during pregnancy is an increasingly common problem, leaving both mom and unborn baby to face an increased risk of adverse outcomes. A 2010 National Survey on Drug Use and Health estimated 4.4 percent of pregnant women admit to illicit drug use 30 days prior. A 2014 study
found the prevalence of opioid use among pregnant women ranges as high as 21 percent.
Abruptly cutting off the supply of opiates to an opioid-dependent pregnant woman is extremely dangerous and can result in preterm labor, fetal distress or fetal demise. Though the standard of care for pregnant women who are addicted to opiates is medication-assisted therapy via methadone, emerging evidence suggests that buprenorphine (Suboxone, Subutex) could be a better option.
Abruptly cutting off the supply of opiates to an opioid-dependent pregnant woman is extremely dangerous and can result in preterm labor, fetal distress or fetal demise.
Methadone vs. Suboxone
In an early study
about methadone use during pregnancy, neonatal withdrawal from methadone appeared to be more severe than withdrawal from heroin
. The study notes that central nervous system signs were the most commonly seen effects of withdrawal. Neonatal seizures occurred in 1.5 percent of the heroin group and 10 percent of the methadone group. This information calls the safety of methadone into question, especially for the unborn child.
According to a 2010 study
funded by the National Institute on Drug Abuse, neonatal abstinence syndrome is common in infants of both buprenorphine- and methadone-maintained mothers. When evaluating the neonatal outcomes, buprenorphine appears to have the same clinical outcome as methadone, although some newer studies suggest that it actually causes fewer withdrawal symptoms.
The Move Toward Buprenorphine
Although methadone maintenance programs have classically been associated with better treatment retention, it’s important to point out that methadone still produces a euphoric high for the user. Buprenorphine, on the other hand, does not elicit the high that opiate addicts seek. Even better, buprenorphine maintenance during pregnancy has shown better outcomes for both mom and unborn child. This information, along with other emerging science, has led many doctors to prefer buprenorphine use for pregnant patients.
Suboxone or Subutex?
There is a difference between the available buprenorphine products, Suboxone and Subutex. Suboxone
contains the abuse-deterrent medication naloxone, while Subutex does not. With a lack of scientific evidence on Suboxone use among pregnant women, most experts opted to use Subutex. Additionally, women who become pregnant while taking Suboxone are generally switched to Subutex.
What about pregnant women who are unlikely to follow an established opiate detox program? Research shows that smaller prescriptions, observed dosing, and increased office visits can help, but the most important factor is to avoid the IV abuse of Subutex.
In a small study of 10 opioid-dependent pregnant women, all were treated with the Suboxone film product. Results proved the maternal findings were... comparable to those seen with Subutex.
Luckily, mounting evidence shows that Suboxone may also be safe in pregnancy. In a small study
of 10 opioid-dependent
pregnant women, all were treated with the Suboxone film product. Results proved the maternal findings were not only safe, they were comparable to those seen with Subutex.
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