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You are not alone in trying to deal with continuing drug use during pregnancy, and it is appropriate to be concerned about both the effects of drugs on the baby and the effects that stopping the drugs and risking withdrawal might have on the pregnancy. The safest course is to get off the pain medications, and the best current way of doing this is with buprenorphine or Subutex. Your obstetrician can help to arrange this.

The National Survey on Drug Use and Health in 2010 found that about 4.5 per cent of pregnant women had used illicit drugs in the previous 30 days. Only 0.1 per cent of pregnant women were found to have used heroin in the preceding 30 days, but about 1 per cent of pregnant women used opioid pain medications for nonmedical reasons during that time. A study in 2008 in which every pregnant woman at University Hospital in New Orleans was screened by urine test for evidence of drug use showed that about 3 per cent tested positive for opioid drugs that had not been prescribed. The concern about the safety of taking opioids and how to manage them during labor and delivery also affects women who have to take prescription pain medications during their pregnancies for one reason or another.

Withdrawal from opioid medications or illicit drugs can be very unpleasant, but it is not fatal for healthy adults, in contrast to alcohol withdrawal or withdrawal from sedative or anxiety drugs like barbiturates or benzodiazepines, the group which includes Valium and Xanax.

Withdrawal also affects the fetus, however, and fetal death can occur from it.

If opioids are continued until delivery, the child will develop withdrawal after birth because he or she is no longer being exposed to the drug through the placenta, as had been the case during pregnancy. The most important objectives during pregnancy are to prevent withdrawal by mother and child and to initiate a drug maintenance program as soon as possible for the mother; after delivery the main focus is to treat withdrawal in the child and begin to work more intensively on addiction with the mother.

Women who take opioids by prescription or otherwise are appropriately concerned about the risk of birth defects.

Most studies do not indicate an increased risk of birth defects with exposure during pregnancy to oxycodone and hydrocodone.

There are some reports of heart defects in children exposed to codeine during pregnancy. There is no current evidence of birth defects associated with methadone or buprenorphine, which is Suboxone or Subutex. In contrast, heroin use definitely increases the risk of injury to or death of the fetus. Methadone is the best treatment option for pregnant women who are using heroin, while the best option for pregnant women taking pain medications is to stop them and start buprenorphine about 72 hours later, just as withdrawal symptoms are beginning. Starting it earlier may precipitate more severe withdrawal symptoms.

Buprenorphine (Suboxone) is an opioid like the pain medications, and in fact is sometimes used in the form of a skin patch for pain treatment. It binds only partially to the attachment site or receptor where these drugs exert their effects on nerve cells, so prevents withdrawal symptoms without causing a high or depressing respiration. Buprenorphine is poorly absorbed when taken orally and comes as small film strips that are dissolved under the tongue. It can be snorted or injected by people who are really determined to get high and then has a risk of overdose, so the narcotic antagonist naloxone, usually given for overdoses, is added to make the buprenorphine ineffective when taken by these routes. Naloxone can cause premature labor if taken during pregnancy, so buprenorphine without naloxone is used (Subutex). After delivery, Subutex should be replaced with Suboxone unless the baby is to be breast fed, as exposure of the newborn to naloxone is not desirable.

The great advantage of Suboxone and Subutex is that they can be given on an outpatient basis. Methadone can only be given by a licensed treatment center, and there is a shortage of these and daily or frequent visits are usually required. Buprenorphine can be prescribed to up to 100 patients by any physician who takes a course and obtains certification and then gets an additional registration number from the Drug Enforcement Agency. This allows pregnant women trying to get off of pain medications to continue with their usual activities and responsibilities. It is important, and is now mandated by the DEA, to become involved with some kind of rehabilitation or counseling to deal with the issues of drug use and addiction. This can take the form of Narcotics Anonymous, which applies the 12-step principles of recovery from alcoholism to drug abuse and addiction, but the more numerous meetings of Alcoholics Anonymous are also welcoming to people wishing to recover from prescription drug use.

There are many natural things that can also be done to prevent withdrawal. A long period of drug use often results in a highly toxic state, and cleansing and detoxification are helpful. Vegetable juices, fruit juices with as little sugar as possible, teas made from calming herbs and as much fresh and clean water as you can manage are key to detoxifying. Exercise produces endorphins, internal chemicals that have the effects of opiates naturally, as well as increasing oxygen utilization and encouraging mental relaxation. Eating several small meals a day will prevent blood sugar swings, and refined sugar should be avoided for this reason. Calcium is calming and reduces tremors and anxiety, while protein lessens drug cravings and facilitates the replenishment of brain transmitter chemicals that have been depleted. Lemon juice or lime juice in water and cranberry juice will enhance liver and kidney removal of toxins, and sports drinks rich in electrolytes are helpful if there is vomiting or diarrhea during withdrawal that can deplete these. Homeopathic remedies are available over the counter and are considered safe for pregnancy. Four pellets of 30c or 30x potency under the tongue twice a day are often recommended, but not combined with food or drink. Aconite for restlessness, Arsenicum for diarrhea and vomiting but also for despair and agitation, Ignatia for chills and thirst or with pain, Nux vomica for tremor and sensitivity to light and sound as well as nausea and vomiting, Stramonium for hallucinations and convulsions and Zinc for jitteriness, nervousness and irritability. A high-dose vitamin supplement is particularly important for nutritional support of the pregnancy.

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