Treatment Options Exist for Opiate Dependent Pregnant Women at All Stages of Their Pregnancy
Authored by Vlad Grubyy
It happens. Women who are addicted to alcohol or drugs become pregnant and need specialized care so that both baby and mother are healthy.
Nationally, rates of hospitalizations of women at delivery with opioid use disorder quadrupled between 1999 and 2014, with many states in the Northeast such as Maryland and Vermont hit particularly hard. The number of babies born with neonatal abstinence syndrome also skyrocketed during this time period. While no significant studies have been done since, with nearly 50,000 opiate overdose deaths in 2017, according to the United States Center for Disease Control, it’s likely that the numbers of addicted pregnant women aren’t any better today.
While many want to focus on outrage that a woman becomes pregnant while in active addiction, the focus should be on helping both the child and the mother.
Outrage is better served by targeting the greed that created thousands of residents of all fifty of our states addicted to opioids—some of them women of childbearing age. Addiction is a mental health disease and special care is needed for the health of the children of these women who are addicted to opioids, and for the women themselves
Recovery Centers of America at Bracebridge Hall, in Earleville, MD, has created a program with specialized treatment for these pregnant addicted mothers. The program has a full team of medical providers, including physicians on staff, who provide individualized care for pregnant women with a substance use disorder. For opioid patients who are pregnant, RCA’s pregnancy and parenting program has an evidence-based treatment program for mothers up to the 32nd week of pregnancy. Two types of treatment exist for this patient. First, if the mother is admitted early in her pregnancy (generally before her twelfth week of pregnancy), she can choose detoxification or medication-assisted-treatment and then receive supervised residential treatment for her addiction. For patients further along in their pregnancy, however, methadone or buprenorphine treatment is the standard of care as detox carries too many risks to the baby after twelve weeks, according to the Medical Director at RCA Bracebridge Hall, Mark Harris, D.O.
According to Dr. Harris, many women in the program want to detox because they want the best thing for their babies and their own life as a parent moving forward. However, by the time they learn of their pregnancy and undergo the tests needed to be admitted for treatment, it is often past the first trimester. Dr. Harris explained that medication-assisted-treatment is a safe option for the opiate-addicted pregnant patient and the baby throughout the pregnancy. The medications are a type of specialized opiates, however, so the baby will have some withdrawal symptoms that will need treatment at birth.
The American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine support methadone and buprenorphine treatment as best practice for opioid use disorder during pregnancy. Methadone has been used to treat pregnant women with opiate addictions since the 1970s. In 1998, a National Institutes of Health consensus panel recommended methadone maintenance as the standard of care for pregnant women with opioid addiction (National Institutes of Health Consensus Development Panel 1998). Effective medical maintenance treatment with methadone has the same benefits for pregnant patients as for patients in general. In addition, methadone substantially reduces fluctuations in maternal serum opioid levels, so it protects a fetus from repeated withdrawal episodes. Recently, buprenorphine has been shown to offer additional positive results for the baby as well.
Prior to admission at RCA-Bracebridge Hall, all pregnant women must undergo a detailed medical evaluation which includes a level two fetal ultrasound, lab studies, and a review by an OB/Gyn.
“It’s a tough situation and there is a lot of shame with these patients,“ said Dr. Harris. The bottom line is we need to get the word out that the sooner these patients get into treatment, the more options there are for their children’s health.”
RCA’s Pregnant and Parenting Women Program also implements parenting skills training, fitness and wellness, and cultural activities related to pregnancy and parenting. Patients are treated with evidence-based services including Motivational Enhancement Therapy, trauma informed care, recovery and empowerment, and a nurturing parent program for families in substance abuse treatment and recovery. Finally, RCA is partnering with community groups to facilitate transitional housing in a sober environment for patients after they deliver their babies.
Families can break the cycle of addiction and begin living healthy happy lives. The Pregnancy and Parenting Program at Recovery Centers of America Bracebridge Hall provides health and hope for mothers suffering from a substance use disorder.
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