Tuesday, January 19, 2010

Opiate addiction in pregnancy

A colleague called last week to ask about what to do with a pregnant patient who is hooked on heroin. The traditional treatment is for the women to be put onto methadone and maintained on methadone throughout the pregnancy. This treatment has been tested in clinical studies and does work. The babies are usually born a little small, and of course the baby will be born addicted to methadone and have to go through withdrawal. This usually involves having the baby stay in the hospital for a week or two after birth. In fact, most babies tolerate this very well, and don’t show too much withdrawal symptoms – although since they can’t actually talk to you, it is hard to know what they are actually experiencing.

Fortunately there is now some evidence of an alternative treatment using Naltrexone implants. Drs George O’Neil, Gary Hulse, and their colleagues in Australia have published a number of articles using Naltrexone Implants. They have implants that reliably deliver 6 months or more of Naltrexone and a large number of their patients have become pregnant and delivered babies with these implants in place. The results are very encouraging. The babies are born very healthy with no birth defects. They are not born addicted to any drugs and they are considerably bigger and heavier that babies born on methadone.

As we get implants that last longer in this country, and this becomes a more acceptable form of treatment I think many pregnant patients will want to take care of their addiction with Naltrexone Implants instead of methadone.

Dr Coleman

1 comment:

  1. unfortunately naltexone implants, while they do block the effects of opiates, do not cure the disease of addiction nor treat it. Opioid addiction causes a shutdown in the brain's ability to produce natural endorphins--sometimes temporarily, sometimes permanently. Many doctors believe that some opioid addicts may have had abnormally low production of endorphins to begin with, thereby predisposing them to opioid addiction and causing a very different response to the drug than most people would have. Methadone serves to stabilize and normalize the brain chemistry of the patient, in much the same way that long term testosterone replacement therapy is sometimes required for those who have abused anabolic steroids, etc, or diabetic patients whose pancreas no longer produces insulin.

    The answer for these patients is not to simply block the effects of opiates. This still leaves the patient severely depressed, anhedonic, exhausted, irritable and at risk of relapse or trying to overcome the blockade, or even using other drugs NOT blocked by Naltrexone in a desperate bid to self medicate this condition. This solves very little and does not help the root of the problem--brain chemistry alteration.

    In addition, it is not correct to state that the babies are born "addicted" to methadone. The correct term for infants is physically dependent. The medical definitions of addiction and physical dependence are very different, and addiction involves not just dependence but also a series of behaviors of which infants are incapable. For this same reason, methadone patients who take their medication as directed and who are not using other drugs do not meet the definition of being "addicted" to methadone, though they are physically dependent. Though most lay people are not aware of these definitions, those in the medical professions must try to make themselves aware of this, as much misunderstanding, prejudice and false and inflammatory rhetoric springs up around the misuse of these terms.