Medicines used to treat opioid use disorder

People who take opioids over a long period of time are at risk of developing opioid use disorder. Opioid use disorder is described as having cravings to use opioids, inability to control the use of opioids, and continued use despite having negative health and life-related consequences.

In some people, opioids can boost feelings of pleasure and create a sense of well-being. Once those feelings wear off, a person may take more opioids to get those feelings again. Over time, these individuals may need to take larger quantities to get the same feelings. This is how dependence starts. Opioid use disorder can lead to serious health problems, including overdose and death.

During pregnancy, medicines are available to treat opioid use disorder. These medicines are safe to use during pregnancy and breastfeeding and have been shown to improve outcomes both for patients and their babies through increased prenatal care and by reducing the risk of overdose and death.

For those with opioid use disorder during pregnancy, it's recommended to start these medicines as early as possible and continue use throughout pregnancy, after birth and beyond. Medicines for opioid use disorder carry a risk for neonatal abstinence syndrome, a condition where babies go through withdrawal after birth from substances they were exposed to in the womb. However, this risk is lower than in those babies exposed to nonprescribed opioids such as fentanyl or heroin and is generally less severe and for a shorter time. Medicines used may include:

• Methadone. Methadone is a long-acting opioid that reduces the effects of other opioids and reduces cravings and withdrawal symptoms. It is a preferred medicine for the treatment of opioid use disorder in pregnancy and helps individuals achieve and maintain recovery. Methadone is not associated with birth defects and is prescribed by a certified opioid treatment program.

  Due to the effects of pregnancy, it is common for people to need their methadone dose increased or split into two separate doses during pregnancy.

• Buprenorphine.Buprenorphine has some effects of opioids but also blocks other effects of opioids. It reduces cravings and withdrawal symptoms. It is a preferred medicine for the treatment of opioid use disorder in pregnancy and helps individuals achieve and maintain recovery. Buprenorphine is not associated with birth defects.

Discuss medicines for the treatment of opioid use disorder with your healthcare professional to decide which option is best for you.

Triptans for migraines

Triptans are medicines used to treat headaches and migraines. They may be taken by mouth in a pill form, in a nasal spray or by injection. Recent research has found that taking triptans for migraines during pregnancy is safe. Sumatriptan is the preferred medicine because it has the most safety data for use in pregnancy.

Discuss the benefits and risks of continuing a triptan during pregnancy with your healthcare professional.

Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors (SSRIs) are medicines commonly used to treat depression and anxiety. They are considered the first line treatment for depression and anxiety during pregnancy and after birth.

SSRI use in the first trimester carries a low risk of birth defects and little to no risk for miscarriage. These medicines may be associated with a small risk of high blood pressure disorders in pregnancy such as preeclampsia, as well as preterm birth.

Untreated and undertreated mental health conditions are associated with poor outcomes for pregnant and postpartum people. In general, stopping effective medicines for mental health during pregnancy or the postpartum period increases the risk of relapse and is not recommended.

For people who have been treated with success with an antidepressant in the past, that antidepressant is often recommended as the first choice. For those starting a medicine for the first time during pregnancy or if previous medicines were unsuccessful, sertraline (Zoloft) is typically the preferred medicine due to reassuring safety data.

Discuss the benefits and risks of starting or continuing an SSRI during pregnancy with your healthcare professional.

Cannabis

Cannabis is a broad term that describes products or chemical compounds that come from the cannabis plant species. It is commonly known as marijuana or weed. Cannabis is legal in much of the United States and use may be medical or recreational.

Whether medical or recreational, cannabis use during pregnancy should be avoided. Cannabis use increases the risk of gestational diabetes, gestational hypertension and preeclampsia. Use also may increase the risk of placental abruption, a condition where the placenta separates from the uterus too early.

Cannabis crosses the placenta and has been linked to higher rates of low birth weight, preterm birth and need for admission to the neonatal intensive care unit.

Nicotine replacements

Tobacco use during pregnancy can lead to many complications. Healthcare professionals advise quitting all forms of nicotine during pregnancy. The use of therapy may be enough for some. For those who have trouble quitting, nicotine replacement therapy (NRT) may be an option. The use of patches, gum, lozenges and other forms of nicotine may help people who smoke quit.

All in all, nicotine replacement therapy is considered safer than smoking because NRT has fewer toxins. Nicotine replacement products provide smaller amounts of nicotine in a slower-release form. This decreases cravings and makes quitting easier.

More research is needed to fully understand the effects of NRT use during pregnancy. It is generally recommended to use the lowest effective dose. Discuss the risks and benefits of the different forms of NRT with your healthcare professional to decide what is right for you.