Care scarce for opioid-addicted pregnant women

Adults who become addicted to prescription painkillers aren't always the only patients their doctors must consider. Women who are pregnant and addicted risk having babies suffering from neonatal abstinence syndrome and other substance-related complications, and often have difficulty obtaining proper care for themselves or their unborn children, according to a report from MedPage Today.

Key barriers that keep addicted mothers from getting treatment for their dependencies and/or proper prenatal care include a dearth of OB/GYNs willing and able to take such cases and mothers' fears of being stigmatized or legally punished for their substance use, according to the publication. Malpractice risks are high for OB/GYNs to begin with, noted the article, while 18 states consider substance abuse during pregnancy "a form of child abuse."

Medication-assisted therapies (MAT) do exist, however, that can improve outcomes for women and babies. Methadone is the only medication currently approved for use in pregnant women, but the drug is available only in licensed clinics--and only 9 percent of substance abuse treatment centers in the country provide MAT at all.

Despite warning labels against it, some physicians prescribe Subutex (buprenorphrine) off-label to addicted mothers, Medscape reported. Randy Easterling, M.D., medical director for the Marion Hill Chemical Dependency Unit in Vicksburg, Mississippi, is among these doctors.

Michael Marcotte, M.D., medical director of the HOPE program for opiate-addicted pregnant and recently pregnant women for the TriHealth hospital system in Cincinnati, Ohio, offered further insights into doctors' hesitations about MAT: "I think that a lot of well-meaning obstetricians say 'It's better if you don't use methadone or bupenorphrine during pregnancy because then your baby won't be addicted,' but in our experience if we don't provide women with this [legal] medication ... they will often relapse to heroin," he said.

MAT alone doesn't address the underlying causes of addiction, experts added, which makes coordinated behavioral healthcare crucial to prevent relapse.

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