Opioids are natural pain relieving medications cultivated from the poppy plant since 3400B.C. Today most of these prescription painkillers are man made and synthesized by pharmaceutical companies or through illegal makeshift laboratories and are sold on the street and are distributed all over the world creating an addictive opioid epidemic. Naturally occurring opioids such as morphine and codeine are now put on the back burner and newer synthetic opioids including methadone, fentanyl, carfentanil and U-47700 are making their way into people’s homes resulting in severe addiction, overdose and death. According to statistics, opioid dependence affects approximately five million individuals in the United States each year and is responsible for 17,000 deaths each year in the U.S. Approximately 18 women per day die from painkiller misuse or abuse, and approximately 30 women per day are treated in emergency departments for the same concerns. The impact of opioid addiction in pregnant women includes the use of heroin and misuse of prescription medications. In 2010, the national survey on drug use and health estimated that 4.4% of pregnant women reported illicit drug use in the past 30 days, while 0.1% reported nonmedical use of opioid-containing pain medication. Opioids are a class of prescription painkillers that have some of the highest addiction potential and can result in abuse when not taken correctly. Morphine, oxycodone, hydrocodone, methadone, heroin, fentanyl and codeine are all example of commonly prescribed and abused opioids.
How opioids affect pregnancy and the newborn
Opioid use during pregnancy can result in many pregnancy complications such as fetal growth restriction, placenta abruption, fetal death, preterm labor, and intrauterine passage of meconium. Opioids can affect the baby in many ways during pregnancy depending on the length of gestation. In the first trimester, opioids can result in severe organ malformation and birth defects. Opioid abuse in the 2nd and 3rd trimesters can result in developmental delays and tissue damage in the fetus. Additionally opioid withdrawal can be devastating to the baby and withdrawal effects can take place within hours of birth. Opioid withdrawal effects in newborn result in high-pitched crying, tremors, poor feeding, slow weight gain, seizures and even death. These symptoms, when associated with opioid withdraw in an infant are known as neonatal abstinence syndrome (NAS) and occur when opioids pass through the placenta during pregnancy, resulting in physical addiction in the baby.
Treatment for opioid use in pregnancy
The current treatment for pregnant women with opioid dependence is opioid assisted therapy with methadone. Further evidence has shown that buprenorphine can also be used in treatment. Methadone is an opioid agonist that is used to reduce or eliminate withdrawal effects associated with opioids. It is titrated to a lower dosage over a duration of time until the mother is completely weaned off of this medication. Buprenorphine is a partial opioid agonist meaning that it blocks opioid receptors and also activates opioid receptors in the brain. It works to reduce or eliminate opioid withdrawal side effects and cravings without producing the opioid “high” associated with opioid agonists. The treatment for neonatal abstinence syndrome (NAS) in newborns requires administering small doses of morphine in order to slowly wean the neonates and prevent withdrawal effects. Hospitals are required to alert authorities when a mother is addicted to drugs to work with a social worker to assist families with life at home with a child.