Pregnant women who are addicted to heroin or prescription pain relievers should be treated with either methadone or buprenorphine (Suboxone, Subutex).
This according to new guidelines recently published by the American Academy of Pediatrics.
I wasn’t surprised by the new guidelines, because similar recommendations have already been made by the U.S. National Institutes of Health and the World Health Organization, among others. And it is well known that detoxification from opiates during pregnancy is associated with increased risk of fetal harm and may result in loss of the pregnancy.
Medication-assisted treatment with methadone or Suboxone is a responsible choice for pregnant women who are opiate dependent. Women who make this choice should be praised and supported.
Instead, the opposite often happens. And pregnant women who follow the scientific evidence and top expert medical advice often face stigma.
Part of this stigma stems from inaccurate claims that babies will be born “addicted.” The truth is that babies born to women in treatment with methadone or Suboxone are not addicted.
Addiction refers to dysfunctional and compulsive drug use that continues in spite of negative consequences. Clearly, a newborn baby is not capable of using compulsively, or having a dysfunctional relationship with a substance. And we should remember that without the methadone or Suboxone, it’s quite possible that there would be no newborn at all.
Labeling an infant born to a mother in treatment with methadone or Suboxone “addicted” is not only inaccurate, it also contributes to stigma. Such stigma can lead to punitive treatment of the mother and negative consequences for both the mother and child.
Many babies born to mothers in treatment with methadone or Suboxone will experience some symptoms of physical withdrawal after birth, but this results from physical dependence on the medication and not addiction to the medication.
Withdrawal symptoms may be uncomfortable for the baby. But they are a side effect of a medically necessary medical treatment. They are temporary, can be treated to limit distress to the baby, and are not known to cause any long term harm.
Mothers who are in treatment with methadone or Suboxone are encouraged to breast feed their babies (unless otherwise contraindicated). Small amounts of methadone or Suboxone that may be passed to the baby with the breast milk can help reduce any symptoms of withdrawal.
Research shows that women who are pregnant and addicted to opiates have the best outcomes for themselves and their child when they:
- Participate in treatment with methadone or Suboxone while they are pregnant
- Breastfeed their baby
- Continue methadone or Suboxone treatment as needed to successfully initiate and maintain long term recovery
Medication-assisted treatment is responsible for the safe delivery of many healthy babies to mothers who would otherwise still be using, and therefore less able to parent successfully.
Perhaps the Academy of Pediatrics should recommend medication-assisted recovery for expecting fathers who are addicted too. I know I do.