October 26, 2015
Dr. Michael J. O’Connell, New Hampshire, recently commented that as addiction to various forms of opioids is becoming prevalent, more young women than ever are presenting for delivery on methadone, heroin, oxy and other drugs. This causes a considerable nightmare for these newborns and for those healthcare workers administering to them.
Neonatal abstinence syndrome (NAS) is the withdrawal of the baby from the drugs mom abused before and during pregnancy. The treatment for the newborn is a continuation with gradual weaning from some form of opioid, often IV morphine. The process can take weeks in the hospital and costs are staggering. The treatment for the mom is less complicated and requires little additional hospital stay, but is just as unpalatable from a societal perspective.
There are few answers to this gestational addiction problem, but buprenorphine is a solid drug to address the issue while society figures out the underlying problem. If the pregnant addict confesses to her addiction, and converts to buprenorphine (Subutex, Suboxone) early in pregnancy, the NAS is markedly reduced to just a few days. The problem is how to convert the mother from the methadone, or oxy or whatever potent opioid she is taking to the buprenorphine? Many studies are now emerging that support the safety of doing this in a gradual manner during the first trimester. The process must be monitored by a provider experienced in such a transition, is very familiar with buprenorphine, and also has access to urine tox screening and quantitative LCMS.