Treating Moms For Opioid Abuse

Medically supervised withdrawal is an option, but not the first one

Medically-assisted treatment (MAT), or opioid agonist pharmacology, should be the first option considered for pregnant women who are addicted to opioids, but the more problematic medically supervised withdrawal can be an option in certain situations, according to updated guidelines from the American College of Obstetricians and Gynecologists (ACOG).

Medically supervised withdrawal carries with it a greater chance of relapse and requires long-term follow-up treatment by a physician.

“Concern about medication-assisted treatment must be weighed against the negative effects of ongoing misuse of opioids, which can be much more detrimental to mom and baby,” Maria Mascola, MD, the lead author of the revised guideline, said in a statement.

Chief among those concerns is neonatal abstinence syndrome, which often afflicts newborns who have been exposed to opioids because of the mother’s use during pregnancy. Mascola said that “it is important to remember that it is an expected and treatable condition that had not been found to have any significant effect on cognitive development.”

MAT, on the other hand, improves adherence to prenatal care and addiction treatment programs and reduces the risk of pregnancy complications.

“And while neonatal abstinence syndrome is often seen in infants who have been exposed prenatally to opioids, it is important to remember that it is an expected and treatable condition that has not been found to have any significant effect on cognitive development.”

The revised guidelines provide a detailed and up-to-date overview of the treatment options that include methadone, buprenorphine, naltrexone, and naloxone.

All pregnant women should be screened for opioid abuse beginning with the first prenatal visit, according to the ACOG.

The guidelines reflect just how the opioid epidemic affects every aspect of society, and opioid abuse among pregnant women has kept pace with its escalating abuse across all socioeconomic strata.

That’s why “screening based only on factors, such as poor adherence to prenatal care or prior adverse pregnancy outcome, can lead to missed cases, and may add to stereotyping and stigma,” the ACOG guidelines state. “Therefore, it is essential that screening be universal.”

The revised guidelines encourage doctors to talk about the full range of contraception options with women who abuse opioids. The unintended pregnancy rate for this population is 80%, which far exceeds the national average of 45%.

“The postpartum period is already a vulnerable time for new moms, in general, as they face the stresses of sleep deprivation, caring for a newborn, and possibly symptoms of postpartum depression,” Mascola said. “Women with opioid use disorder are dealing with all those things in addition to the challenges of their addiction, which—without treatment and support—can often lead to relapse.”

Sources: ACOG; July 26, 2017; Obstetrics & Gynecology; August 2017; Medscape; August 2017; Guttmacher Institute; September 2016.