Opioid Dependence in Pregnancy. James J. Nocon, M.D., J.D. Indiana University School of Medicine Chairman, Indiana Prenatal Substance Abuse Commission Director, Prenatal Recovery Clinic Wishard Memorial Hospital 1001 West 10 th Street, F5102 Indianapolis, Indiana 46202 firstname.lastname@example.org
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
James J. Nocon, M.D., J.D.
Indiana University School of Medicine
Chairman, Indiana Prenatal Substance Abuse Commission
Director, Prenatal Recovery Clinic
Wishard Memorial Hospital
1001 West 10th Street, F5102
Indianapolis, Indiana 46202
October 7, 2011
Pregnancy makes a difference in long-term recovery.
After one year of treatment:
65.7% of women who entered treatment while pregnant used no drugs, while
Only 27.7% of non-pregnant women remained drug free. (p<0.0005)
Peles E, Adelson M. Gender Differences and Pregnant Women in a Methadone Maintenance Treatment (MMT) Clinic. J Addictive Diseases 2006; 25: 39-45.
1800 to 2000
21st Century: 2002-2007
Cocaine and THC 59
Other Combinations 48
Based on 287 pregnant patients treated from 2002 to 2007.
Late 19th Century: Women accounted for 2/3 of America’s opiate addicts and a large percentage of marijuana, sedative, cocaine and amphetamine addiction.
Only 1 in 5 illegal drug addicts during 1914-1954 were women
Approximate 15% of all pregnant women today are using alcohol, illegal and illicit drugs during pregnancy.
Note: Americans constitute 4% of the world’s population and consume 2/3 of the entire drug supply.
Alcoholic women usually have alcoholic spouses and less spousal support. (Holds true for opiates, as well)
Redgrave, et al, Alcohol misuse by women. Int. Rev. Psychiatry 2003;15:256-268
Women more likely to abuse prescription drugs
“My mother gave me her Xanax.”
Vicodin, Lortab, Xanax and Klonopin.
Bardel, et al. Reported current use of prescription drugs and some of its determinants among 35-65 year old women in mid-Sweden; a population based study. J Clin Epidemiol. 200 53;637-643
Just as alcohol, tobacco, and drugs activate the pleasure circuit in the brain, so do many behaviors such as sexual activity, winning a contest, gambling, and being praised.
What drugs and behaviors have in common is the release of various neurotransmitters in nucleus accumbens in the brain:
Dopamine – creates the “buzz.”
Serotonin – sense of well being.
Endorphins – euphoria.
GABA (gamma amino butyric acid) – satiety and somnolence (sleepy after a big meal or sex)
As repeated use of the drug or behavior depletes the dopamine, more activity is required to get the same effect. “Tolerance.”
There comes a point when the affected person becomes an addict, as if a switch in the brain is flipped, and the person no longer has the ability to make free choices about the continued use of the drug.
Leshner AI. Addiction is a brain disease, and it matters. Science 1997;278:45-47
Addiction is a “double whammy.”
McCann UD, Szabo Z, Scheffel U, Dannals RF, Ricaurte GA. Positron emission tomographic evidence of toxic effect of MDMA ("Ecstasy") on brain serotonin neurons in human beings. Lancet 1998 Oct 31;352(9138):1433-7.
Alcohol and tobacco cause more fetal damage than all the other drugs combined including all the known teratogens.
Among Women using BOTH Alcohol and Nicotine in the pregnancy
• 20.4% used Marijuana
• 9.5% used Cocaine
Women NOT using Alcohol or Nicotine
• 0.2% used Marijuana
• 0.1% used Cocaine
Alcohol and Nicotine use is also a marker for other drug use.
Derived from Poppy, PapaverSomniferum, 4000 BC
Other Commonly Used drugs
Opioid (31) Opioid + (45) p
Preterm Delivery 4 (12.9 %) 8 (17.7%) NS
Low Birth Weight (<2500g) 3 8 NS
Mean Birth Weight 3085 g 2879g NS
Positive Meconium 0 12 (26.6%) 0.001
NAS Treated 1 5 NS
Mean Length of Stay 3.3 7.8 0.01
Failed to return PP 3 13 0.01
Returned PP “negative” 23 (74.2%) 25 (55.5%) NS
Bup. (46) Meth (90) p
Preterm Delivery 5 (10.9 %) 27 (30%) 0.001
Low Birth Weight (<2500g) 4 26 0.01
Mean Birth Weight 3079 g 2718g 0.005
Neonatal Abstinence (NAS) 8 89 0.001
NAS Treated 6 80 0.001
Mean Length of Stay 6.78 30.3 0.001
Failed to return PP 13 (28.8%) 28 (31.1%) NS
Returned PP “negative” 29 (65.1%) 59 (65.5%) NS
See also, Kakko J, Heilig M, Sarman I. Buprenorphine and methadone treatment of opiate dependence during pregnancy: comparison of fetal growth and neonatal outcomes in two consecutive case series. Drug Alcohol Depend 2008 Jul 1;96(1-2):69-78.
What works - just about anything:
Identifying the problem - 50% will abstain
Motivating the patient - 85% will abstain
What doesn’t - ignoring the problem.