Opioid substitution therapy
Lots of evidence has been collected in support of the medical and social benefits of OST for opiate users, including during pregnancy.
Lots of evidence has been collected in support of the medical and social benefits of OST for opiate users, including during pregnancy. All medicines prescribed during pregnancy and breastfeeding should be considered as special protective measures not only towards the woman, but also in regard to the unborn child.
Methadone is the most commonly prescribed medication for opioid agonist maintenance. Unlike heroin, it does not increase the risk of pre-term delivery and its safety during pregnancy is proven. It is important to know that, like heroin, it may cause withdrawal symptoms in the newborn. By offering protection against early delivery, it is of great importance for the baby’s long term health. Antenatal opiate detoxification is safe; management of detox should be dictated by women’s willingness to go through it and their ability to cope.
If WUD are on buprenorphine maintenance treatment during pregnancy, as with all opiates, deprivation may result in neonatal withdrawal. However, severity and duration of withdrawal may be less than in babies whose mothers have been on methadone maintenance. Mothers treated with buprenorphine were more likely to start medication prior to or earlier in pregnancy, had longer gestation and larger infants. Newborns of buprenorphine- vs. methadone-maintained mothers required treatment for neonatal abstinence significantly less often and for a shorter duration.
Initiating buprenorphine or methadone maintenance in women who use street drugs can lead to withdrawal symptoms and should be carried out during pregnancy in an inpatient setting. During the process of switching, contractions may be triggered by withdrawal symptoms. Buprenorphine has a slight antidepressant effect and is non-sedative. The resulting “clear head” could be an undesirable effect for the patient.
There are a number of reasons to recommend OST treatment to WUD during pregnancy. It improves medical outcomes for pregnant women and their babies as well as social outcomes and physical and mental health of pregnant women and mothers. It contributes to prevention of overdose and other drug-related deaths. It increases individual stability and social functioning while reducing offending behaviors, crimes and illicit drug use. It also has a positive impact on the health and wellbeing of communities.