Editor's note: This is the second of two parts about opiate abuse and its potential consequences during pregnancy.
In my last post, I provided some history of opiate use in the US and how one Philadelphia doctor began addressing the issue in the 1970s. Now I am going to discuss why opiate use abuse became a problem in recent times. Also, the latest efforts to help women who use opiates during pregnancy and newborns who suffer from Neonatal Abstinence Syndrome, a drug withdrawal syndrome as a result of opiate abuse during pregnancy.
In the early years of the 21st century, the leaders of US medicine decided that no one should suffer pain. Unfortunately, the elimination of pain was accomplished by prescribing huge oral doses of opiates that did not have to be injected. The lack of having to inject the drug spread the addicted population far and wide. Opiate addiction was primarily a disease of the urban poor when I was a young doctor in the 1970s and now it is a national problem sparing no neighborhood or class, and maybe most prominent in the rural areas of the Northeast.
But there is some reason to hope. The Centers for Disease Control and Prevention just released a new set of guidelines for prescribing opiate pain medicine that should decrease the supply (if the medicine manufacturers and medical providers actually follow the suggestions). There are also researchers addressing opiate withdrawal from various perspectives.
Diane Abatemarco, PhD, MSW, chief of the Maternal Addiction Treatment Education and Research Program at Thomas Jefferson University, and others are introducing mindfulness training to increase bonding in addicted woman. And increased bonding is remarkably important to reduce drug withdrawal in the newborns. The baby-centered post-partum movement (where babies room-in with their mother for 24 hours a day after birth, with a lot of skin-to-skin contact, and breast feeding is strongly encouraged) is already showing positive results in preventing infant withdrawal with only 35 to 40 percent of opiate exposed infants needing treatment instead of 50 percent. Increased breastfeeding itself gives the baby just enough of the mother's drug to prevent withdrawal without making the child ill.
Walter Kraft, MD, a hospitalist and researcher also at Thomas Jefferson University, and colleagues around the country are testing buprenorfine (a partial agonist – works at the same site as a opioid in the brain, but does not produce much of a "high") instead of morphine for treatment of NAS and has shortened the hospital stay for newborns by one third (22 days versus 33 days) in his preliminary data.
Gary Peltz, MD, at Stanford University in California is using ondansetron, an anti-vomiting agent that is not addictive, to try and prevent withdrawal in newborns with some success. As with most medications, none of these drugs are approved in babies, so widespread approval will be slow in coming even if they work.
To minimize the increasing problem of opiate use during pregnancy, the US will have improve care in many ways:
Make strong, long-lasting prescribed opiates less available
Have more wrap around programs such as MATER at Jefferson that treat all aspects of the problem for both addicted mother and her child
Continue to improve perinatal care to make NAS less overwhelming such as preventing withdrawal or minimizing it if it occurs as commented on above.