How Doctors Fail Pregnant Addicts

How Doctors Fail Pregnant Addicts

By Jennifer Matesa 05/07/12

The author of a recent study on opiate-dependent babies tells The Fix that doctors rely too much on buprenorphine.

Image: 
This opiate-addicted newborn must undergo
methadone treatment.
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An opiate-dependent baby is born every hour in the US. It's largely due to skyrocketing rates of prescription painkiller abuse, and costs up to $20 million in treatments annually, according to a recent study in the Journal of the American Medical Association. The study's author, Marie J. Hayes, Ph.D., writes in an editorial that ran alongside the study that one big problem with treating drug addiction in pregnancy is the tendency of pregnant addicts to binge-and-withdraw—even when they’re in a maintenance program on methadone or buprenorphine. This forces the developing fetus to withdraw along with the mother, putting added stress on already delicate opiate-related neurological developments including learning, memory, emotion and cognition. Hayes also notes that pregnant women addicts prescribed buprenorphine—commonly known as Subutex or Suboxone—more often drop out of studies than women prescribed methadone, which suggests that bupe might not be the best treatment for pregnant women.

Yet general practitioners and OB-GYNs continue to hand bupe out to pregnant patients in the belief that the drug—which is less tightly controlled than methadone and can be prescribed in ordinary doctors’ offices—treats addiction. “In Maine, it is a daily happening; every physician struggles with opiate addiction in their pregnant population,” Hayes tells The Fix. “But opiate addiction is not an easy thing to manage by the seat of the pants. It’s not the kind of thing that you just give the mother buprenorphine and she’s all set. Because actually the addiction is not treated by the buprenorphine; only the [physical] dependence is treated... The real problem [in treating addiction] is psychiatric. So what doctors need to know is that the patients’ first referral should be for psychotherapy and social supports. And when you say that, everybody nods, but they don’t do it—they just give them the buprenorphine and send them on their way.”