The numbers don’t lie: with 1.9 million Americans facing a prescription drug abuse problem in 2014 alone, the United States is facing a major opioid addiction epidemic. What’s further alarming is the rising occurrence of neonatal abstinence syndrome (NAS) in newborn babies — a condition where the infant is born dependent on opioids and exhibits withdrawal symptoms. NAS occurs as a result of pregnant women using opioids during pregnancy, and it’s seen a 5-fold increase since 2000. Nearly 22,000 babies were born with this condition in 2012, the equivalent of one baby being born with opiate withdrawal symptoms every 25 minutes.
This guide will cover everything you need to know about opiate addiction and pregnancy. It will discuss potential reasons why and how opioids have become prevalent in today’s society, the dangers of addiction and usage during pregnancy, options for treatment, and a brief note on legal considerations. The intention here is not to critique or pass judgment on anyone who finds herself in this position, but to give her the information she needs to find her way to a safe, healthy life for her child and herself. Remember to always consult a doctor or addiction specialist for personalized medical treatment.
The Opioid Epidemic: How and Why It’s Happening
There are many ways someone might become addicted to opioids. One possibility is addiction stemming from treatment for a chronic pain condition. Although an estimated 90 percent of chronic pain patients are prescribed opiates, recent research shows that these kinds of drugs are actually not effective in treating pain long-term. Patients often develop a tolerance, requiring increased doses to get the same effect. As time goes on the opioid can even make people more sensitive to pain, especially if they attempt to cut back on their dosage. It can be a slippery slope leading to dependency, which can be especially detrimental for anyone looking to start a family or who may become pregnant.
Acute pain, like that suffered from broken or fractured bones and post-surgical discomfort, is also often treated with prescription opiates. Part of what makes these drugs so tricky is that even taking them as directed for short periods of time can lead to physical dependency and withdrawal symptoms after cessation. Symptoms may include nausea, sweating, rapid heart rate, and anxiety. This kind of discomfort can cause even those with no addiction history to seek more of their prescription than recommended by their doctor, or even to find outside means.
There’s good and bad in the regulation of prescription opioids. A positive is that regulation aims to keep people from falling victim to addiction by restricting access. The downside of this is that it can cause people to take alternative, dangerous routes to feeding their habit. Many will turn to heroin, because in addition to being a very powerful opiate, it’s cheaper and can be found more easily on the street than painkillers. Unfortunately, heroin is an extremely dangerous drug and increases a person’s risk of overdose.
No matter how opiate addiction occurs, once a woman becomes pregnant it isn’t as easy as simply kicking the habit. As the next section will illustrate, it’s also not the safest route for mother or baby.
Pregnancy: Managing Your Addiction While Protecting Your Child
To an outsider, it may seem that the obvious answer for an opiate-addicted expectant mother is to quit using the opiate immediately after learning she’s pregnant. Opioids are extremely powerful, however, so going from constant large doses to none at all can be a shock to the body. In pregnant women, it can even cause miscarriage. Quitting cold turkey also leaves her more susceptible to relapse; withdrawal symptoms can often be so overwhelming that a person can’t help but return to old habits to alleviate the pain and suffering.
Many doctors turn to medication-assisted treatment to help wean expectant mothers off an opiate without throwing their bodies into the shock of withdrawal. It calls for the use of low doses of drugs like methadone or buprenorphine — enough to keep a low level of the opioid in her system to prevent withdrawal symptoms, but not enough to get her high. This kind of therapy can ease the transition into sobriety and make it much easier to kick the habit for good.
There are differing ideas for which medication is best to use in pregnant women attempting to kick their opiate habit. A 2010 study found that buprenorphine has similar maternal outcomes as methadone but is better in reducing symptoms in newborns. babies require less medication and time in the hospital. Buprenorphine hasn’t been used as regularly for this kind of treatment, however, so some doctors aren’t comfortable prescribing it. Further, making the switch from methadone to buprenorphine can be particularly difficult for the mother. Though it’s certainly important to look out for the welfare of the child, the mother’s health cannot be sacrificed in the process, so if methadone has been issued for treatment and is proving to be successful, the best route is likely to stick with the methadone. In general, it’s best to start mothers who haven’t undergone any addiction treatment with buprenorphine and if symptoms don’t improve, make the switch to methadone.
There’s a significant downside to this medication-assisted treatment, however: taking any kind of opiate while pregnant means the child has a 60 to 80 percent chance of being born with NAS. This means the baby will leave the womb already hooked on opiates, and he is immediately cut from his supply upon birth. It can be an extremely painful way to enter the world. Though withdrawal symptoms typically occur within 72 hours of birth, they may take up to a week to present themselves and could include sweating, trembling or tremors, diarrhea, blotchy skin coloring, fever, hyperactive reflexes, vomiting, stuffy nose, sneezing, rapid breathing, poor feeding, and excessive, high-pitched crying. Extreme cases may even cause seizures.
A baby born with NAS will require monitoring by nurses with specialized training to watch for new, recurring, and worsening withdrawal symptoms. Severe dehydration may call for treatment with intravenous, or IV, fluids. Feeding problems are relatively common as are low birth weight and slow growth, so some babies will require smaller portions of high-calorie formula given more often. Sleeping troubles are another common occurrence as withdrawal can cause constant overstimulation — babies may require reduced lighting and noise along with gentle rocking in a swaddled blanket.
Particularly bad cases of NAS may require the child to go through treatment similar to his mother’s: low doses of methadone and morphine that can curb withdrawal symptoms while weaning him off the opiate. (Bear in mind that while this regimen isn’t uncommon, it hasn’t officially been approved by the Food and Drug Administration.) Breastfeeding may also help as the mother will still have the opioid in her system and it will be passed on to the baby through her breast milk. The dosage will be reduced over time as the baby becomes less dependent on it. Keep in mind that even with treatment, babies going through NAS will still exhibit some symptoms and will likely cry a lot. Depending on the severity of the condition, symptoms can last anywhere from one to eight weeks.
With the proper treatment and monitoring, most children born with NAS will recover and be able to go home healthy. The problem is that there has yet to be a study on the long-term effects of the drugs, so it’s difficult to say if this treatment will cause problems in the child’s future development. There is, however, a study in the works that will look at both long-term effects of medication-assisted treatment as well as comparing the effects of methadone versus morphine.
It’s important to note that there are legal aspects to consider if you’re pregnant and battling an opiate addiction. The truth is, it can be a tricky situation. Although medication-assisted treatment is seen as the standard, some states may have laws that will conflict. Tennessee is the only state with a statute specifically making it a crime to use drugs while pregnant, but authorities in at least 45 states have attempted to prosecute women for the practice. Depending on where you are (and some laws may be county-specific), doctors may suggest a course of treatment that a law enforcement or child welfare agent will tell you is unlawful. Further, some areas may require doctors and nurses to report drug use during pregnancy, even if it’s only suspected.
It’s a tragic dilemma to place a woman in need in: it seems that she must either choose attempting to safely enter drug abuse recovery or risk losing custody of her child. Do what you can to research the laws in your area. If you fear you may be in danger of losing custody of your child, you can contact the National Advocates for Pregnant Women via their online form or by phone at 212-255-9252. They can counsel you for further steps you can take to keep both you and your child safe.
Don’t delay too long in seeking treatment, even if the laws in your area are questionable; what’s most important is getting the proper prenatal care for your child and recovery care for yourself. Your doctors can likely refer you to further help, and some hospitals even have programs devoted to the cause.
If you’re dealing with an opiate addiction while pregnant, keep a few key points in mind: you are not alone, recovery is possible, and you have multiple options. Surround yourself with supportive loved ones who will keep you on track throughout your journey. Never let yourself forget that you’re fighting not only to regain your own life, but to create the healthiest life possible for your child.