Medications that physicians have traditionally prescribed to treat opioid use disorders—such as methadone and Subutex—can be misused by taking them in larger amounts than prescribed or by injecting them.
The medication Suboxone is different.
A combination of buprenorphine and naloxone, Suboxone helps to prevent relapses by blocking the effect of the opioids.
“The naloxone discourages misuse as it is activated if an individual attempts to inject the medication,” said Laura Lander, West Virginia University Social Work Section Chief and associate professor in the WVU School of Medicine.
And that activation isn’t pleasant.
“Misuse of this medication could make you start to feel sick, or even go into withdrawal,” explained Patrick Marshalek, a psychiatrist and clinical associate professor in WVU’s School of Medicine and the medical director of WVU’s Chestnut Ridge Center.
In a recent project, he and Lander examined the medical records of 26 pregnant women who were prescribed Suboxone to treat their opioid use disorder.
All of the women participated in the Chestnut Ridge Center’s Comprehensive Opioid Addiction Treatment program.
Marshalek and Lander also reviewed the medical records of the women’s newborn babies. The researchers looked at the newborns’ gestational age; weight, length and head circumference; Apgar score; duration of hospital stay; diagnosis of neonatal opioid withdrawal syndrome; and prescribed pharmacological treatment for withdrawal.
They found that babies exposed to Suboxone in utero fared as well as, or better than babies exposed to more conventional addiction treatments, such as treatment with methadone or Subutex.
“It used to be, if you were pregnant, you would be prescribed methadone,” said Lander, who is also an addiction therapist at Chestnut Ridge Center.
Clinicians didn’t put Subutex into common use for treating pregnant, opioid-dependent women until a landmark study in 2010 by Hendree Jones, a co-researcher on the current project, indicated that babies whose mothers took Subutex while pregnant had a lower incidence of withdrawal. If they did have withdrawal, it tended to be milder and required a shorter hospital stay.
Now Lander and Marshalek hope their findings, published in the “American Journal on Addictions,” will make clinicians feel more comfortable prescribing Suboxone to their pregnant patients in treatment.
In the future, a randomized clinical trial would be conducted to explore how Suboxone and Subutex affect babies over the long term, even into childhood. In the meantime, Lander and Marshalek are training healthcare practitioners across West Virginia to pharmacologically treat opioid dependence. These patients include opioid-dependent pregnant women, whom Lander called “the most stigmatized folks,” even by their own peers with substance use disorders.
Lander and Marshalek’s research indicates that Suboxone may be a safe option for helping these stigmatized women who, as Marshalek said, already “face additional barriers to care.”
Title: “Treating women with opioid use disorder during pregnancy in Appalachia: Initial neonatal outcomes following buprenorphine + naloxone exposure”
Publication: “American Journal on Addictions.” 2018;27:92–96.
CONTACT: Cassie Thomas
WVU School of Medicine
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