Pregnancy and opioid use: strategies for treatment

Pregnancy and opioid use: strategies for treatment

Illicit opioid consumption is associated with an increase in obstetric complications in pregnant women. It also brings with it a range of potential dangers for the child, both before and after birth. Neonatal complications include narcotic withdrawal, postnatal growth deficiency, microcephaly, neurobehavioural problems, increase in neonatal mortality and an increase in sudden infant death syndrome.

In a new EMCDDA Paper published today, the EMCDDA looks at strategies for treating pregnant opioid users. It describes how the primary goal in treating opioid dependence in pregnant women is to stabilise the patient, in order to avoid the permanent fluctuation of plasma levels and related foetal consequences (e.g. foetal distress and preterm birth).

Psychosocially assisted opioid substitution treatment (OST) is the first-line treatment for opioid dependence in pregnant women and several combinations of substitution medicines and psychosocial approaches are available. The pharmacological interventions studied in this overview were methadone, buprenorphine and slow-release oral morphine (SROM). The psychosocial interventions covered were cognitive behaviour approaches and contingency management.

The observed differences between the three substitution approaches did not show a homogeneous and comprehensive pattern to conclude that one treatment is superior to the others for all relevant outcomes. While methadone seems superior in retaining patients in treatment, buprenorphine seems to yield to less severe neonatal abstinence syndrome and higher birth weight.

All the psychosocial interventions included in the review gave similar results in terms of dropout rate and reduction of drug use, with contingency management obtaining promising results in one study. Recent World Health Organization (WHO) guidelines on pregnant women (1) consider psychosocial interventions to be an integral component of treatment (regardless of the type of medication selected for the OST).

The report concludes that: ‘Studies of pregnant women are complex for several reasons, including ethical and practical difficulties. It is therefore crucial that we exhaustively analyse all elements of existing studies in order to add to the discussion’.