Treating Opioidaddicted Pregnant Women

Methadone maintenance has been viewed as an effective treatment for opioid addiction in pregnant women since the early 1970s. In addition to the benefits of psychosocial interventions provided by the program, methadone maintenance treatment prevents erratic maternal opioid drug levels, thus protecting the fetus from repeated episodes of withdrawal. Programs either provide prenatal care onsite, or monitor the patient to see that prenatal care is obtained elsewhere, thus reducing the incidence of obstetrical and fetal complications, in utero growth retardation, and neonatal morbidity and mortality (Finnegan, 1991). Exposure to HIV infection through ongoing needle use is also reduced. Programs typically provide interventions around nutrition, parenting skills, exercise, and other related topics.

Methadone-maintained mothers produce offspring more similar to drug-free controls, in contrast to the poorer health status of offspring born to women using street drugs. It is clear that the most damaging consequences of opioid use during pregnancy occur with repeated episodes of intoxication and withdrawal (Jarvis & Schnoll, 1994). Although expectant mothers can be stabilized on methadone, body changes specific to pregnancy cause them to frequently develop increasing signs and symptoms of withdrawal as the pregnancy progresses, and they may need dose increases in order to maintain therapeutic plasma level and remain comfortable. Splitting the dose so that it can be ingested twice daily often produces better results, both reducing fetal stress and increasing the comfort of the preg nant woman, but local regulatory obstacles, not allowing patients to take half their daily dose out side the clinic, make this impractical for many programs.

There is inconsistent evidence to support the commonly held belief that the severity of the neonatal abstinence syndrome is proportional to the methadone dose, but many programs urge the expectant mothers to reduce their dose so the ''baby won't be born addicted.'' In fact, the management of neonatal abstinence syndrome is relatively straightforward; fetal discomfort can usually be eliminated within hours and withdrawal can be accomplished within 14 to 28 days. No lasting impairment from these experiences has been demonstrated.

Drug Addiction

Drug Addiction

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