Fentanyl and Opiates in Pregnancy

Prescription painkillers are a class of drugs that are used to treat pain. Among the most popular prescription painkillers is the group of medications known as opioids.  Common opioids include morphine, oxycodone, and codeine, among others. These drugs are in the same class as heroin and derived from the same source, the opium poppy plant.

Additionally, pharmaceutical companies have developed synthetic opiates, which are manufactured to have similar chemical properties to opiates. This class includes hydromorphone (Dilaudid), meperdine (Demerol), and fentanyl. Because they are manufactured in a lab, these drugs can be many times stronger than opiates derived from poppies.

Whether they are synthetic or natural, all opioids can be highly addictive and may lead to dependence in some patients.

It’s true that women may experience pain while pregnant, whether it be from a car accident, undergoing major surgery, or dealing with a chronic pain condition. Because of this, pregnant women may wonder then if they can safely use opioids to relieve pain in pregnancy. The answer is not an easy one.

The American College of Obstetricians and Gynecologists (ACOG) readily agrees that pregnant women deserve adequate pain management. However, the current opioid abuse epidemic in the United States can’t be ignored. Based on a 2010 survey, about 4.4 percent of pregnant women have used illicit drugs in the previous 30 days. This includes opioids that have been prescribed by doctors but used inappropriately, or that have been bought illegally.

Women who use opioids while pregnant are at risk for a few complications. Opioid use can quickly lead to tolerance and the need for greater quantities of the drug to get through the day without experiencing withdrawal symptoms or worsening pain. The risks of overdose, infection related to injecting drugs or sharing needles, and malnutrition are also present.

If a woman goes on to buy opioids illegally, the behaviors associated with this can also put her at risk for being exposed to sexually transmitted infections, domestic violence, losing custody of her children, and incarceration. Heroin use also makes complications such as preterm delivery, fetal growth restriction, stillbirth, and placental abruption more likely.

Babies born to moms who use chronic narcotics in pregnancy are at risk for developing Neonatal Abstinence Syndrome, or NAS. This is when a baby who was exposed to narcotics while in the uterus is born and then goes through withdrawal. Symptoms include tremors, irritability, problems with sleeping, seizures, and problems with feeding, among others. Some of these babies need to go to the NICU to be treated with small doses of opioids to help ease their withdrawal symptoms.

But what about the pregnant woman who has chronic pain prior to pregnancy and who wants to know if she can continue to use her narcotic medication to treat her pain—which may actually be made worse by pregnancy?

In this scenario, it is important that your doctor is aware of your history of chronic pain and medication needs. We know that abruptly stopping narcotics in someone who is physically dependent on them can lead to severe withdrawal symptoms. Withdrawal from narcotics in pregnancy can lead to preterm birth, stillbirth and relapse, and the possibility of using street drugs to treat symptoms.

To avoid this, first attempt to get to the lowest narcotic dose that is needed to relieve symptoms. Use complementary techniques such as massage, exercise, physical therapy, acupuncture, and mental health counseling to help relieve pain in an alternate way. Enlisting the help of a pain specialist who is comfortable treating pregnant women can also be helpful.

Occasionally, switching to the synthetic opioid known as methadone can help women maintain a stable dosing of narcotic during a twenty-four-hour period. Using this drug in women addicted to heroin or prescription painkillers has helped in avoiding withdrawal and illicit drug use in pregnant women safely since the 1970s. If you might be interested in switching to methadone maintenance treatment, ask your doctor to refer you to a local program.

The bottom line is that occasionally opioids are needed to treat pain in pregnancy, but they should never be the first therapy for minor pains and discomforts. If you are using chronic narcotics and are pregnant, don’t abruptly stop your medication until you talk with your doctor so a plan can be made to keep you and your baby safe.

Sources:

• The American College of Obstetricians and Gynecologists
• Committee Opinion #524: Opioid abuse, dependence, and addiction in pregnancy, May 2012.
  The American College of Obstetricians and Gynecologists
• ACOG statement on opioid use during pregnancy
• 26 May 2016.
  Stanford Children’s Health
• Neonatal abstinence syndrome

Powered by Bundoo®