Methadone and pregnancy

[IkeBoy18]

Not sure if this is the right forum or OB/GYN.



I am currently rotating in a prison where there is a pt (20yo currently 9wks preggers) on methadone 20mg. It was suggested that the pt be weaned off methadone because the pt is in prison and will not be able to relapse. The pt was upset and said that another clinic told her the methadone was to "protect the baby."

Ive been scouring the net and cant really find good information except: "The Government’s Center for Substance Abuse Treatment says this: 'Medical withdrawal of the pregnant women from methadone is not indicated or recommended.”'

It doesnt say why. Any ideas?

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[emd123]

Is the methadone for pain, or addiction?

If for addiction, you need to pick the brain of addiction/psych and OB.

If the the methadone is for pain, I say, it's a lose-lose situation.

Run Forest, run.

Turf to OB and peds, who is going to have to deal with a poor feeding, lethargic, opiate withdrawing newborn. I personally don't put 20 year old pregnant women and their fetuses on methadone, or any opiates for that matter, for pain. In fact, in have zero patients in their 20's on opiates, and zero patients on methadone of any age. Plenty of docs do stuff I don't agree with, though.

Good luck, man.

 

[SSdoc33]

Is the methadone for pain, or addiction?

If for addiction, you need to pick the brain of addiction/psych and OB.

If the the methadone is for pain, I say, it's a lose-lose situation.

Run Forest, run.

Turf to OB and peds, who is going to have to deal with a poor feeding, lethargic, opiate withdrawing newborn. I personally don't put 20 year old pregnant women and their fetuses on methadone, or any opiates for that matter, for pain. In fact, in have zero patients in their 20's on opiates, and zero patients on methadone of any age. Plenty of docs do stuff I don't agree with, though.

Good luck, man.

Very unhelpful post. The student is looking for a legit answer. If you don't know, just say so. She was clearly on methadone before she got pregnant.

I think you have to keep her on it, then deal with the consequences in the baby. Good case for MFM, if available.

Btw, it would probably be very easy for her to get her hands on some opioids in jail, if she wants

 

[Taus]

Can't help.... But on a semi related note...
I got a dump last week from mfm on a preggo who was kicked out of her pain docs practice for selling her oxy 30's... for her fibro... W uds + for multiple illicits. They asked me to take over rx for the oxy or rx methadone. Umm... No... Though stated much more politely in my consult.

 

[IkeBoy18]

Thank you for the responses.

Sorry, she was a heroin addict and did not find out she was pregnant until she was incarcerated and was already on methadone. She was then transferred to the states prison hospital where we are currently treating her. Her previous clinic, associated with her prison told her (per pt) to stay on the methadone to protect the baby. My attending suggested otherwise. I was just trying to find some solid information.

 

[emd123]

Very unhelpful post. The student is looking for a legit answer. If you don't know, just say so. She was clearly on methadone before she got pregnant.

I think you have to keep her on it, then deal with the consequences in the baby. Good case for MFM, if available.

Btw, it would probably be very easy for her to get her hands on some opioids in jail, if she wants

You've recommend continuing this medication, to a person, online, not even knowing if it's for pain, or addiction. Now after your post, he says it's strictly for addiction. You've recommended, as a pain doctor, he continue it solely for addition. It's illegal to prescribe opiates, strictly for the purposes or maintaining dependence or addiction unless you have that DEA certification. I don't, do you?

That's why my post wasn't helpful. Because he left out extremely important bits of info. People jump to giving rash responses on here without any info. You would write the Rx for a 20 year old methadone addiction (not Pain) patient, in jail and pregnant?

Seriously?

Give me a break

If not, why are you telling a stranger online, to do it?

 

[Aether2000]

There are several issues at play here in this situation. Whether being treated for addiction or for pain, there is some evidence of increased risk of birth defects and reduced birth weight with opioids in a study of prescription opioids with limitations that did not test the control or study patients for illicits http://www.ajog.org/article/S0002-9378(10)02524-X/abstract . However it is unlikely the mother in prison receiving methadone would really care. Also, there is a much higher incidence of NAS in those that continue opioids to the end of pregnancy. This results in billions of dollars in unnecessary expenditures for ICU stays and seizure treatment for these infants. Of course the mother taking methadone in prison doesn't care. The OB wonks have stated that methadone is preferred vs short acting opioids. Buprenorphine does not have significant studies to support its use during pregnancy even though it would clearly be safer for the mother. Once again, the methadone receiving mother in prison does not care- she wants methadone, not buprenorphine. So by continuing methadone, one risks a possible increase in birth defects, NAS, maintenance of addiction. Elimination of methadone or opioids via very gradual withdrawal would make the mother pissed off, but otherwise in a potentially controlled environment where drugs should be less available and drug testing can be done daily, should not have significant increased risk of anything except litigation by the prisoner for taking away her candy.

 

[Yo GabbaPentin]

Strongly agree with gradual methadone taper. She's not on a huge dose. Wean baby and mom by 5 mg per 4-5 days. That would be if I dealt with addiction... Which I do not.

Would rather risk pissing off jailbird mom over risk to the child. Or better yet, risk of suing YOU over birth defects of her child, who clearly was a prodigy until that IDIOT doctor kept her on methadone.

 

[kstarm]

I think there is still question if opioids really do cause an increase risk of birth defects. As algos alluded to this study has some issues. It was a survery 6 weeks to 2 years following the birth of a child in which patients reported what they were taking for medications from memory. Also it didn't control of illicts including alcohol use. Also there has been at least one study that looked at women who were taking illict substances during early pregnancy that didn't show any significant increase in the risk of birth defects.

Regardless, agree with the others about tapering. I imagine it was to "protect the baby" by helping the mother stay off of heroin.

 

[WolverineFan79]

I imagine you've already made your decision as to what you are going to do regarding the pregnant inmate and her methadone. However, I wanted to post a comment for future reference to those who read this forum. I worked with opiate addicts at a methadone clinic and some of them were pregnant. It is dangerous to decrease or stop a pregnant women's dose of methadone, because withdrawal symptoms can cause her to have a miscarriage. The Addiction logistics that I worked with won wouldn't even decrease their dose if they had a dirty uds, because it was too dangerous. And she didn't want to be liable for the loss of pregnancy. Also someone mentioned switching her to Bup but there is a process you have to follow. You can't just switch someone. Or you may have precipitated withdrawal symptoms. The process would require the woman to wean completely off the methadone and be off it for several days before starting the Bup. This wouldn't be safe for a pregnant woman.