Medical Treatment of Opioid Use Disorder in Pregnant Patients
By: Rehab South Florida Editorial
Medical Treatment of Opioid Use Disorder in Pregnant Patients
Medical Treatment of Opioid Use Disorder in Pregnant Patients. When treating opioid use disorder in pregnant patients there are two pharmacotherapy options commonly available — buprenorphine and methadone. Both of these options are used to assist in the withdrawal of opioid use in a medically controlled environment.
Methadone: Number One Pharmacotherapy Choice for Use in Pregnant Patients
When it comes to pharmacology, methadone is the preferred option due to its effectiveness to not only block withdrawal symptoms for a full 24-hours but also because it reduces euphoric effects commonly experienced with non-prescription opioid use in patients.
Methadone is also available in multiple formats for administration, making it something that every patient can take in some form or another, whether it’s as an injectable, oral solution or in pill format.
One major difference is its half-life in a pregnant patient compared to a patient that is not pregnant. The normal half-life of up to 24 hours is cut drastically, falling to eight hours in a pregnant patient due to pharmacokinetics linked to pregnancy.
Initial Methadone Dosage for Pregnant Patients
While it’s best to start medical treatment for opioid use disorder in pregnant patients as early as possible, it’s never too late to begin, as it will help lower the risk of an overdose, regardless of when treatment begins.
It’s suggested that the initial treatment and dosage is administered in a hospital environment because of the possibility of adverse reactions. For the safety of the mother-to-be and the unborn child, a controlled environment with experts on-site to monitor and react, if needed, is suggested.
If possible, an oral dose is the best choice, and the initial dosage is typically 30 mg, with an additional five to 10 mg administered every five to six hours as needed to combat withdrawal symptoms. Federal regulations limit the initial dose to no more than 30 mg.
When treatment is done in a hospital setting, day two begins with a dose of methadone equal to the entire first-day dosage. This doesn’t mean that the entire amount is given — some patients don’t experience severe withdrawal, therefore a large second-day dose can be avoided.
In cases of severe withdrawal, the morning doses are given until no further incremental doses are required in order to stabilize the patient without withdrawal signs.
When the stabilization dose is reached, the patient is discharged from the hospital and an outpatient facility takes over. These facilities will not increase the maintenance dose amounts, even as withdrawal symptoms like vomiting and body aches may increase.
Additional Methadone Dosage Options
There are additional methadone dosing options, and that is a split dose and a 3x dose. A split-dose involves two doses per day, given in 12-hour intervals and a 3x dose is three times daily in 8-hour intervals. While it requires more work and tracking, some experience fewer withdrawal symptoms when multi-dosing daily rather than just a single morning dose.
When treating opioid use disorder in pregnant patients and a dose is missed, they may continue the treatment at the same level dosage as long as the missed dose does not extend beyond three days.
Every patient is given a urine test at the start of the treatment program, and then throughout treatment, additional drug tests are given in order to detect non-prescription opioid use. Given weekly, in the U.S., it’s required that patients receive at the very least eight tests per year of treatment.
Side Effects of Methadone in Pregnant Patients
There are some side effects commonly experienced when treating opioid use disorder in pregnant patients, such as drowsiness, excessive perspiration, and constipation. They are typically mild symptoms, and just present a level of discomfort, with no serious health threat. If opioid use was heavy, the patient might become more sensitive to pay as the dosage is reduced.
When treating opioid use disorder in pregnant patients there are some things to take into consideration during intrapartum and postpartum dosing. Intrapartum, the dosage may continue as advised, but postpartum, the dosage may be reduced slightly — typically upwards of 40 percent right after postpartum.
There are many questions regarding breastfeeding while taking methadone to treat opioid use disorder, and it’s actually encouraged, provided the patient is stable and not using non-prescription opioids or other substances. As long as they are following the treatment plan, then breastfeeding is fine.
Side Effects of Methadone in Newborns
Naturally, there are questions related to methadone use in treating opioid addiction and how that impacts the newborn throughout his or her infancy. Exposure to methadone, when prescribed by a hospital and treatment facility, has no negative effect on the child.
There have been numerous studies and reports published but the Substance Abuse and Mental Health Services Administration that supports these claims. The potential benefits far outweigh the potential risks, if any, as long the patient doesn’t use any non-prescribed opioids or other substances during the treatment period.
Additionally, there is a great risk during pregnancy if the patient doesn’t seek treatment and relapses, resulting in an overdose and death.
While a single morning dose of methadone is common proactive among pregnant patients treating opioid use disorder, a twice-daily dose is worth exploring, as it can result in plasma levels that are more sustainable. Many experts also report that a twice-daily dose presents a less chance of a relapse, as well as reduced severity of common side effects.
One requirement for twice-daily dosing is that the patient can take the medication home and self-administer, which some patients are not candidates for because of past substance abuse and the severity of their prior opioid use. When a twice-daily dose is prescribed, the patient must take weekly drug tests to check for non-prescribed opioid usage.
During the initial dosage, it’s not uncommon for psychiatric professionals to evaluate the patient’s state of mind, determining whether or not they will require full in-patient care or if they are stable enough to self-administer dosage at home rather than at the hospital. The optimal time for this evaluation is during the very first urine test — most hospitals integrate this with the first screening.
At the end of the day, the well-being of the unborn child takes precedence over all else, and the treatment plan will often align with the results that the psychiatric evaluation reveals. If there is any indication that the patient might relapse or use other substances, they will need to be monitored throughout the entire process and an in-patient treatment plan will be suggested.
Treatment of opioid use disorder in pregnant patients will always come with controversy and opinions, but at the end of the day, it’s important to understand that opioid addiction is serious, and the alternative to treatment often relapses, leading to an overdose.
In this situation, a child’s life is lost, so everything should be done to help the patient fully recover, even if that means going a pharmacotherapy route — medicating with either buprenorphine or methadone.
There are studies that show the risk to the unborn child is little to no risk, which far outweighs the alternative, which is continued opioid use and a possible overdose situation. Properly supervised medical treatment is the best option for pregnant patients that want to permanently kick their opioid addiction.
There are hospitals and treatment facilities that have extensive experience treating opioid use disorder, specifically in pregnant patients, and help is available to those that truly want it for not only themselves but their unborn child as well.