NAS: Subutex, Suboxone & Methadone In Pregnancy
Every mother wants what's best for her unborn child. Sadly many mothers find themselves in the situation where they required the use of Methadone or Buprenorphine during their pregnancy. Despite the common mythconception, this is not always the result of illicit drug abuse - there are many cases of dependancy caused by the result of legitimate treatments fully supervised by Doctors. Regardless of the reasons why a mother find herself in this situation, it is of the utmost importance that she works closely with medical professionals to make well informed decisions about the welfare of her unborn child...and she do this as early as possible.
To this effect, this hub has been written to help mothers and their families to understand the information about Methadone or Buprenorphine during pregnancy - not just the dangers, but how these drugs work and why early medical attention is necessary. This hub has a companion - NAS: Neonatal Abstinence Syndrome - which will also be beneficial read to those dealing with substance use or abuse during pregnancy.
I dedicate this hub to all those wonderful professionals who work without judgement to bring so many of these NAS babies safely into the world and who work with the families to provide the long term care and support that is needed. Kudos to you!
Methadone Subutex Soboxone - Drug Use In Pregnancy
Regardless of how mothers find themselves in the situation, it is vital to make a well informed decision as to how to proceed with treatment. There are three main drugs that are used to treat drug dependency. Methadone, Buprenorphine and Naltrexone. To give you an idea of how these drugs will affect your unborn child, you need to understand how they affect you.
Methadone - Agonists are drugs that stimulate the opiate receptors in your brain - easy to remember...they cause you agony if you stop using them abruptly! Agonists include Heroin, Morphine, Benzodiazapines, Methodone etc.The use of Methatdone during pregnancy has been well documented and it's use is deemed as "safe." However there are better options available today.
Naltrexone - Antagonists are drugs that coat the receptors in the brain and prevent them from receiving the stimuli from agonists.
Buprenorphine - Subutex and Suboxone both contain Buprenorphine - it's the active ingredient on which they are based. Suboxone can be regarded as Subutex Plus (for it contains some extra ingredients that prevent it's misuse - naloxone). Buprenorphine is a partial agonist. It coats the receptors in the brain whilst allowing a small amount to pass through thus keeping withdrawals at bay.
To put it simply:
Agonists = the door is wide open
Antagonists = the door is closed and locked
Partial agonists = the door is left ajar.
So what's best for baby?
Up to 94% of babies born to opioid dependent mothers exhibit signs of NAS so it's vital that mothers seek early antenatal care. It's the general consensus that antagonists should not be started during pregnancy as sudden withdrawal from any drugs can cause seizures, premature delivery or even the death of the fetus.
Recent studies (May 19, 2010 (San Francisco, California) have shown that Subutex is safer for neonates than methadone which has been used traditionally. In addition, being a partial agonist, Buprenorphine withdrawals are milder. The additional ingredient Naloxone which is found in Suboxone can cause seizures and other problems in neonates therefore Subutex is currently the number one choice by Doctors.
Subutex is a relatively new drug. It is a C class drug which means the manufacturers do not recommend it's use during pregnancy...this is a precaution all drug manufacturers take to protect themselves from future law suits.
Since it is unethical to conduct drug trials on unborn children, the only data available is that which has been gathered from mothers who volunteer for drug surveys. So far, Subutex has been considered most favourably and thousands of baby's have arrived safely without long term complications.These children have yet to grow old though and the continual studies of their health is of great interest.
In contrast, Methadone has been used to treat opioid dependency for over 40yrs - thousands of Methadone babies have grown to have no/low occurrence of long term issues. However, Methadone, being an agonist (an opioid) does cause high occurrence of NAS.
In short, those Subutex babies that do show signs of NAS experience milder withdrawals. Those who require hospitalization will stay for less time than those born to opiate dependent mothers and require less medication. You can find more info here.
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The Bad News vs The Benefits...
The use of any drugs including those found in your supermarket or pharmacy carries certain risks. A drug is deemed safe when the risks cause minimal long term damage, when the risks occur in a minute percentage of patients and when the benefits outweigh the dangers of not treating the injury, illness or addiction.
Your Doctor will inform you of the many dangers associated with the use of Methadone or Buprenorphine during pregnancy including premature birth, placental abruption, IUGR (Interuterine Growth Restriction), fetal loss, malformations and a whole host of other complications. These risks are small...but they are present. Please keep in mind these problems also occur in drug free pregnancies and are no reason to cease your treatment - the risks are higher if you continue to use drugs instead of these treatments.
Over half of neonates who are exposed to Buprenorphine in utero during pregnancy will experience NAS. About 40% of Buprenorphine babies will require treatment. Don't be put off though, approx 36% of Subutex babies experience no signs of withdrawal (a figure that was only dreamt of decades ago) and the percentage of Methadone or opiate babies who experience NAS much higher in comparison. Please read here for more details about NAS.
Many of these problems occur in a small percentage of births but the fact is the risk is increased. The benefits of using these drugs must therefore outweigh the dangers? They do.
- Mothers are less likely to overdose on a prescribed medication.
- Mothers are maintaining a consistent level of the drug in their bloodstream - fluctuations can trigger the early onset of labour or miscarriage.
- Mothers are using a regulated drug as opposed to street drugs which also contain other harmful ingredients.
- Mothers are less likely to continue using drugs/alcohol.
- There's a decreased likelihood of mothers sharing injecting equipment and exposing themselves and their baby to blood born virus's like Hepatitis or HIV
- Only 64% of Buprenorphine babies experiense NAS as opposed to 94% of babies born to opioid dependent mothers. Not all of these babies will require treatment.
- 36% of Subutex babies experience no symptoms of NAS
- Subutex is a partial agonist which means the withdrawals are milder than other opiates and methadone.
- Subutex neonates require less medication and and have shorter stays in hospital.
Breast Feeding and Subutex
For all the potential that Subutex is showing, there is still a hesitancy to approve the use of Subutex whilst breast feeding. Again, this is a precaution that every pharmacutical company takes in an effort to spare itself future embarrassment.
For more information about the arguments for and against the use of Buprenorphine during lactation please read NAS: Neonatal Abstinence Syndrome
For additional information consult your Doctor. For additional reading...
- Methadone and Pregnancy
- ScienceDirect - Drug and Alcohol Dependence : Use of buprenorphine in pregnancy: patient management
Summery of the 21 published reports on the use of Buprenorphine during pregnancy and the statistics of NAS.
Results of a recent study Methadone vs Subutex during pregnancy. (Conducted in May 2010)
NO medical decisions should be made without the consultation of your Doctor. You should not cease the use of Methadone, Suboxone or Subutex.
Some mothers may be inclined to conceal drug/alcohol dependency from their medical professionals for a number of reasons...usually involving their ego. There is a veil of secrecy between pregnant patients with drug dependencies and their Doctors - it needs to come down. Help break the stereotype and be a good Mum...tell your Doctor.
For an overview of NAS and it's treatment please click here to read this articles sister called NAS: Neonatal Abstinence Syndrome.
For a supportive ear...
As a temporary solution to my flooded Inbox, I have created a forum for mothers and their families to come and ask questions or share experiences about using Buprenorphine during pregnancy and breastfeeding.
I'd like to invite you to come and visit...but more importantly CONTRIBUTE to this forum.
Please address you mail to email@example.com
The use Buprenorphine (Subutex & Suboxone) or Methadone during pregnancy is a complex issue and there is lotsof conflicting advice. I have created this email for mothers and families who wish to contact me privately about their specific situation.I will be happy to share the additional information I have learned that is not discussed in this hub and answer private emails about the use of Buprenorphine and Methadone during pregnancy and lactation or about beginning Subutex treatment in pregnancy.