opioid-dependent pregnant women face. Unfortunately, many addiction treatment centers are not equipped with the resources or knowledge to adequately address the health of both the pregnant mother and her unborn child during rehab. In turn, pregnant women who are dealing with addiction don’t have many options when it comes to seeking treatment and are often referred to hospitals or emergency rooms that are unable to provide a comprehensive spectrum of care.
The first step for an opioid dependent pregnant woman who wants help quitting is to find a medical detox program where she can safely start her recovery. The ultimate goal of the detoxification process is to stabilize the mother’s body as she gradually clears the last traces of drugs from her system over time. During this time, a team of detox professionals will assist her in managing withdrawal symptoms as they emerge.
After detox, however, I recommend starting treatment in inpatient treatment because of the level of medical observation available. How long you stay in an inpatient program depends on a number of factors, such as your physical and mental health, the type of drugs abused, and how far along you are in your pregnancy. In some cases post-detox, you may be referred to an intensive outpatient program (IOP) or partial hospitalization program (PHP) that is open to treating perinatal substance abuse patients.
Luckily, the team at Laguna Treatment Hospital in Orange County is prepared to help treat pregnant women who are dependent on opioids. We have a fetal heart monitor, so we look at the health of the baby on a daily basis. Laguna understands that the most important thing is for a mother to get care and help as soon as possible. When a pregnant woman enters our facility, we are not only treating 1 person, we are treating 2, sometimes 3 people and it’s important that a mother has access to the resources she needs to safely detox from drugs or alcohol.
As soon as a new mother is admitted at Laguna Treatment Hospital, she is seen by an obstetrician within 24 hours. Some women enter treatment without any previous prenatal care, so we make sure that their prenatal needs are addressed immediately.
Laguna’s team of obstetricians and treatment specialists provide women with holistic care, including prenatal appointments, proper nutrition, medical monitoring of mother and baby, and medication-assisted treatment, if necessary. We may put the mother on buprenorphine, a buprenorphine and naloxone combination (Suboxone), methadone, or another treatment medication in order to help her detox safely as her pregnancy progresses.
Detoxing during pregnancy is extremely tricky. There is a high risk of aborting the pregnancy during detox, so I generally first substitute the abused opiates with methadone or buprenorphine. Professional guidelines indicate that women shouldn’t detox in the first trimester. At our facility, I’ve been successful in detoxing opioid-addicted women during the second and third trimester.
A hidden danger of detox is that afterwards the mother is at a very high risk of overdosing. The brain’s opioid receptors completely reset, and even the smallest amount of heroin or prescription painkillers can send the body into respiratory depression or overdose. At our Laguna Treatment Hospital, we understand this risk and incorporate relapse prevention planning into our rehab programs for all pregnant women and new mothers.
If you live in another state or area, the clinical staff at Laguna will make sure that your postpartum care is coordinated with local medical professionals. Ideally, you will be linked to an obstetrician and a pediatric or neonatal doctor to continue your care after leaving treatment.
Too many women don’t seek the help they need because they are afraid that child protective services (CPS) will take their children away. In my experience, this is usually not the case. Even if CPS does get involved, the systems are designed to keep children with their mothers whenever possible. I understand why women may be afraid, but the goal of CPS is genuinely to help to keep the family together rather than hurt the family.
You might be worried about not being able to use treatment drugs during pregnancy, but Laguna will work to make rehab as comfortable as possible for both you and your baby. We can put you on maintenance therapy and give you medications to alleviate cravings and lessen withdrawal symptoms.
When I tell most women that, they can’t believe it. The very thing keeping them from seeking treatment sooner is the fear of quitting opioids without the benefit of any treatment medications. It is a common misconception that these medicines can’t be taken during pregnancy; in fact, they can save the life of patients and their children.
My biggest message to pregnant mothers who are abusing drugs or alcohol is that there is help and there is hope. We will work with mothers in every situation—we’ve seen it all. Take a deep breath and think about what’s best for you and your baby. Getting help is not as difficult as you may think.