According to the Centers for Disease Control and Prevention, the United States is currently in the middle of an opioid epidemic, with 18 out of 100 Americans having used illicit drugs or misused Rx drugs. On average, 115 Americans die every day from an opioid overdose. Simply put, millions of Americans across the country are addicted to opioids. As a result, healthcare professionals are experiencing an influx of patients suffering from opioid use disorders, otherwise referred to as opiate use disorders. Such disorders can affect almost every patient population, including pregnant women.
Multiple Opioid Risks for Pregnant Women
Opioid use disorders can be extremely dangerous to all patient populations, although pregnant women are among the most alarming patient populations suffering from opioid addiction since opioids can have devastating long-term effects on a pregnant woman’s unborn fetus. Opiates can have long-term effects on babies, including developmental delays, motor dysfunction, and behavioral problems. All of these can dramatically impact a child’s ability to maintain a healthy and well-adjusted life.
To compound the problem of pregnancy and opioid addiction, the abrupt discontinuation of opioids and withdrawing from opiates while pregnant can be extremely dangerous to both the expecting mother and her unborn fetus. In other words, if a mother-to-be is abusing heroin or another opioid such as oxycodone during pregnancy suddenly stopped using the opioid due to a concern for her baby’s health, she could put her life and the life of her unborn fetus in dire jeopardy. So how can healthcare professionals, including pharmacists, safely and effectively treat pregnant women addicted to opioids? The answer may lie in what is commonly referred to as medication-assisted treatment.
Medication-assisted treatment can refer to the process of using medications in combination with other treatment options to provide therapy to individuals suffering from substance use disorders. The most common medications used in medication-assisted treatment for opioid addiction include both methadone and buprenorphine. Medication-assisted treatment has become a common method of therapy for opioid use disorders among many patient populations, including pregnant women — although pregnant women face different and unique risks when undergoing medication-assisted treatment.
Case Study: Pondering Methodone Order
A pharmacist working in a hospital receives a methadone order for a 32-year-old female patient. Immediately, the pharmacist checks the patient’s profile for potential allergies, warnings, and notes. The patient does not have a methadone allergy; however, the pharmacist does observe a pregnancy note in the patient’s profile. Upon further examination, the pharmacist verifies the patient is indeed pregnant. Furthermore, the pharmacist discovers the indication for the methadone is medication-assisted treatment for an opioid use disorder. The pharmacist believes the dose of the methadone order is within the therapeutic range, although the pharmacist hesitates and does not verify the order. Instead, the pharmacist ponders the use of methadone and other opioids during pregnancy, as well as the benefits and risks of addiction treatment during pregnancy.
As with most medications administered during pregnancy, the use of methadone and buprenorphine in pregnant women does pose both benefits and risks. Thus, healthcare professionals must weigh the benefits and risks of medication-assisted treatment in pregnant women before they initiate therapy. Also, pregnant women receiving either methadone or buprenorphine should be educated about the potential dangers of each medication, so that they may formulate an informed decision regarding treatment.
Along the same lines, pregnant women should also be educated about the health risks of abusing opioids while pregnant as well as the long-term effects use could have on the unborn fetus. The use of medication-assisted treatment, however, may prove to be the safer option when it comes to opioid use disorders in pregnant women in comparison to some of the alternatives, such as opioid abuse and opiate withdrawal while pregnant. After all, when a pregnant woman receives medication-assisted treatment, she is, typically, under the care and observation of a team of healthcare professionals dedicated to her safety as well as the safety of her unborn child.This can make all the difference in the child’s development and ability to live a happy, healthy life.
Healthcare Professionals Need Additional Opioid Training
Due to the large numbers of patients using or abusing opioids, healthcare professionals should receive education on the effects of opioids and how to effectively administer care to those seeking treatment for opioid addiction. The very real truth of the matter is thatopioid abuse is prevalent among many patient populations and pregnant women are not exempt from the grip of an opioid use disorder. Thus, healthcare professionals should expect to encounter pregnant women seeking treatment for opioid abuse, much like the 32-year-old female patient in the example above.
As in the example above, healthcare professionals must consider the effects of opioid addiction therapy on those patients receiving medication-assisted treatment. On the other hand, suppose the pharmacist is still considering the methadone order for the 32-year-old female patient who is pregnant. The pharmacist has obtained all of the necessary and relevant information required to verify the order and has weighed all of the benefits and risks of the treatment option. The pharmacist understands that overcoming an opioid use disorder can be extremely difficult and trying on a patient’s health, especially when the patient is pregnant. The pharmacist also understands that without the medication-assisted treatment, the patient may seek alternative means to obtain an opioid, which may lead to abuse or withdrawal, and additional health complications for both the patient and her child.
After much internal debate, the pharmacist concludes the medication-assisted treatment may be the safest option for the patient and verifies the order. The patient receives her methadone treatment and is monitored by her team of healthcare professionals to ensure her safety, as well as the safety of her unborn child. As previously mentioned, opioid use disorders can be dangerous for a pregnant woman and the future health of her child. However, through education, knowledge and progressive therapy options such as medication-assisted treatment,healthcare professionals can provide the safe and effective healthcare pregnant women with opioid use disorders require.