Addiction Treatment for Pregnant Women Poses Challenges

Aug 16, 2018

Some medications used to treat opioid use disorders can be abused if taken in large amounts or injected. Others, such as suboxone, prevent the effect of the opioids. Two WVU researchers are studying whether this drug could be used to treat pregnant women with opioid use disorders. Kara  Lofton spoke with researcher Laura Lander about the findings and the challenges of treating pregnant women.

LOFTON: Your research focuses on treating opioid use disorders in pregnant women. What are the challenges with working with this particular patient population?

LANDER: One of the most challenging things for pregnant women with substance use disorder is the stigma that they face in accessing treatment. Oftentimes they are in situations where their families may or may not know about their substance use or the extent of their substance use or may not be supportive of them getting treatment -- if they, say, have partners that are still using themselves.

Some of the other challenges are certainly transportation and child care, which can make it difficult for patients to come into treatment if they have no transportation and they have other kids in the home. It's difficult for them to bring [children] to treatment.

What we're studying is a variety of different things. Both what is most effective in treating pregnant women with substance use disorders and then we also have some research looking at neonatal abstinence syndrome. It's basically withdrawal symptoms that babies encounter when they are born exposed to substances in utero.

LOFTON: So what are some of the concerns with using medication to treat opioid use disorders in pregnant women?

LANDER: So one of the major concerns is that medication (the medication we use here, is buprenorphine naloxone -- so that's a combination medication) or other medications used in pregnancy for the treatment of opioid use disorder is methadone. And both of those medications do expose the baby to opioids.

Methadone is a full opioid agonist. So it functions as an opioid but it's very long acting, which is one of its benefits. And buprenorphine naloxone - buprenorphine is a partial opioid agonist. It's also very long acting. It's a little bit safer in that it's just a partial agonist and it's very hard to overdose on or become very intoxicated on but it does expose the baby to opioids in utero. So with the treatment with both different kinds of medications the baby can develop neonatal abstinence syndrome.

Now it is the case that not every infant born to a mom who's on either one of these medications does develop the syndrome and so part of our research is trying to figure out why some babies do develop that and others don't. Is there a genetic component to that?

LOFTON: The patients you studied for this particular research are participants in the WVU comprehensive opioid addiction treatment program which, as far as I understand it, does allow participants to stay on medication as long as needed. Is the approach different for pregnant women?

LANDER: No, we actually use the same approach for pregnant women except we try to take to make even a greater effort to retain women in treatment. So we in the comprehensive opioid addiction treatment program, we require patients to do lots of different things -- not just take medication -- because it is our belief, and it's certainly supported by the research, that people get better not by taking a pill but to making a variety of changes, including behavioral changes, and thinking changes, and changes in people, places and things in order to get better and to recover from substance use disorder.

And so it's very difficult for people to, from the very first day, adhere to all of our requirements. So the only difference in the pregnancy program is some of the rules are slightly different in an effort to retain pregnant women in treatment unless they are diverting or misusing their medication. Those would be the rules in which we're not going to bend on those rules because they're not utilizing treatment in the way that would be most helpful to them.

LOFTON: One of the challenges with treating pregnant women is that you aren't just treating the mother but the fetus as well. What kind of outcomes are you seeing in newborn babies?

LANDER: So one of the biggest challenges we actually have, and we're hoping to institute a smoking cessation program soon with the help of the School of Pharmacy, is actually -- the most negative impact we see is related to smoking. I would say about 90 percent of our pregnant women smoke cigarettes and it's very hard to tease out what might be a low birth weight related to cigarettes as opposed to poor nutrition and other factors. But we believe that most of the low birth weight that we might see is most likely related to nicotine use. And so we provide education on that and we're hoping to actually have a full-fledged program that that pregnant women can participate in as part of their treatment here.

But the impact in terms of the initial growth parameters and things like Apgar Scores, babies do very, very well on medication, on the suboxone. What we know less about is the long-term impacts on the developing child. And that's where we would like to see some, we would like to pursue some additional research and funding for studies looking at say five years out. How are the kids doing?

One of the difficult things about doing that is environmental factors certainly influence how kids might be doing at age 5 when they are school age and to keep the environmental factors separate from say the impact of intrauterine exposure to buprenorphine is a little bit difficult.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Marshall Health, Charleston Area Medical Center and WVU Medicine.