? for the OB/GYNs & neo-natologists

[DCJenn]

OK people- time to play "Quiz your spouse".

Recently we have had two people, one a lawyer and one a pediatrician question whether it's beneficial to prescribe methadone to pregnant people. Of course, we believe that it's better because there's no risk of getting nasty stuff mixed in that happens with street drugs, and the babies are easier to manage in the NICU- at least from everything we've read and heard. (they're coming at it from a short-term cost containment mindset because methadone babies DO take a long time to detox. ) They were questioning whether it was better to just keep the patients on heroin. (um, except its illegal? so we'd by default be promoting illegal behavior in pregnant clients? that would be great on the front page of the paper...)

So, I need ammunition. We need Best Practices for working with heroin and poly-substance addicted mothers. and further, if any of the Neo people know of any studies that demonstrate 1) the difference between methadone/heroin/poly-substance addicted babies in terms of length of stay, general detox requirements and any long term impact on them once they're home.

you know, in all of the docs free time!

and if anyone has access to the American Society of Addictive Medicine online, can you let me know. Also, The Journal of Drug and Alcohol Dependence, the American Journal on Addictions or the Journal of Perinatology.

Ok, I'm done for now.

Thanks in advance!

Jenn

[DCJenn]

oh, I don't want to leave any psychiatrists out- but I don't think we have any. (hmmm, a clear indicator of a decent medical specialty perhaps?)

And please ask if any of them have any anecdotal information on buprenorphine vs. methadone. All of the studies I'm finding are saying that the methadone babies are more addicted but the buprenorphine mommies are more likely to continue to use and/or to go back to heroin after delivery.

J.

[rainbabies]

i'll ask. i have heard dh talk about giving it to his moms when they're at the hospital...but he has also said that the clinics REFUSE the pregnant moms. not wanting to deal with the pregnancy part.

[DCJenn]

Yeah, that's our problem, we're literally the only place in SA that will work w/ the pregnant ladies and we're swamped.

At any one time we'll have between 10 and 30.

Jenn

PS- Of course SA is the first stop on the heroin superhighway from Mexico so it can be cheaper for them to stay on heroin which is why my boss has decreed that all of the pregnant ladies we treat get 30 days free after delivery.

[mommax3]

DH has or has had several moms on methadone, but none using heroin regularly, at least that he knew of, so he can't make comparisons. He says he encourages them to get off methadone if they can, knowing that they will be on something, and much prefers methadone to the alternative. So not much help here, sorry.

Sally

[DCJenn]

Here's another thing-

Apparently the babies detox better if the mother has been at a dose less than 30 mgs of methadone. But, the kicker is as the mother gains weight (i.e. blood volume) as the pregnancy continues, they 90% of the time need to gradually increase their dose and ultimately end up splitting the dose into BID or TID so that they don't get any breakthrough withdrawal symptoms.

I read a ton last night and it does look like buprenorphine is a better way to go for the babies but not for mom.

and also for the neo-natologists- apparently clonidine is being tested as a medication for the neonates. Anyone have any experience with that? And also, we were thinking that part of the inevitable pissyness of a baby with NAS (narcotic abstinence syndrome) has to also be nicotine withdrawal and we were wondering if anyone had any thoughts about that little can of worms.

J.