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Tuesday, March 15, 2016

Treating Opioid-Addicted Mothers -- Subutex and Behavioral Therapy

In the U.S., a baby suffering from opiate withdrawal is born every 25 minutes, according to the National Institute on Drug Abuse.

Of course, the very fact that opioid users addicted to prescription pain killers and heroin would risk pregnancy draws fire from strict conservatives who preach sobriety and abstinence. Yet, the fact remains that addicts do become pregnant, and when an addicted mother is pregnant, what once was a single adult suffering from addiction then becomes an adult and an innocent child struggling with substance abuse. These are matters of life and death.

Women taking opioid prescription drugs are at risk.

Millions of American women of childbearing age take opioids, and many begin taking prescription painkillers before realizing they're pregnant. These women may be unknowingly exposing their unborn child to great danger.

In a first-ever analysis of the problem's scope, the Centers for Disease Control and Prevention found that a third of the young women enrolled in Medicaid and a quarter of the young women with private insurance filled opioid prescriptions every year from 2008 through 2012.

That raises deep concerns because roughly half of all U.S. pregnancies are unplanned, and consuming opioids like oxycodone during the earliest weeks of pregnancy can cause birth defects. The CDC's report looked at women between the ages of 15 and 44.

 (Bill Briggs. "Pill-Popping Mommas: 'Many' Pregnant Women Take Opioids, CDC Finds." 
NBC News. January 22, 2015.)              

Also, the sad truth is that the United States is in the throes of a heroin epidemic. Like those with prescription painkiller addictions, a mother who exposes her unborn child to heroin during pregnancy takes great risks. The baby may be born with a host of defects, and it will require treatment for  withdrawal symptoms The heavier the dose of heroin and the longer the child has been exposed in the womb, the more severe those withdrawal symptoms will be.

Help For Addicted Mothers

In 2013, when physicians at the hospital began to see a rise in opiate-addicted pregnant women, they initiated the Dartmouth-Hitchcock Perinatal Addiction Treatment Program. It’s a rare treatment center where pregnant women and young mothers can get counseling, medical check-ups, and medication to help curb their heroin cravings.

Cathy Milliken, the director of the program’s addiction treatment program, says, “When women are pregnant, if they were to quit heroin cold-turkey, they could miscarry. It’s a dangerous strategy. Having someone take Subutex is a safer way for them to move through their pregnancy.”

Subutex is a medication commonly prescribed to recovering addicts to curb withdrawal. It helps prevent withdrawal symptoms because it is an opioid as well in those who have stopped taking other narcotics like OxyContin , morphine or heroin.

In October 2002, FDA approved two sublingual formulations of the Schedule III opioid partial agonist medication buprenorphine for the treatment of opioid addiction. These medications are Subutex (buprenorphine) and Suboxone.

For long-term success, she added, “Medications are helpful, but optimal treatment is really when you’re doing talk therapy with someone.”

A review of the research published by the Harvard Review of Psychiatry found that pills like these can at least double the chances of staying clean, when combined with counseling and behavioral therapies.

In 2014, over 1.3 million people received behavioral health services at health centers.

 (Keturah Gray, Nick Capote, Glenn Ruppel, and Lauren Effron. "The Breaking Point: Young Parents Battling Heroin Addiction to Get Clean for Their Kids." ABC News. March 11, 2016.)

 (Rebecca Granet. "Generation ‘H’: Pregnant And Recovering From Heroin Addiction."
CBS New York. March 03, 2016.)

A study conducted by a multi-disciplinary team of researchers from North America and Europe published in the New England Journal of Medicine (2010) found babies born to women addicted to opioids fare better when their mothers are treated with either the addiction medication buprenorphine or methadone than babies whose mothers are not treated at all.

In this comparative effectiveness trial, buprenorphine was found to be superior to methadone in reducing withdrawal symptoms in the newborns.

("Buprenorphine treatment in pregnancy: less distress to babies." Press Release -- National Institutes of Health. December 9, 2010.)

My Take

The unborn child is the most vulnerable being. No matter your view of addiction or your proposed solution to stopping drug abuse, you must realize that no baby -- in the womb or after birth -- should be denied the best treatment available. I'm sure objections and judgments will include the expense to taxpayers, claims of irresponsibility and neglect, and flat-out hatred for any form of "self-inflicted" addiction.

My answer is that we are honor bound to be empathetic while using viable methods to stop drug abuse and addiction. Judging who brought substance abuse upon themselves, who should or shouldn't have risked having a child, or who is "worthy" of life-giving treatment denies that need of showing empathy to a child. I call that child abuse. Who could stand idly by and watch an innocent needlessly suffer?

I'm not above expressing stern advice. My plea to opioid addicts is this: "Please do not become parents until you are clean. Don't bring an addicted child into the world. And, take every precaution to prevent pregnancy. You must consider the consequences of conceiving a child -- neither are you capable of lovingly bringing that child into the world nor are you capable of properly raising that human being."

However, reality also includes mistakes. My advice to opioid addicts is also this: "If you do become pregnant, seek immediate help and commit to long-term medication and therapy. Do so for the sake of your child. Begin a sober life." I believe it is inexcusable for society to shut down a path to saving two lives.

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