I am just now becoming more active in the fight against opioid addiction. I’ve shared my thoughts on this in real time and on a big stage. I’m newly waivered to prescribe Suboxone and Subutex. I’m working with both the obstetrics and substance abuse departments to set up a Prenatal Substance Use Disorders “clinic”.
So this CNN article titled “Stopping the opioid crisis: in the womb” really grabbed my attention.
It is a well-written article, quite engaging. And it’s wonderful that the author is calling attention to a particularly vulnerable population. Exactly how many pregnant women are using pain pills or heroin can only be estimated, but it’s alot.
In a 2010 national survey, 4.4% of women reported using illicit drugs of any kind in pregnancy. In another report, 1% of pregnant women reported using opiates, while 2.6% screened positive for opiates in their urine. So, even if we round down, we’re talking about alot of women.
But the article profiles a controversial approach to treatment: detox and abstinence.
Detox and abstinence has consistently shown poor results, with as many as 80% of patients relapsing, compared to treatment with medications, with only 15% relapsing. Medications, specifically methadone and buprenorphine (AKA Subutex), can help prevent withdrawal symptoms and control cravings, and can help patients to function in society. While methadone can only be prescribed through certified clinics, any primary care provider who completes a training course can prescribe buprenorphine.
Basically, treatment with medications is effective and safe. Yes, relapses can occur, but far less frequently than with traditional treatment. And death from opiate overdose? Far, far less.
And with pregnant patients, it is the very, very high relapse and overdose rate that we worry about the most. Anecdotally, I know of very few pregnant patients who opt for detox. The only one I heard of in recent months died. Of a heroin overdose. The baby died too. (I was not involved in their care.)
So to see this article highlight and celebrate the detox and abstinence approach is a little disconcerting. To be fair, they do present the data supporting medication- assisted therapy like buprenorphine, and state that it is the “official” stance of substance abuse programs treating pregnant women to recommend medications like buprenorphine.
I’m also bothered by use of the word “clean”. The patient being profiled didn’t want to use medications because they felt that in doing so, they weren’t truly “clean”.
I can see the concerns about the baby. After all, babies born to mothers using buproenoprhine have to then be weaned off of opiates. But, they are born alive, and with less risk of having contracted HIV or Hep C from the mother’s needle use. It’s a heavy risk/benefit analysis.
In the end, I am glad that CNN published this article, though I worry about the accuracy of the message it sends.