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self index.cfm
site_filepath /www/sites/mfapp/templates/main/
 
Alan Trachtenberg, Md  
     
     
National Advocates for PregnantWomen (NAPW): a non-profit organization dedicated to securing the human andcivil rights, health and welfare of pregnant and parentingwomen


OPIOIDDEPENDENCE DURING PREGNANCY (text file): Effects and Management by
KarolKaltenbach, PhD, Vincenzo Berghella, MD, and Loretta Finnegan, MD. OBSTETRICSAND GYNECOLOGY CLINICS OF NORTH AMERICA. VOLUME 25 ? NUMBER I ? MARCH 1998 139PP. 140-51.

OPIOIDDEPENDENCE DURING PREGNANCY (pdf Image file): Effects and Management by KarolKaltenbach, PhD, Vincenzo Berghella, MD, and Loretta Finnegan, MD. OBSTETRICSAND GYNECOLOGY CLINICS OF NORTH AMERICA. VOLUME 25 ? NUMBER I ? MARCH 1998 139PP. 140-51.

NeonatalDrug Withdrawal: American Academy of Pediatrics (AAP) Policy Statement / WebLink

BritishColumbia Reproductive Care Program Substance Use Guideline 4B:
PERINATALOPIOID EXPOSURE,CARE OF THE NEWBORN

BritishColumbia Reproductive Care Program Substance Use Guideline 4B:
PERINATALOPIOID EXPOSURE,CARE OF THE NEWBORN (local copy)


Methadonemaintenance is optimal in pregnancy.
(adapted from the Journal ofPsychoactive Drugs, 26:155-161, 1994)

The Brown University Digest ofAddiction Theory and Application, Feb 1995 v14
n2

Despite possiblecomplications and public policy controversy, methadone
maintenance duringpregnancy is stiff the treatment of choice for opioid
addicted women,according to a recent article in the Journal of Psychoactive
Drugs. Thecourse results in better fetal outcomes and helps stem the tide of
HIVinfection in mothers and their children.

According to Margaret A.E.Jarvis, M.D., and Sidney H. Schnoll, M.D., Ph.D.,
from the Medical College ofVirginia, the risks to mother and fetus in
methadone maintenance are farfewer than those associated with cycles of
sudden withdrawal andreintoxication by street drugs, as well as the related
lifestyle dangersincluding high-risk HIV related behaviors. Women denied or
removed frommethadone maintenance during pregnancy are highly likely to
relapse intoheroin use.

Jarvis and Schnoll based their conclusions on a review of theliterature.
Although there are few studies on the effects of opioids in humanfetuses,
animal studies indicate that such drug use produces fetalstress.
Precipitated withdrawal is worse than intoxication, but cycles ofabuse and
withdrawal are particularly harmful.

"It is clear thatdevastating consequences of opioid use during pregnancy
occur with repeatedepisodes of intoxication and withdrawal," they say.

Methadone maintenanceis the best way to provide stabilization, although
infants born to methadonemaintained mothers may undergo a withdrawal
syndrome after birth. Infantwithdrawal "combines the symptoms of the adult
withdrawal syndrome, withirritability, poorly coordinated sucking and, in
the most severe cases,seizure and death." Lowering the methadone dosage can
lessen or eveneliminate this withdrawal syndrome, however. The authors
report that "atmethadone doses of less than 20 mg per day, little or no
neonatal abstinenceis seen."

Of course, lowering the methadone dosage may affect themother's ability to
remain drug free, especially since some studies haveindicated that methadone
metabolism accelerates during the last trimester ofpregnancy. Thus,
"increasing the dose of methadone might be necessary toprevent withdrawal
symptoms late in pregnancy." Alternatively, "splitting thedose of methadone
into a twice-daily schedule" may help to avoid the need toincrease the
dosage.

Methadone treatment for pregnant women works bestin "well-coordinated
multidisciplinary care settings" where good obstetricaland medical care, as
well as counseling and parenting education, can beprovided.

Although opioid withdrawal during pregnancy is dangerous forthe mother and
the fetus, in some cases, it cannot be avoided. If the patientrefuses
methadone maintenance, lives in a place where maintenance is notavailable,
or has been stable for some time and wants to become completelydrug free,
she may need to be withdrawn from opioids.

The authors saythat a careful, controlled, and slow withdrawal should not
endanger the fetusduring any stage of the pregnancy. If withdrawal is
necessary, the womanshould be provided with extensive psychosocial support,
so that she will beless likely to return to heroin use once drug free.

However, the authorsemphasize that they "discourage" withdrawal from
methadone during pregnancyexcept under unusual circumstances.

Suggested readings:

Doberczak,T.M., Kandall, S.R., Friedman, P. Relationships between maternal
methadonedosage, maternal-neonatal methadone levels and neonatalwithdrawal.
Obstetrics and Gynecology, 81:936-940,1993.

Giles, W.,Patterson, T., et al. Outpatient methadone programme for pregnant
heroinusing women. Australian and New Zealand Journal of Obstetrics and
Gynecology,29:225-229, 1989.

Maas, U., Kattner, E., et al. Infrequent neonatal,opiate withdrawal
following maternal detoxification during pregnancy. Journalof Perinatal
Medicine, 18:111-118, 1990.

Margaret A.E. Jarvis, SidneyH. Schnoll "Methadone Treatment During
Pregnancy," Journal of PsychoactiveDrugs, 26:155-161, 1994. Reprint requests
to: Dr. Jarvis, Division ofSubstance Abuse Medicine, Box 980109, Medical
College of Virginia, Richmond,VA 23298.


Female hard drug-usersin crisis Childhood traumas and survival strategies by Carien Karsten(1993)


Methadone duringpregnancy & Lactation (Beth Israel)



The Role of Partnersin Women?s Recovery: (http://socrates.berkeley.edu/~aiarc/projects/partners.htm)
- From the National Abandoned Infants Assistance Resource Center of theSchool of Social Welfare of the University of California at Berkeley:
Intimate partners play a critical role in women?s introduction to andrecovery from alcohol and other drug abuse. Frequently, trauma and domesticviolence also influence women?s motivation and ability to recover, as well astheir intimate relationships. To further explore the dynamic intersection amongsubstance abuse, trauma, and intimate relationships, the AIA Resource Centerconvened a group of technical experts. One of the results was a monographentitled Partners? Influence on Women?s Addiction and Recovery: The Connectionbetween Substance Abuse, Trauma, and Intimate Relationships: (http://socrates.berkeley.edu/~aiarc/projects/partners.pdf)

National Abandoned Infants Assistance Resource Center
Universityof California, Berkeley
Family Welfare Research Group
1950 AddisonStreet, Suite 104 # 7402
Berkeley, CA 94720-7402
Phone: (510) 643-8390
Fax: (510) 643-7019
E-mail: aia@uclink4.berkeley.edu Homepage: (http://socrates.berkeley.edu/~aiarc/index.html)